Jimmy Wilson (a fictional name) was 17 and born with cerebral palsy which confined him to a wheelchair most of his life. He had outgrown his manual wheelchair.
Jimmy’s family lived in a two level house. It had a ramp from the front door to a sloping sidewalk leading to the rear entrance of the lower level. Someone had to push Jimmy in his chair from one level to the next because of his diminished upper body strength.
Jimmy’s parents learned about power-assist accessories that could adapt a manual wheelchair into one that moved greater distances with each arm thrust. Jimmy had an opportunity to try a power-assist chair at home for a week and loved it. This convinced his parents that this was the right replacement chair for him.
The Wilsons’ health insurance company so far had refused to cover the cost of this type of wheelchair because it was more expensive than even a fully motorized wheelchair. The power assist technology was so new that their health insurance company did not have a payment code for it and no guidelines for justification. There were criteria for manual wheelchairs or for fully motorized wheelchairs, but not for power-assisted chairs.
When I first met them, Mrs. Wilson seemed very engaged in the effort to convince their insurance company to help with the cost. Mr. Wilson was supportive but more subdued, quiet and less involved.
We filed an insurance appeal. This appeal would be heard by a board of medical practitioners via telephone conference. In the following weeks Mrs. Wilson and I worked to get a new letter of medical necessity for this type of wheelchair from Jimmy’s doctor. Mrs. Wilson created a photo array of their house showing the logistical problems for Jimmy to get from one level to the other with his current wheelchair.
A half hour before the appointed time for the conference call, Mr. and Mrs. Wilson came to my office for last-minute preparations for the appeal conference. They decided that Mr. Wilson would present their case to the panel. As we began to discuss how to present the evidence it was clear Mr. Wilson was both nervous and angry that a panel of strange people would decide whether or not the insurance company would pay for the wheelchair. I wondered how he would present the situation to the panel.
Finally, the call came. We were introduced to a five member voting panel. With introductions completed, Mr. Wilson began to tell the story of his son’s struggles around the house and in public with his manual wheelchair. He told the panel about the week they were given a power assist chair to try. Jimmy, for the first time, could wheel up the driveway without assistance and he was so excited, he wanted to do it again. Jimmy had found new freedom and independence. Mr. Wilson explained that a totally motorized chair would give Jimmy mobility but not the exercise of his weakening muscles that a power-assist chair would offer. Exercising his muscles was the only defense Jimmy had against the condition that was crippling his body. This challenge and independence, Mr. Wilson explained, was extremely important to a 17-year-old who would be going to college next year. He told the appeal panel that Jimmy was an honor student with a very bright future and, “ would make a very positive impact on the world.”
As Mr. Wilson spoke passionately about his son’s challenges and dreams for the future, the love he felt for his son filled the room. I was moved. Mrs. Wilson reached for a tissue to dry her eyes. When Mr. Wilson finished, the panel asked some questions and then the call was over.
Two weeks later the decision came. The insurance company had reversed its prior decision and approved the power-assist wheelchair for Jimmy. The decision came on his 18th birthday.
That phone call lasted about 15 minutes and occurred many years ago but I will never forget it. I had, for the most part, sat quietly and listened. As I have reflected on this case in the weeks, months and years that followed, I have come to understand how important listening carefully and patiently to my clients is. Lawyers are so conditioned to get to the relevant facts and think ahead to what they will say next that we often fail to fully listen to our clients and hear their concerns, their needs and their frustrations. Sometimes clients simply want someone to listen and hear them.