Paralyzed man suing insurer that says injuries don't meet definition of paralysis
'If he doesn't qualify, who does? What's the point of insurance?' says Mitchell Murphy's lawyer
A former Nova Scotia resident is suing his insurance company after being denied $120,000 he claims he's entitled to after a freak accident nearly six years ago left him paralyzed from the waist down.
A legal statement of claim says the money was to be paid out to Mitchell Murphy, 28, following an accident where he lost the functional use of both of his legs.
His insurer, however, argues Murphy doesn't meet its definition of paralysis for that payout, according to a provision in SSQ Insurance Company Inc.'s policy.
Fell 7 metres
Murphy hasn't been able to walk since June 4, 2011, just months before his final semester of university was set to begin in Cleveland.
In a tragic accident, he caught his flip-flop on a restaurant's staircase and fell nearly seven metres over the railing. As a result, he suffered a traumatic brain injury and a spinal cord injury.
"Since that time, he's been paralyzed from the waist down," said Sivan Tumarkin, Murphy's lawyer.
Murphy was covered as a beneficiary under his mother's insurance policy through her work at the Minas Basin Pulp and Power Company in Hantsport, N.S.
SSQ, a Toronto-based company, paid $6,183 to cover the costs of Murphy's 10-week hospital stay in 2011, but Tumarkin said that's the only financial benefit his client received from the company.
Doesn't meet definition
Murphy and his mother unsuccessfully appealed SSQ's policy denial three times before deciding to launch a lawsuit.
"Each time, the insurance company [wrote] a denial letter back saying we reviewed the documents, but in our view you do not meet the definition of paraplegia, of paralysis," Tumarkin said.
In a statement of defence filed in Ontario Superior Court, SSQ defines paraplegia as "the permanent paralysis and functional loss of use of both lower limbs" and defines loss of use to mean "the total and irrecoverable loss of use."
SSQ states that in February 2013, it advised Murphy of this definition and that the medical documentation on file didn't indicate that his loss was permanent in accordance with its policy.
The insurer wrote Murphy again in March 2016 advising him that he's "able to ambulate with the use of assistive devices" and therefore the provision of "total and irrecoverable loss of use" in accordance with the policy had not been satisfied.
'If he doesn't qualify, who does?'
"If he doesn't qualify, who does? What's the point of insurance? It's supposed to be a safety net," said Tumarkin.
He said Murphy, who spent part of his youth in Lower Sackville, is only able to move around with assistive devices in a clinical setting with a therapist. Outside of a clinical setting, he can't move around.
Tumarkin said his client only gets some sensation in his legs occasionally.
"If you look at his legs, there's atrophy there," said Tumarkin. "They look like toothpicks."
Paralysis is permanent, say docs
He said Murphy's doctors have written the insurance company to state he's paralyzed from the waist down, the paralysis is permanent and there's a total loss of functional use.
While Murphy remains optimistic he'll one day walk again, Tumarkin said "the reality is that he is going to be confined in a wheelchair the rest of his life."
Tumarkin said the $120,000 in insurance money could have been, and still could be, put toward rehabilitation and treatment. Money is also needed for modifications made to the home Murphy now lives in with his mother in Spring Hill, Fla.
"Imagine a 28-year-old man not being able to fully shower by himself. You know, it's very taxing, but he's been a trooper," Tumarkin said.
On its website, SSQ is described as one of Canada's leading financial institutions with over 3,000,000 customers and $11 billion in assets.
In an emailed statement to CBC News, company spokeswoman Danielle Rioux said a lot of information is taken into consideration before SSQ renders a claims decision, including independent medical assessments.
She said the company cares deeply about its customers and "every effort has been made to provide Murphy an equitable and just result."
Rioux said when claims are submitted, coverage is provided based on the insurance policy.
'Sympathetic' to Murphy
"SSQ is sympathetic to Mr. Murphy's case. However, in order to be equitable towards all our customers, we must uphold the provisions of our contracts," she wrote.
CBC requested to speak to a SSQ representative by phone. However, Rioux stated SSQ doesn't publicly comment on the confidential information of its customers due to strict privacy standards.
She also said the company believes publicly commenting on an active court action is inappropriate, improper and increases the risk of making factually incorrect statements.
Tumarkin, who spoke to CBC News by phone, said his client's case is unique.
"Every doctor who has seen him has said that he's paralyzed for life," he said.
"For the insurance company to say no he's not, that's what's unique about it ... even insurance companies, for the most part, don't take such extreme positions."
None of the allegations has been proven in court.
Murphy is seeking payment of the $120,000 in benefits denied to him, plus $250,000 in general damages because of stress and anxiety. He is also asking for $5 million in aggravated damages for acting in bad faith, which SSQ specifically denies.