Paralyzed ex-Lion says insurance company balks

The Detroit News http://detnews.com/1999/lions/9905/16/05160107.htm

Frustrated Utley battles for benefits

Paralyzed ex-Lion says insurance company balks at paying for needed treatment, care

By Fred Girard / The Detroit News

    The file at Workers' Compensation headquarters in Lansing is literally bursting at the seams, two manila folders so stuffed with legal documents they have to be carried in a cardboard carton. The case name it bears almost defies belief:
    "Michael G. Utley v. Detroit Lions Inc. and Liberty Mutual Insurance Co."
    Utley, permanently a quadriplegic with a partially severed spinal cord, told The Detroit News the Lions have been supportive of him since he was injured eight years ago, but it has been "hard, hard, hard" dealing with their insurance company.
    "It has caused frustration," Utley said. "I don't expect a red carpet, but I don't want them throwing barriers in my way, either."
    The insurance company fought paying for a rehabilitation program that allowed Utley to stand up from his wheelchair recently, and it still refuses to pay for a nurse to travel with him or a spotter for the weightlifting Utley uses as daily therapy, the records show.
    "I've been around 25-plus years and I often say nothing surprises me, but that may be an exception," said Richard Berthelsen, chief legal counsel for the NFL Players Association.
    "You couldn't have a more dramatic example of a football injury, and a more deserving person to get every benefit under our collective bargaining agreement than Mike Utley. We negotiated long and hard for these benefits and we expect to get them."
    The Lions disavowed any knowledge of Liberty Mutual's treatment of Utley.
    "I would be surprised to hear that," Tom Lesnau, the Lions vice-president and chief financial officer, said when he learned about Utley's workers' comp file. "The Lions believe the law was established specifically for people like Mike Utley, and Mike should be the person who can collect on that."
    Berthelsen, however, said the Lions share responsibility for the handling of Utley's case. "The insurance company, when it's opposing a claim, needs the employer's cooperation," he said. "If the employer didn't like the insurance company opposing claims, it could find a different company or it could instruct them that it doesn't want to oppose this claim. It's all about money."
    Lee Sommers, the Liberty Mutual claims adjuster who sits shoulder-to-shoulder with Lions' counsel Bob Humphrey at every hearing and negotiation, declined to be interviewed.
    Utley is one of only five former professional athletes among the 46,732 people now receiving weekly Workers' Compensation benefits, state records show -- he gets the maximum, $580 a week. He is the only former pro athlete on the records of the state's Second Injury Fund, which supplements weekly benefits for people who have lost the use of two limbs or organs as the payment rate rises year by year.
    Utley has been an inspiration to the estimated 250,000 Americans who have suffered paralyzing spinal cord injuries. He showed his fighting spirit almost from the moment he fell to the Pontiac Silverdome turf Nov. 17, 1991, with two crushed vertebrae, giving the stricken crowd a thumbs-up as he was carried away.
    To many he became an icon last February in Phoenix when he stood from his wheelchair and took a few halting steps. Standing close with arms outstretched were his girlfriend, Dani Andersen, who is a paramedic, and friends Rob Frederickson, a Lions linebacker, and Bill Lewis, a retired NFL center -- but Utley took those steps by himself.
    Utley says the near-miracle took place despite of, rather than with the help of, the Lions' insurer, Liberty Mutual.

'He's not walking'

    By far the most important factor in Utley's rehabilitation, he said, has been a biofeedback program developed at Miami's Jackson Memorial Hospital. "Not in 1 million years would I have been able to take those steps without that program," Utley said.
    But Liberty Mutual refused to pay for his treatments for years, records show, fighting with court filings and depositions before finally being forced to submit when Medicare approved the treatment.
    "It flabbergasts me, absolutely amazes me, that they fought that," Utley said. "The insurance company was, 'Aw, hell, he doesn't need that.' They didn't see results immediately. They said, 'He's not walking.' Then they said it was experimental. I'm sorry, this has been going on since 1967; I don't think it's too experimental in 1999."
    Utley began the program within months of his injury. Electrodes were attached to various muscles as he strove mentally to "see" electrical impulses in that exact spot. For five tortuous years, the computer readout screen showed nothing but a flat line.
    Then, two years ago, the unbelievable happened.
    "I started getting some signals down inside my legs," Utley said. "Out of 640 units (of electricity), which is normal, I had maybe half a unit. Then it was 2 percent, then 5 percent. I thought, 'That's pretty cool,' but you need 160 units to be able to stand on your own."
    The breakthrough would have occurred months or even years earlier, Utley said, if not for the mental strain of battling Liberty Mutual.
    "When I do need help, damn it, I do need help," he said. "There's a reason I do everything. The reason I do biofeedback is to help myself functionally. Now, will I walk like you or anybody else normal? The answer is probably not. But biofeedback will help me function, like being able to stand up, get into a car, have a nice fancy dinner in a restaurant with my girl.
    "All I want to tell (Liberty Mutual) is, give me a chance. I will make the best of all my opportunities. Just don't put up barriers so I have to keep sidetracking instead of going to the top."
    Another barrier, Utley said, has been the insurance company's refusal to pay for a spotter for his daily weightlifting routines.
    "I physically cannot go in the weight room and lift by myself," Utley said. "For every transfer I do, I'm putting myself into jeopardy. The owner of Gold's Gym (in Wenatchee, Wash., where Utley lives) will not allow me to go in there and lift by myself. But I need to be strong enough to swing from my chair to my bed, just as an example. How can I get strong enough if I can't go to the weight room?"
    Perhaps most debilitating, Utley says, has been Liberty Mutual's steadfast refusal to pay expenses for Utley's private nurse when he must travel, which is frequently. The insurance company admits Utley needs the nurse, according to the case file, but has ordered him to hire one on a day basis in his destination city.
    "I tried their way for almost a year," Utley said. "It was a disaster. I had people not show up, not know my own personal care, not know my bowel program -- very uncool. Very, very degrading. That is very difficult for somebody to handle emotionally. I have to have people around me who believe in me and are going to give me support."

The money game

    As they do with virtually every professional athlete who files for Workers' Compensation benefits, Liberty Mutual offered to settle with Utley for a lump sum -- meaning the insurer would never owe him another dime.
    "They wanted to settle for $1 million or some god-awful, pathetic figure like that," Utley said. "But this injury is very, very expensive. Look at it this way: It costs $6.50 for a sterile catheter kit every time I have to pee. Then there's all the (prescription) drugs I have to take every day. They cost a lot. I could go on and on. I have no idea how much all my medical expenses since the injury come to, but it's certainly in the millions."
    Utley has received $136,906 in weekly benefits through Saturday. Now 33, he would receive another $934,960 by age 65 based on this year's rate. Since the rate rises every year, the actual amount will be even greater. Medical bills are paid directly by the insurance company in addition to weekly benefits.
    Berthelsen, the Players' Association attorney, said money for the benefits Utley is seeking belong to the players, not the Lions or Liberty Mutual.
    Workers' Compensation benefits come out of the players' own salary pool, he said. Even if Utley's case caused that expense to rise, Berthelsen said, "There's not a player on the Detroit Lions or a player in this league who wouldn't vote for that additional benefit expense to come out of salaries and be absorbed."
    Utley said he envisions a day when he and other paralysis victims can rehabilitate their bodies to the point they become far less of a financial burden on insurance companies.
    "I'm not going to take anything that I don't deserve. That's not who I am," he said. "The insurance company needs to understand that if they'll help me now, it's going to mean a lot less money later. First I must do my job, then I have to pester the insurance company to come forward and do their job. Why? Because people are going to get independent. And that is my goal.
    "This injury affects more than just me. It affects my girlfriend, it affects my parents, my brother, my sister, my friends and every other person with a spinal-cord injury who says, 'I look up to you.'"