In a society that favors the able-bodied, people with disabilities, like amputees, need to not only advocate for themselves but also have someone who will go the extra mile, like amputee lawyer Conal Doyle.
Even if you’ve never heard of him, you or a loved one may have benefited from his advocacy. His legal victories have compelled major insurers, like Anthem, to rewrite their policies, reinforce their medical review teams, and alter their evaluation practices.
In one of Doyle’s more public victories in 2021, insurance company Anthem changed its prosthetic limb policy, which allowed more people with limb loss and limb difference to use microprocessor-controlled prosthetic knees, ankles, and feet. Before the class-action lawsuit, Anthem categorized these devices as investigational and unnecessary—words that, according to Doyle, reflect the state-of-the-art microprocessor knees in 1999, when the technology was introduced in the U.S.
Doyle is a congenital above-knee amputee. He knows first-hand what amputees need, and Anthem, as an insurer, wasn’t meeting prosthetic users at least halfway. The company’s documentation defines microprocessor-controlled lower-limb prostheses as value-add devices designed for non-essential activities.
However, in his initial filing, Doyle pointed out that “a microprocessor-controlled prosthetic limb creates better stability and, therefore, reduces the incidence of stumbles and falls, lessens the extra energy it takes to move an artificial leg, decreases pain and discomfort, and aids walking…in every setting.” Doyle’s arguments were backed by updated findings, trumping Anthem’s outdated claims.
Fighting against outdated views
Doyle understood that insurers’ decisions often rest on a fragile foundation when it comes to prosthetics. Their policies are peppered with clauses that reflect an outdated understanding of limb loss and prosthetics.
Insurers’ policies are often peppered with clauses that reflect an outdated understanding of limb loss and prosthetics.
For example, in an interview with Living With Amplitude, Doyle said that United Healthcare, the largest insurer in the country, didn’t even have a single prosthetist they employed or consulted. Understanding what amputees need for a better quality of life requires knowledge from someone who, at the very least, knows their plight.
But when going against insurers like United Healthcare, according to Doyle, the only way to win is to patiently and persistently use the leverage they may not realize they have—an exceptional understanding of what’s necessary and what’s possible in achieving healthy adaptions to limb loss.
The only way to win is to patiently and persistently use the leverage they may not realize they have—an exceptional understanding of what’s necessary and what’s possible in achieving healthy adaptions to limb loss.
This leverage, Doyle said, can lead to victories in disputes of any scale, from class-action suits to individual claims.
Before facing United Healthcare in 2017, Doyle had a strong track record against heavyweight opponents. One of his first big wins is a medical malpractice suit on behalf of a leg amputee, culminating in a multimillion-dollar settlement after two years of litigation.
That case led to another. Doyle represented an undocumented immigrant, Francisco Castañeda, who’d been denied a biopsy for a cancerous tumor while in government custody. Although Castañeda died two years later, Doyle kept fighting on behalf of his widow and daughter. The case reached the Supreme Court and ended with Doyle securing a $1.95 million pretrial settlement from the federal government and a $1.25 million ruling against the State of California. These outcomes eventually led to sweeping healthcare reform within the U.S. immigration system.
After that case, Doyle made headlines again in 2015 after securing a $13.3 million compensation on behalf of a quadrilateral amputee whose limb loss was caused by negligent care. It was one of California’s most significant medical malpractice recoveries, a state with medical malpractice damages caps.
One step at a time to real change
The Anthem win, which got one of the biggest insurers to reverse its view on the theory that microprocessor-controlled prosthesis was experimental and investigational, is significant. However, systemic change may still be far off.
For example, despite winning against United, Doyle acknowledges that the company still denies valid claims. They’re using different words that are harder to shoot down in a courtroom.
Ultimately, the best way to achieve lasting reform is to write better laws and regulations related to prosthetic coverage. Doyle also prefers requiring insurers to issue pre-certifications so prosthetists can more confidently recommend advanced prosthetic devices.
The best way to achieve lasting reform is to write better laws and regulations related to prosthetic coverage.
For example, without a pre-certification, creating a myoelectric arm and hand requires a prosthetist to lay out at least $40,000 for the parts, make the device, and fit the socket. Then they only find out how much they will get paid after the whole process. However, the insurer might say they’re only covering $15,000, making it hard for prosthetists to recommend the prosthetic limb their patients need.
Be your own advocate
Part of working towards systemic change is for amputees to act as their own advocates. Whether or not you decide to call a lawyer, Doyle advises getting access to your insurance plan documents, which are called the Evidence of Coverage. He recommends reviewing them with your prosthetist to better understand which words will trigger the denial of an insurance claim. According to Doyle, this is the best method to get a good outcome.