Insurer Rebuffs Woman Who Lost Her Hand
ANNISTON, Ala. (CN) - A woman who claims she cut off her own hand with a machete fending off a "large feral cat" sued her insurer, which denied her claim for dismemberment benefits and called the whack intentional.
Tammy Martin sued Life Insurance Company of North America, in Federal Court.
In the brief, five-page lawsuit, Martin claims she was attacked by the unidentified cat while using a "large, heavy machete" to cut ham for abandoned kittens.
"On or about June 28, 2012, the plaintiff went to the backline of her property to rescue and adopt for her grandchild one kitten from a litter of bobtail kittens that had been abandoned on her property. She was going to try to lure the kittens out of the brush pile by feeding them. She brought with her a hambone and a large, heavy machete to cut up the meat," the complaint states.
"When the plaintiff knelt down to cut the meat, she was unexpectedly attacked by a bobcat or a large feral cat, which bit her on her left hand.
"The plaintiff swung the machete at the large cat in order to defend herself. When she swung the machete, the cat let go and she accidentally struck her arm with the blade of the machete, resulting in severance of her left hand from her arm."
Martin was taken to Eliza Coffee Memorial for treatment. She says her "severed hand was never recovered."
Martin says her husband, David, filed a claim on her behalf under a group accident insurance plan sponsored by WorleyParsons Corp., which provided accidental dismemberment benefits.
Life Insurance Company of North America received the claim in August 2012, Martin says, and denied it by letter in November 2012.
The insurer denied her appeal in April 2013, calling it an "intentional amputation."
The lawsuit quotes the April 18, 2013 letter: "The evidence supports that the most likely cause of the severance of [Martin's] hand was the intentional amputation, subsequent to the injuries sustained in the attack. As such, the severance was the foreseeable result of an intentional act, and is not an accident as defined by the policy. In addition, the payment of benefits is specifically excluded, as a result of an intentionally self inflicted injury."
In repeatedly denying her claim, Martin says the insurer misconstrued medical records to conclude that she was attacked and wounded, and "subsequently decided to chop off her hand."
She appealed again, in October 2013, submitting testimony from her doctor, who said he rejected Life Insurance Company of North America's interpretation, and advised the insurer in writing and in deposition testimony that its assumption was bogus, according to the complaint.
Martin says her appeal noted that the terms "intentional self-inflicted injury" and "accident" were not defined under the plan.
"LINA [Life Insurance Company of North America], however, denied the plaintiff's final appeal and concluded that her conduct was still the result of an 'intentional act' and that her actions were 'foreseeable' based upon a new definition that they created; a definition not provided for under the plan, nor discussed in any previous appeals, nor provided for under Alabama law," the complaint states.
"The new definition created by the defendant runs counter to both Alabama law and the ERISA [Employee Retirement Income Security Act] federal common law adopted by other circuits, and amounts to abuse of discretion and resulted in an arbitrary and capricious denial of plan benefits by LINA."
Having "exhausted administrative remedies under the terms of the plan," Martin seeks the payment of plan benefits plus attorney fees.
She is represented by Thomas McCutcheon, of Florence.