Wachtel v. Metropolitan Life Insurance
The plaintiff, Mr. Wachtel, sued his health insurance carrier, Empire (previously Metropolitan), for reimbursement of a manually operated wheelchair for his wife, Carrie R. Wachtel, who suffers from multiple sclerosis. Although the insurer had provided a motorized wheelchair, Mrs. Wachtel's Orthodox Jewish faith precludes its use on the Jewish Sabbath. The court considered whether the insurer could be compelled to provide an additional benefit based on religious beliefs. It found that the insurer's definition of 'medically necessary' lacked clear exclusions applicable to this situation. Therefore, the court ruled that the manual wheelchair was medically necessary given Mrs. Wachtel's inability to use the motorized chair one day a week due to religious tenets, and entered judgment for the plaintiff.