Close Close

Life Health > Health Insurance > Health Insurance

Harder, better, faster, stronger

Your article was successfully shared with the contacts you provided.

Matias Ferreria was born in Uruguay and emigrated to America when he was three. Throughout his childhood, he was an athlete, and went on to play football, baseball and wrestling in high school. Like many immigrants, he was intensely patriotic, and in 2009, he joined the United States Marine Corps, trained as a machine gunner and became part of the 1st Batallion, 8th Marines assigned to Operation Enduring Freedom in Afghanistan.

In early January 2011, Matias took part in a large Coalition operation to secure a town in Helmand Province against the Taliban. Helmand, along with Kandahar, are the most dangerous parts of the country, where most Coalition casualties have occurred. The town was on the far side of a wadi, or dry riverbed, and since so many Coalition convoys had been blown up crossing such terrain, the SOP was to approach the town on foot first.

After initial reconnaissance reported the town as clear, Matias’s team moved in to set up a firing position. They selected a flat-topped building that had an excellent view of the surrounding area. To get there, Matias and his fellow soldiers climbed to the top of an adjacent pump shed and ascended to the roof from there.

Once the first team members were on the roof, Matias headed back to get the rest of his gear and his guys. Everything went according to plan until he jumped from the rooftop and landed on top of the pump shed, and he lost a few seconds of time. Suddenly he was on his back, with fellow soldiers screaming at him to stay still. Confused, and in deep shock, Matias eventually felt some pain in his lower body. That was when he noticed his helmet flashlight had been knocked loose and dangled before his eyes.

Instinctively, he checked his gear. Unlike a lot of his fellow soldiers, he had not removed his body armor once the town was thought to be clear. This was common practice for those who found the gear hot, bulky and uncomfortable. But Matias had kept his on, as well as his impact-resistant Oakleys. He searched for his 9mm sidearm. Still there. He couldn’t put his finger on what was out of place, just that he was suddenly starting to hurt badly. Then he realized what was missing wasn’t any of his equipment. It was his legs. Both of them, below the knee.

When Matias landed on the pump shed, he crashed through the roof and triggered an improvised explosive device hidden inside. IEDs killed 292 Coalition soldiers serving in Afghanistan in 2011, accounting for just over half of all Coalition combat fatalities that year. Matias probably would have been one of them had he removed his armor.

The snipers he teamed with called in a medevac and within 30 minutes, he was on his way to Bagram, where surgeons stabilized him so he could be sent to Germany, where he underwent more emergency surgery. A third round of surgery awaited him at the Walter Reed National Military Medical Center in Bethesda, Maryland. While in the ICU, he was finally able to see his family for the first time since the explosion. Because the blast had shattered his femur and broke his pelvis, he faced a long recuperation before he was transferred to the last, longest and most difficult phase of his recovery: therapy.

Staying in Walter Reed, Matias recalled, was like living in a hotel. Surrounded by fellow wounded soldiers, there was an instant camaraderie that helped cushion the realization that he had suffered a deeply debilitating injury. He had been in the war for only a few short months before he had been taken out of it, but that was not the worst part. The worst part was when Matias broke down in tears, realizing he would never play football again, never dance again, never go out with his friends again. His life, as he had known it, was over.


According to a 2001 World Health Organization report, more than one billion people across the planet live with some form of disability. Of these, some 200 million (roughly equal to the population of Brazil, the world’s fifth-most populous country) have conditions such as quadriplegia, severe depression or blindness, which impose serious difficulties in normal daily functions.

These numbers are only going to increase due to aging populations and a global increase in chronic health problems such as diabetes, cardiovascular disease, cancer and mental illness. In fact, they already have gone up; some 15% of the world’s population is currently considered to be disabled in some form or another. In 1970, that number was only 10%.

That same WHO report listed a host of possible ways to address global disability challenges, ranging from legislation, national awareness campaigns, accessibility standards for buildings, UN data collection, improving employment standards for workers with disabilities, and research on how physical limitations affect one’s quality of life. Incredibly, none of the 40 plus recommendations offered was for people to buy disability insurance.

Disability insurance is the oft-forgotten stepchild of the personal life and health insurance family. It is the one product that people do not prefer to buy in person; they would rather get it through work. Only one percent of consumers actually go looking to buy disability, and only 18 % of consumers can remember ever being approached to buy some. And even when somebody is poised to buy coverage, the factor most likely to turn them off is cost, which relegates the product from a must-buy to a maybe-later proposition.

According to industry statistics, the disability market collected some $473.1 million in premiums in 1996. That grew slowly but steadily, year over year. By 1999, disability premiums reached $481.8 million. By 2003, they reached $544.7 million. By 2006, $592.2 million.

In 2007, premiums jumped to $621.8, and went to $640.5 in 2008, but then came the Great Recession, and in 2009, premiums fell to 2005-06 levels, and they have never quite recovered. And while these numbers might seem large, they are chump change compared to what people pay for health insurance, life insurance and annuities.

That Americans would be so unengaged over this kind of coverage (and that the industry is less-than-zealous about selling it) flies in the face of a serious and growing need. According to LIMRA, the Windsor, Conn.-based insurance research firm, more than 70 percent of American households rely on two incomes to make ends meet, and ever since the economic downturn of 2008-2009, the prospect of a breadwinner suddenly experiencing a debilitating health problem without some kind of safety net spells financial doom. (The risk of foreclosure due to disability is 16 times greater than the risk of foreclosure due to death, says the National Safety Council.)

Moreover, disability is increasingly a product older Americans are turning to as they face increasing longevity and the health problems certain to come with it. Americans in the 50-59 and the 60+ age brackets both increased how much disability they bought in 2008 by double digits, something that cannot be said for any other age group. Disability statistics from Cornell University for 2009 noted that 26 percent of Americans ages 65 to 74 had disabilities. That number almost doubles for people 75 and older.

When it comes to people like Matias, in the 21 to 64 age bracket, only 10.4 percent of people have a disability. Moreover, this group suffers from a 67% unemployment rate.

The irony of all of this is that while Americans are deeply underinsured when it comes to disability, that might not be such a bad thing for insurers. According to Unum, one of the largest writers of disability coverage, nearly one in three Americans ages 35-65 will become disabled for more than 90 days. Once somebody is disabled for 90 days, their average disability claim is two years. More than 20 million Americans suffer disabling injuries each year, some two-thirds of which are not covered by workers compensation.

For disability insurers, what this means is that their greatest challenge isn’t selling more policies. It’s figuring out how to keep the claims from bleeding them white while remaining sensitive to the fact that nobody really wants to go on disability. Ask any disability insurer why they want to get policyholders back in the saddle, and some will say because it contains costs. But others will say because at some point, disability isn’t just about money. It’s about rebuilding people’s lives.


Back at Walter Reed, Matias dried his tears and let his Marine training kick in. When he first joined the Corps, an old, retired colonel once told him that the reason why Marines can get so many things done, despite the odds stacked against them, was because they can resolve mentally to achieve a task and let their bodies take over, running automatically from muscle memory. They remove from the equation that interface between mind and body that, once pain and fatigue kick in, allows the mind to build an argument to to convince the body to stop. Marines make that internal conversation impossible when they have to, and now, Matias realized he would have to do the same with himself regarding his injury.

He could no longer try to be the person he was, he told himself. And that was all right. He had nothing to prove to the world; his service had done more than enough of that already. Now, he just had to prove to himself that he would walk again.

It would not be easy. Some four months after his injury, he was finally moving around again. He started taking daily walks down the hallways of Walter Reed to the facility’s training center. One day, it was there that he met two women from Achilles International, an outreach group that worked with people with disabilities to help them train for, and compete in, athletic events. They wanted to know if Matias would be interested in riding a handcycle.

Handcycles are specially designed, three-wheeled bikes that can be pedaled with one’s hands. It sounds easy to ride one. And it is, for short distances. Try riding one for 20 miles, and one will learn just how poorly conditioned their arms really are.

At first, Matias was skeptical about the handcycles, but he figured if riding one might improve his condition, why not? He joined other wounded vets at Walter Reed on handbiking trips around Washington, D.C., just to get into shape, but very quickly, it turned into something more. Doing these workouts became a routine event for Matias and his colleagues, all of whom had been athletes of some kind or another, now in search for some new way to rebuild their physical ability.

Achilles would visit Walter Reed once a month to organize workouts and slowly, Matias worked himself up to the point where he signed up to ride in the Achilles Hope and Possibility 5-Mile race in Central Park, New York, on June 26, 2011. He handcycled it, but he knew he could have walked it. He resolved that in 2012, he would run the race. In the meantime, he began handcycling longer and longer distances.

Working with Achilles volunteers, he ran in a Navy 5-miler on September 25, 2011, which he dedicated to Edwin Gonzalez, a friend of Matias’ and a fellow Marine who was killed in Afghanistan. After that, Matias followed his physical therapist’s suggestion to run in an Army 10-miler on October 3. On October 16, he handcycled all the way through the Detroit marathon.

His next race was his first running with an Achilles Freedom Team of Wounded Veterans, a special support group within Achilles that was dedicated to helping injured military personnel. It was a Marine Corps 10K on October 30, in which Matias ran alongside a close personal friend who had served in Afghanistan, as well as his own father, who was a cancer survivor. On November 6, he handcycled the New York marathon.

His next objective? The Disney half-marathon on January 7, 2012. He had taken handcycling as fas as he wanted, and now he wanted to start running longer distances. The problem was he was never a particularly good runner, even before his injury. And while serving with the Marines, he could do a 27 or 30-mile hike with his gear, but running 13.1 miles was different. And on two artificial running legs, it would be really different. And while his friends and supporters at Achilles were convinced Matias could cross the finish line, the fact remained that in Achilles’ 30-year history, no double-leg amputee had ever successfully run a half-marathon. Matias was going to try just a few days before his first anniversary of the blast that nearly killed him.


In 1965, Dick Traum lost his right leg below the knee when he was hit by a car at a gas station. In 1976, he became the first person ever to run the New York marathon on an artificial leg. He had to start the run five hours ahead of time so he would not finish in the dark, but finish he did, and when the medals were given out to the winners of the marathon that evening, a special award was given to him for his achievement. He was greeted with a standing ovation.

But there was still a deep awkwardness regarding people with disabilities, Traum recalls, and he made it his mission to enable people with all kinds of disabilities – physical, mental, behavioral – to participate in mainstream athletic events. He partnered with the New York Roadrunners club and launched an eight-week running program for runners with disabilities. The program recruited a few runners and would met once a week to run together. By January 1983, they had their first race with the NY Roadrunners, and the program became the Achilles club, so named because at the time giving running groups Greek names was the thing to do, and Dick wanted to name the group after a figure who was a hero but who also had a disability of his own. He chose Achilles.

By the end of 1983, Achilles had six members running in the New York marathon, which was huge for Dick because disabled people simply were not doing that at the time. The number increased to 13 in the ’84 marathon and to 25 in ’85. Dick figured the numbers would top out there – how many people with disabilities could there be who wanted to run in marathons? – but Achilles kept growing by word of mouth.

Today, Achilles International is a non-profit organization headquartered in New York. It reaches nearly 30,000 disabled athletes worldwide though its 27 U.S. and international chapters. Achilles organizes regular training sessions at its various chapters and provides social media support for people too far-flung to physically train with other Achilles athletes. The group also provides airfare, hotel, food, racing fees and printed jerseys for athletes running in formal races. The organization reaches out to people with every kind of disability imaginable, ranging from cancer survivors and amputees to people with traumatic brain injuries, cerebral palsy, autism and multiple sclerosis. It supports disabled triathletes, has a kid’s program and even runs a kayaking program. It is always looking for new opportunities.

In 2004, Traum noticed that the wars in Iraq and Afghanistan were producing an unusually high number of seriously injured soldiers. Advances in body armor and battlefield medicine had resulted in perhaps one soldier dying on the battlefield for every 12 wounded, whereas in WWII, the ratio had been half of that. The result was that an unprecedented number of troops were coming home missing arms, legs, parts of their face or with serious mental trauma. By then, Achilles already had a nationwide infrastructure in place, so it swiftly created the Achilles Freedom Team for Wounded vets . The Freedom Team kept on hand a fleet of some 30 handcycles and would bring them to Walter Reed once a month to introduce them to recently arrived soldiers, some of whom had been injured only three weeks before. The idea was to reach these veterans right away with something that would give them an opportunity to rehabilitate themselves through a physical activity that lent itself to escalating goals. Ride around the park. Ride around the city. Ride in a marathon. Run a 5K. Run five miles. Run 10. 13.1. 26.2. After a while, the goals become about more than just running or biking. Get a job. Get settled down. Enjoy life.

One of the things that Traum loves most about the Freedom Team is the deep impact it has had on the soldiers who join it. He has heard of Freedom Team vets rearranging surgery dates so they would not interfere with races. One group of 12 soldiers who raced in the Boston Marathon returned to Walter Reed only to find the hospital doctors, staff and other patients cheering for them as they arrived.

For some, the results have been groundbreaking. One soldier, a Maj. David Roselle, lost his leg below the knee in Iraq, Traum recalls. He joined Achilles, ran a marathon and then sought to re-enlist. When he was initially rebuffed because of his leg, Roselle pointed out that he had run a marathon on it. He subsequently became the first soldier in U.S. history to be re-assigned to combat duty while wearing a prosthetic limb. “That’s not only good for him,” Traum says, “That’s good for everybody.”


Mark Marsters is the senior vice president in charge of disability operations for Cigna, a health insurer based in Bloomfield. Conn. Marsters got to know Achilles through a personal rehabilitation story of his own. Several years ago, through a series of health assessments Cigna provided for its own employees, Mark realized he was dangerously overweight and had prescription-worthy high cholesterol. Mark compared himself to Cigna’s CEO David Cordani, himself an accomplished triathlete, and decided something had to change. Cordani preached health and wellness, and practiced it, too. Marsters decided to do the same. And, thinking as only an insurance professional might, he realized that if he did not, 20 or 30 years in the future, he would pay for it with far more expensive medical costs.

He started running an hour a day on an elliptical machine and quickly graduated to 5Ks, 10Ks, 10 milers and half-marathons. He shed 50 pounds and ran the San Francisco half marathon in 1:53. He has since run in 20 marathons as well as numerous other races, which is how he met Dick Traum.

Cigna has been a longtime sponsor of the Falmouth Road Race on Cape Cod, and it was there that Mark noticed the Achilles Team, which was also running there. Mark and Dick instantly realized their two groups could help each other. For all of Achilles’ success, it always had difficulty finding new athletes. People with disabilities usually did not seek out Achilles; it was typically the other way around. Meanwhile, at any given time, Cigna has about 50,000 people on disability claims of one kind or another.

Marsters often asks himself whether people are really disabled, or are they simply less productive in a certain category, whether it be a hobby, sports, daily living or work. He has seen legions of people who want to regain their lost health and productivity, but who don’t really know how, and who certainly don’t want to spend the rest of their life sitting on a couch. Marsters realized that if Cigna could refer its disability claimants to Achilles, many of them might find the group support they need to mainstream themselves into more productive lives.

This January, Cigna launched a pilot program out of its Dallas location that would monitor claimants for triggers that indicated people who were mentally committed to rehabilitating themselves as aggressively as they could. This covered people with a wide variety of challenges, ranging from physical injuries, loss of mobility and behavioral problems. Cigna already was convinced that physical activity reduced anxiety and stress among disability patients, and Achilles was convinced it did even more, pointing to studies that showed how regular exercise among patients with traumatic brain injuries actually improves cognitive ability.

In addition to the referral program with Achilles, Cigna also provided the group with $50,000 of support to its Freedom Team of Wounded Veterans and another $50,000 to Achilles’ children’s program.

Marsters points out that Cigna has no intention to apply a cost-benefit analysis to its support of Achilles. “At a higher level, we consider productivity to be an extension of your health,” Marsters says. “The benefit that we consider is how much we can help people get back their health and regain a level of productivity that is suitable for them. We see this as a benefit to our policyholders rather than a benefit for Cigna.”

When pressed to discuss how this partnership could help Cigna financially, Marsters says the costs for coaching, training and mainstreaming people with some kind of physical challenge is nominal, especially when compared to how much it boosts the bottom line of businesses paying for disability coverage. And even in cases where people are referred to Achilles but remain on disability, Marsters still expects there to be significant improvements in those people’s overall physical, mental and emotional well-being. Bottom line: Cigna’s support of Achilles will more than pay for itself even if it only resolves a handful of disability claims. But that’s beside the point.

Megan Wynn Lombardo, Achilles’ director of development, says that somewhere at the top, there must be some attention to the numbers when it comes to Cigna’s support, but she has not yet seen it. She, like anybody else at Achilles when asked of Cigna, offers glowing praise of the company. She notes that Cigna has expended a huge amount of human resources to working with Achilles, in addition to its financial support.

This is the most thought-out project Lombardo says she has ever been a part of, noting that the Cigna rehabilitation counselors who are involved are doing it because they feel passionately about helping people. “I don’t know how many people say this, but I have been inspired by this insurance company,” she says. “They are definitely motivated by a desire to help their customers improve their lives.”


Cigna, it turns out, is also the sponsor of the Disney marathon, an annual weekend event that draws some 60,000 runners to Orlando to compete in one of three races: a 5K, a half-marathon and a full marathon. Another 40,000 friends and family come along too. The second week of January used to be Orlando’s worst occupancy week. Now, it is its best.

When Matias and five other Achilles athletes signed on to run the race, Cigna picked up their racing costs. More than that, Cigna’s CEO David Cordani personally reached out to Matias to train with him before the race, and would run alongside Matias on January 7.

Once Matias learned who he was running with, he called Genna Griffith, Achilles’ director of the Freedom Team and expressed his concern. Did he really just sign him up with a guy who runs every single day for 10 miles?

But before the Disney race, Cordani met with Matias in Washington, D.C. to introduce himself, and any doubts Matias had vanished. “He walked in and treated me like we were friends from the get-go,” Matias said. “I thought this guy was hilarious.”

As they trained for the race, Matias and Cordani kept in close contact, with Cordani giving Matias lots of support. As the race day neared, Cordani called to ask if Matias was ready. Yep, Matias answered. Good to go.

The day of the race, Matias met with Cordani and he says that before he knew it, he was at the starting line. Once the race began, he and Cordani talked and joked as they ran, discussing women problems, school, whatever came to mind.

But while Matias’ spirits were high, his body had its limits. The legs he was running on were specially designed running legs that look like bands of metal bent into the shape of an inverted question mark. These take some getting used to, and Matias had put in his miles beforehand, but there is a lining between the prosthesis and Matias’ legs that does not breathe. Eventually it soaks with sweat, irritates the skin and becomes very painful to run with.

More than once, Matias had to stop so he could rest and remove his legs, but there would be no quitting. Once in the race, Matias said, he was thinking about everybody who had gotten him there more than himself. Failing to finish would mean letting these people down, and Matias was not about to let that happen. As soon as he was able, he strapped his legs back on, and got back in the zone.

The last time he stopped, Cordani pointed out that they were at mile marker 13. One-tenth of a mile to go. He helped Matias up and told him that they were going to finish together. They hit the course one final time, and as the finish line came into view, people erupted with cheers at the sight of the wounded vet with the metal legs. Matias finished, and he finished strong.

Not everybody makes it in these races. Achilles’ Lombardo notes that across their breadth of programs, it is not unheard of for some people to drop out entirely. Sometimes, people rebuild their lives and simply don’t have the time to train with Achilles that they once did. But sometimes, the challenge of living with a disability becomes overwhelming, and people just drop out.

Things on the Freedom Team are a little different. Everybody who runs or bikes goes after it like they have no choice: it’s either this or life never gets started again. “I’ve never seen anybody quit,” Matias says. “Not on the Achilles team.”

Matias is already preparing for his next run, and he is clear that some day, he would like to run a full marathon. He does not see himself as disabled. He sees himself as a guy who, every morning, puts on his legs just like somebody else might put on their shoes. To him, there is no difference.

Some days are better than others, though, and sometimes when he is having difficulty walking, or when somebody undeserving parks in the handicap space he was counting on, he starts to think about how he is the D-word. But when he gripes about it on Facebook, his friends are quick to bring him back down to Earth. “Really, dude?” One wrote back one time. “You did a half marathon. What do you have to complain about?”

Matias is currently studying to become a nurse at American University, and in his spare time, he volunteers with Achilles, making the same kinds of visits to Walter Reed that got him into running. it is not always easy; some wounded veterans are more open to possibilities than others. And some curse him for even bringing up the notion of running. Matias remembers one time when the parents of a wounded soldier demanded he leave their son’s therapy room for even bringing up Achilles. Matias complied, but he took the parents aside, pulled up one jeans leg and revealed his prosthetic. Then he revealed the other. Suddenly tearful, the parents let Matias back into the room.

“Hey, man, I know how it is,” Matias told the wounded soldier. “You’re going to be normal again, I promise you. It hurts, but it’s just a stage.” After that, he says, the soldiers’ mindset changes in a heartbeat, and they want to know more. How can I drive? How can I party? “Trust me, you can still get wasted.” Matias tells them with a smile. It’s a military thing. “You can still get stupid. Stay positive.”

Since his injury, Matias is sometimes approached by people who tell him he is a hero for what he has gone through, for what he has accomplished, and for what he has done for others. But he insists he is not. To him, the heroes are the ones who do not come home at all, or who come home in a box, or who come home not in their right minds. The heroes, he says, are the ones who never get to experience what he is experiencing.

Some would beg to differ.