Jury Orders Aetna to Pay $25M Verdict in Denied Coverage Case
A jury has ordered Aetna to pay more than $25 million to the family of an Oklahoma City woman who died a year after the insurance company refused to cover a type of radiation therapy.
Jurors found that Aetna doctors didn’t spend enough time reviewing Orrana Cunningham’s case before denying her coverage for proton beam therapy in 2014, The Oklahoman reported. The jury ruled that Aetna recklessly disregarded its duty to deal fairly and in good faith with Cunningham, who had nasopharyngeal cancer.
Aetna is considering whether to appeal the ruling. Company attorney John Shely said the insurer tries to do the right thing.
“If it’s in our control to change, that’s what we’re going to do,” Shely said. “Aetna has learned something here.”
An Aetna doctor denied Cunningham coverage for the therapy in 2014, deeming it experimental. Two other in-house doctors reviewed and upheld the decision.
The Food and Drug Administration had approved proton beam therapy, which is also a treatment covered by Medicare, according to Doug Terry, the family’s attorney. He alleged that Aetna denied coverage for financial reasons and that its doctors were unqualified, overworked and biased when making decisions. Court records show that one doctor complained to the insurer about having to review more than 80 cases a day.
After she was denied coverage, Cunningham and her husband decided to mortgage their home in Meeker, about 35 miles east of Oklahoma City, to pay for the therapy in Texas. She died in May 2015 at age 54.
“My wife, her goal, was to make this fight,” Ron Cunningham said. “Her comment was, ‘If we can save one person and stop Aetna from doing what they traditionally do on every claim, it was worth the battle.”‘
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