Jury Sends Message to Health Insurance Company with $25.5 Million Verdict

11/13/2018 | Unfair Insurance Practices/Bad Faith

A jury in Oklahoma City awarded $25.5 million in damages to the family of a deceased cancer patient because her health insurer, AETNA, denied coverage for necessary radiation therapy.  According to the jury, AETNA recklessly disregarded its duty to deal fairly and in good faith with its insured. The jury intended for its verdict to send a message to AETNA: change your ways.

In 2014, Orrana Cunningham was suffering from stage 4 nasopharyngeal cancer near her brain stem. Following her doctors’ advice, Orrana sought proton beam therapy, a targeted form of radiation with the ability to pinpoint her tumor without the risks of blindness and other side effects of standard radiation.  AETNA refused to cover this treatment under Orrana’s insurance plan, calling the treatment “experimental.” Orrana and her husband were forced to mortgage their home to pay for the therapy. Unfortunately, Orrana passed away in 2015, at the age of 54.

Before her death, Orrana had filed the initial paperwork to sue AETNA for denying coverage in “bad faith.” According to her husband, Ron, Orrana believed that if her case helped save the life of one person, it would be worth it.  Ron called the jury’s award vindication for his wife’s suffering: "My wife, her goal, was to make this fight.” At least one Oklahoma jury proved they are ready to join Cunningham in the ring. The $25 million-dollar verdict, which is believed to be the highest bad-faith verdict in Oklahoma state history, certainly sends a blow to AETNA and any other insurers who are not treating their insured in good faith.

The Cunningham’s’ attorney, Doug Terry,  theorized that AETNA denied coverage because of financial motives, and that its reviewing doctors were underqualified, overworked and biased to deny coverage. Terry pointed out that Medicare covers this type of treatment, and it is already FDA approved. In addition, trial records demonstrated that one AETNA doctor complained about his heavy workload, sometimes having to review more than 80 cases a day.

The hope is, of course, that AETNA (and others) will hear the jury’s message loud and clear Whether the company does change its ways is yet to be seen. According to the company’s attorney, John Shely, "AETNA has learned something here." The company is reportedly still considering whether to appeal the ruling.