Verdict Awarded in Cancer Patient Insurance Coverage Denial Case

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February 08, 2019
Edward Smith

Verdict Awarded in Cancer Patient Insurance Coverage Denial Case

The family of a cancer patient has been awarded $25.5 million by the jury after 12 days of trial. When Orrana Cunningham, suffering from nasopharyngeal cancer, died following the healthcare insurance company Aetna’s denial of coverage for proton beam therapy, her family decided to take the matter to court. Mrs. Cunningham was suffering from stage 4 nasopharyngeal cancer near her brain stem, besides several other acute parts in her head, including her optic nerves and brain. The jury said that Aetna Insurance had acted in bad faith and this verdict would compel them to change its approach towards patients.

Reasons for Denial of Insurance Coverage

Mrs. Cunningham’s doctors at MD Anderson Cancer Center had put in a request for coverage of proton beam therapy, which is a highly targeted form of radiation treatment. This therapy could locate her tumor successfully without the dangerous risks of blindness or other side effects that come with standard radiation therapy. But Aetna, the victim’s insurer, denied the coverage by saying that proton beam therapy is still in experimental and investigational stages.

It is notable that coverage of proton beam therapy was clearly spelled out in Mrs. Cunningham’s insurance contract. According to the evidence presented at trial, the Aetna medical directors rejected the claim without even reading the insurance contract. As Mrs. Cunningham’s oncologist at MD Anderson testified, the medical director of Aetna had admitted during a telephone call with him that he realized the oncologist was right, but he was going to deny the coverage anyway.

The Trial

During the trial, evidence revealed that none of the medical directors of Aetna (who were responsible for denying the claim) had ever performed any kind of radiation treatment in their medical experience.

After Aetna denied the insurance coverage, Mrs. Cunningham had to receive the treatment through personal funding of $92,082. Her husband, Ron Cunningham, mortgaged their home and set up a campaign page on GoFundMe to collect additional funds for the treatment.

Before she died, the patient’s scans showed that the proton beam treatment was working for her and her tumor was shrinking.

Watch YouTube Video: Jury Orders Aetna to Pay $25M to Family of Woman Who Died of Cancer. The video below provides more insights on the Cunningham vs. Aetna case.

Failure to Comply with the Duty of Good Faith

During a crucial piece of evidence presented during the trial, it came to light that none of the Aetna doctors knew about the duty of good faith. They had never received any kind of training regarding Aetna’s obligations to its insured clients. They were receiving hefty bonuses every year from the company’s profits though.

In a shocking statement during the trial, all of the Aetna’s medical directors admitted that they spent more time going over the lawsuit than reviewing Oranna Cunningham’s case. John Shely, the lawyer representing Aetna, said in the closing arguments that the health insurance company was proud of its three directors responsible for denying insurance coverage.

After going over all the evidence, the jurors concluded that Aetna disregarded its duty of good faith in dealing with the Cunninghams, and failed to evaluate and investigate the insurance coverage for the requested treatment. Jurors also said that Aetna breached its contract with Mrs. Cunningham.

The Compensation

It awarded compensatory damages for personal expenses and emotional distress caused as a result of Aetna’s repeated claim rejections. The compensation has been granted in the form of an individual payment of $500,000 in favor of Ron Cunningham and $15 million to Oranna Cunningham’s estate. In addition, punitive damages of $10 million were awarded by the jury, making the total verdict $25,592,089.19 (including the actual treatment expenses incurred by the victim).

Sacramento Personal Injury Lawyers

I’m Ed Smith, a personal injury lawyer in Sacramento. Insurance companies have a duty to act in good faith. If you believe that you or a loved one has been a victim of insurance bad faith, call me for free and friendly advice at (916) 921-6400 or (800) 404-5400.

I’m a member of the National Association of Distinguished Counsel the Million Dollar Forum.

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