Aetna to pay $25.5 million after denying cancer treatment

An Oklahoma jury this week told Aetna to pay $25.5 million to a patient’s estate after the insurer denied her a certain cancer treatment.

The jury in the Oklahoma County District Court decided that Aetna recklessly disregarded its duty to act fairly and in good faith when it denied Orrana Cunningham the life-saving treatment. They awarded her husband and estate $15.5 million in actual damages and $10 million in punitive damages.

Cunningham, who is now deceased, was diagnosed in November 2014 with Stage IV nasopharyngeal squamous carcinoma, a rare cancer at the base of the skull. Her physicians in Oklahoma City and at MD Anderson Cancer Center determined that proton beam therapy would give Cunningham “the best and only chance of survival” while avoiding catastrophic side effects, according to a court document filed by the plaintiffs in Oklahoma County District Court.

But Aetna denied the claim for treatment, deciding it was “experimental or investigational” and excluded from coverage. The Cunninghams argued that Aetna’s medical directors were unqualified to make that decision because none of them were radiation oncologists and had never treated a patient with head and neck cancer with radiation therapy.

They also argued that the medical directors were overworked and unable to devote more than an hour to reading and reviewing materials submitted by Cunningham’s physicians. They went further in alleging that Aetna gives its medical directors incentives to deny claims by paying them bonuses based on company profitability.

“The evidence proved Aetna’s system is in fact broken, and we are hopeful verdicts like this one will encourage them to fix it,” the Cunningham’s law firm, Doug Terry Law, wrote on its website.

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