November 14, 2018

Aetna, the nation’s third-largest insurer with 23.1 million customers, has been reckless and engaged in abhorrent, bad faith behavior. A recent jury award for $25.5 million is a statement to Aetna that they cannot put profits before policyholders. Aetna acted in bad faith by denying a patient life-saving cancer treatment, a jury in the Oklahoma County District Court ruled this month.

In 2014, when Orrana Cunningham needed proton beam therapy for stage 4 nasopharyngeal cancer, her insurer, Aetna, declined to cover the treatment. That denial, like many that occur every day in the U.S., cost Orrana and her husband, Ron Cunningham, a retired Oklahoma City firefighter, over $90,000.  The couple mortgaged their home to pay for the therapy. Orrana passed away the following year at the age of 54.

A jury awarded Orrana’s family $25.5 million for recklessly disregarding its duty to deal fairly and in good faith with the Cunninghams. The award is believed to be the largest verdict in an individual bad faith insurance case in Oklahoma history.

Evidence was presented at trial that showed Aetna’s doctors spent just minutes reviewing Orrana’s case, despite the severity and uniqueness of her condition. At trial, one Aetna medical director acknowledged handling 80 cases a day. In a practice that has become all too common, Aetna’s medical directors rubber-stamped the denials without doing their due diligence.

An Aetna doctor said the coverage was denied because proton beam therapy was experimental and investigational, though the treatment was critically necessary for Orrana’s life-threatening condition, and had not only been approved by the Food and Drug Administration, but is also covered by Medicare.  Twelve angry – understandably so – jurors found that Aetna “recklessly disregarded its duty to deal fairly and act in good faith with the Cunninghams.”

Corless Barfield Trial Group has had much experience litigating against insurers who deny legitimate medical and property damage claims.  Insurance companies regularly employ improper tactics to deny legitimate claims for life, health, disability, and other forms of insurance. 

When you purchase an insurance policy you expect that your insurance company will treat you fairly should you ever need to file a claim. You did your part to protect yourself and your family by purchasing insurance and paying your premiums while following the rules. Then, through no fault of your own, you suffer a personal injury or become sick.  The natural place to look to for help is your insurance company, which is required to act fairly and in good faith and to consider the interests of its policyholders equal to its own interests. Unfortunately, insurance companies have teams of adjusters and attorneys to protect their own interests, not yours.  

When an insurance company fails to abide by the law and act in good faith, the insured may be able to pursue a “bad faith” cause of action against the company with the help of an experienced bad faith insurance lawyer. Call Corless Barfield Trial Group today toll-free at 877-517-5595 or locally at 813-258-4998.

Back in February 2018, California’s insurance commissioner Dave Jones launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care.

Unfortunately, under our insurance system in the U.S., the insurance company – not your doctor – decides whether something is “medically necessary” and whether it will be covered. In the Cunningham case, Aetna made decisions with no medical basis. This case illustrates an insurance industry intent on widening the gap between the have and have-nots. In the case of health insurance, have-nots is the difference between life and death so that an insurer can escalate profits.

If you or a loved one was denied medical care because an insurance company negligently denied your claim or denied your claim in bad faith, talk to an attorney. You may be entitled to compensation for the additional medical costs, lost wages, and pain and suffering from untreated conditions or stopped treatment. For a free consultation on your case, contact Corless Barfield Trial Group at 877-517-5595 or 813-258-4998.