An Oklahoma County District Court jury awarded almost $25.6M to the family of a cancer patient denied coverage by Aetna. The award is believed to be the largest in the history of the state for an individual bad faith insurance case. Ron Cunningham sued Aetna after the health insurer denied his wife, Orrana Cunningham, coverage for proton beam therapy. In 2014, Mrs. Cunningham was diagnosed with stage 4 nasopharyngeal cancer. Her doctors at the University of Texas MD Anderson recommended she receive proton beam therapy, a targeted form of radiation. Aetna denied her coverage, calling the therapy “experimental” and “investigational.”
After mortgaging their home to pay for her treatment, Mrs. Cunningham received proton beam therapy, which appeared to be working. She completed treatment and returned home. Shortly thereafter, however, she developed herpetic encephalitis, a disease that caused severe brain swelling and ultimately took her life at the age of 54.
Cnn.com reports that jury foreman Ann Schlotthauer believed “Aetna’s medical directors ‘rubber-stamped’ the denials without doing their due diligence. No one was looking at her specific case,” she said. “That’s where we decided that obviously they were in breach of contract and should’ve paid for that treatment. It was medically necessary in her situation.”
In $25.6 Million Verdict Against Aetna in Bad Faith Case, Oklahoma Bad Faith Insider publisher Doug Terry and lead attorney for Ron Cunningham wrote:
I am happy to announce we obtained a $25.6 million verdict for our clients Ron and Orrana Cunningham this week in Judge Lisa Davis’ court in Oklahoma County. The case is Cunningham v. Aetna, CJ-2015-2826…
Aetna breached its insurance contract with the Cunninghams, effectively meaning they found there was coverage under the Aetna policy for proton therapy for Mrs. Cunningham’s nasopharyngeal tumor…
In effect the jury determined the experimental and investigational exclusion in the policy does not apply to exclude proton therapy in this situation…
The jury awarded compensatory damages for the emotional distress caused by Aetna’s repeated denials. They awarded Mr. Cunningham $500,000.00 individually. Then they awarded Mrs. Cunningham’s estate $15,000,000.00…
The jury’s verdict delivered the message that the public will not stand for insurance companies putting profits before policyholders…
The jury ruled that Aetna recklessly disregarded its duty to act in good faith with Cunningham. Mr. Terry also states:
As it turned out, the evidence showed the Aetna doctors (in addition to being medically unqualified to make the decision on this claim), had never heard of the duty of good faith, had never received any training on the obligations owed by Aetna to its insureds under Oklahoma law, were sorely overworked (one was loudly complaining in her personnel file about working 16-hour days and deciding 80+ claims per day) and were receiving sizable bonuses each year, based in part on the profit of Aetna. Each of the medical directors spent about 30-45 minutes reviewing the claim (including a 150+ page appeal package sent to them by MD Anderson). At trial, each medical director claimed to have read everything in the file in that amount of time. Apparently, the jurors did not believe them on this. In contrast, each of the medical directors (who testified live in our case in chief) testified they had spent days and days preparing for their trial testimony. We presented an insurance industry expert, Stephen Prater, to testify regarding his opinion that Aetna’s conduct in this case was egregious and an extreme deviation from industry standard practices…
Also, the evidence at trial was that none of the medical directors even read the insurance contract before denying the claim. Apparently, they instead relied on Aetna’s “Clinical Policy Bulletin” or “CPB” as the basis of their denial, which is not a part of the insurance contract Aetna sold the Cunninghams…
In Cancer Care Denied: The Broken State of Patient Access to Proton Therapy, the Alliance for Proton Therapy writes:
In the end, proton therapy is denied more than four times out of ten (42 percent) and it takes an average of more than five weeks (27 working days) to receive that final denial…
The California insurance commissioner is investigating Aetna after its former medical director admitted he never reviewed patient information when making treatment approval or denial decisions…
In the Cunningham case, multiple jurors said that one of the most convincing experts was radiation oncology/proton expert Dr. Andrew L. Chang. According to attorney Doug Terry in $26.6 Million Verdict Against Aetna in Bad Faith Case, Dr. Chang explained that “the CPB is outdated, skewed and cherry-picked in the way it refers to the medical literature.” Dr. Chang further described proton therapy as a well-established treatment, not experimental as Aetna claimed at trial.
The testimony of expert witnesses often determines the outcome of bad faith cases such as Cunningham v. Aetna. Contact Elite Medical Experts to secure a board-certified, full-time practicing university physician expert witness who is hand-selected and highly qualified to evaluate the fact pattern in your case.
