Sunday 11 November 2018

Jury orders Aetna to pay $25million to the family of a woman who died of cancer after the insurance company REFUSED to cover her treatment recommended by doctors

A jury has ordered Aetna to pay more than $25 million to the family of Orrana Cunningham, who died after the insurance company refused to cover a type of radiation therapy. Pictured: Orrana, right, with her husband Ron

Jurors wanted to send a message to health insurer Aetna after hearing how the company's overworked doctors denied an Oklahoma cancer patient's claim for coverage for proton beam therapy.

The jury awarded $25.5 million to the patient's estate and to her husband, a retired Oklahoma City firefighter, in the bad-faith case against the company.

"We just thought it was a broken system," juror Fred Forde said Tuesday after the 11-day trial ended in Oklahoma County District Court. "We wanted to send a message to Aetna to fix the system. ... You need to do something or you're just going to keep getting sued."

The jury on Monday decided Aetna — one of the nation's largest health insurers — recklessly disregarded its duty to deal fairly and in good faith with Ron and Orrana Cunningham.

The jury voted 9-3 Monday to award $15.5 million in actual damages.

The jury also decided Monday that Aetna was in breach of contract and should pay for the treatment's cost — $92,082.19. The couple had mortgaged their "dream" home in Meeker to pay for the proton beam therapy themselves in Texas after being denied coverage.

Orrana Cunningham died on May 30, 2015, from a viral outbreak after getting treatment for the tumor in her head and returning home. She was 54.

The jury voted 9-3 Tuesday to award another $10 million in punitive damages. Two of the dissenting jurors Tuesday had wanted to award even more.

'Worst suspicions' confirmed

An Aetna doctor in 2014 denied Orrana Cunningham coverage for proton beam therapy for her stage 4 nasopharyngeal cancer on grounds it was experimental and investigational.

Two other in-house doctors reviewed that decision separately and upheld the denial.

Jurors told The Oklahoman they were swayed by evidence the Aetna doctors spent only minutes reviewing Orrana Cunningham's records before denying coverage even though her case was rare because her tumor was so close to the brainstem.

"They're professionals, they've been to college, this is what they do for a living," one juror said. "They could have reviewed the policies more than 20 to 30 minutes."

One doctor had complained to Aetna about having to review more than 80 cases a day, according to evidence presented at the trial.

"She was failed just at every turn," jury forewoman Ann Schlotthauer said. "It was sad."

Some jurors described the Aetna doctors as "rubber stamps," just doing what Aetna wanted them to do.

"All of your worst suspicions about the health insurance industry have been confirmed in this case," the Cunninghams' attorney, Doug Terry, told jurors Monday.

On Tuesday, Terry said justice was done.

"There's not been a verdict of this size in some time in the state of Oklahoma," Terry said. "I'm really hoping — hoping — that the jury's voice is heard beyond the walls of this courtroom and into the boardrooms of insurance companies around the country."

He disputed that proton beam therapy is experimental and accused Aetna of denying coverage for profit reasons. He accused Aetna doctors of being unqualified to make their decisions, overworked and biased because they get profit-based bonuses.

The attorney pointed out to jurors that proton beam therapy has the approval of the Food and Drug Administration. He also pointed out Medicare pays for the treatment for its patients.

"My wife, her goal, was to make this fight," Ron Cunningham, 56, said after the verdict. "Her comment was, 'If we can save one person and stop Aetna from doing what they traditionally do on every claim, it was worth the battle.'"

The widower also said he hopes the verdict will inspire others to stand up to insurance companies and not be bullied.

In closing remarks to jurors Tuesday, an attorney representing Aetna said the company tries to do the right thing and the verdict stings a lot.

"If it's in our control to change, that's what we're going to do," attorney John Shely said. "Aetna has learned something here."

Aetna Life Insurance did pay other claims made by the couple. Jurors were told that Aetna Life Insurance makes $3.6 million in profit every day.

In a statement Wednesday, Aetna said, "We are disappointed with the verdict and are weighing our options for appeal."

Attorney Justin Meek, who also represents the Cunninghams, said an appeal could take years.

"But I am confident the appellate courts will affirm the trial court verdict," Meek said Wednesday.

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