Aetna agrees to $3.4M class action settlement over cancer treatment denials

Aetna class action settlement overview:

• Who: Aetna agreed to pay $3.4 million to settle a class action lawsuit.
• Why: The settlement would resolve claims Aetna mischaracterized proton beam cancer radiation treatment as experimental to deny claims.
• Where: The class action lawsuit was originally filed in Florida federal court.

Aetna has agreed to pay at least $3.4 million to resolve a class action lawsuit claiming the company wrongly denied claims for proton beam cancer radiation treatment.

Plaintiff Mark Lemmerman filed the class action lawsuit against Aetna Inc. and Aetna Life Insurance Co. in 2020, alleging the company shirked federal benefits law by mischaracterizing a proton beam cancer radiation treatment as experimental to deny claims. 

The treatment uses proton beams to target and destroy cancerous tissue while reducing the potential for harming surrounding healthy tissue. The settlement would resolve the Employee Retirement Income Security Act (ERISA) lawsuit over Aetna’s repeated denials of claims for proton beam radiation therapy to treat prostate cancer.

“After five years of litigation, including nearly two years of hard-fought settlement negotiations, the parties have reached and memorialized an agreement that will allow individuals to seek monetary payment related to the denial of insurance coverage for PBT for localized prostate cancer,” Lemmerman wrote in the motion.

Aetna to pay up to $48K to each class member, plaintiff says

Lemmerman says Aetna has agreed to pay up to $48,000 for each of the 71 proposed class members who paid for the proton beam radiation therapy out of pocket after their claims were denied by the company, amounting to a $3.4 million settlement fund.

Class members will receive at least $12,000 each, Lemmerman says, and Aetna has also agreed to pay Lemmerman $15,000 in an agreement that he releases all claims against the company.

Attorney fees, settlement administration costs and other litigation costs are not included in the total $3.4 million fund, Lemmerman told the court, adding that these fees will be paid separately by Aetna.

He says class counsel will request an additional $1.7 million in attorney fees, bringing the total potential bill for Aetna to $5.1 million, although Lemmerman noted the parties did not negotiate counsel fees before reaching an agreement on the settlement fund.

The proposed settlement class would include all participants of ERISA-governed benefit plans provided by Aetna, who were diagnosed with prostate cancer and saw their claims for proton beam therapy denied from Jan. 1, 2015, to March 31, 2024, because the treatment was deemed too experimental.

Meanwhile, Aetna itself has filed a class action lawsuit against 23 drugmakers over claims they conspired to fix the price of 111 generic medications, including penicillin and amoxicillin, among others.

What do you think of the Aetna class action settlement? Let us know in the comments.

The plaintiff is represented by Stephanie Anne Casey and Sabrina Saieh of Colson Hicks Eidson and Harley S. Tropin, Maria D. Garcia and Robert Neary of Kozyak Tropin & Throckmorton.

The Aetna class action lawsuit settlement is Prolow v. Aetna Life Insurance Co., et al., Case No. 9:20-cv-80545, in the U.S. District Court for the Southern District of Florida.

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