Jury Awards $25M To Grieving Family After Aetna Denies Therapy

Aetna has been ordered to pay more than $25 million to the family of a woman who died after the insurance provider denied coverage for radiation therapy.

Jurors in the trial found that the doctors at Aetna did not spend sufficient time reviewing Oklahoma cancer patient Orrana Cunningham’s 2014 claim for proton beam therapy.

The jury voted 9-3 to award Cunningham’s family $15.5 million in actual damages and $10 million in punitive damages.

The jurors also determined that Aetna’s claim denial was in breach of contract so they have also been order to pay $92,082.19 for the total cost of Cunningham’s treatment.

Cunningham suffered from stage 4 nasopharyngeal cancer at the time of her claim, leading her to request proton beam therapy for treatment. Her case was especially rare because her tumor was so close to her brainstem. This did not sway the insurance company, however, and Aetna denied the claim, reportedly deeming the treatment method experimental and investigational.

However, proton beam therapy has approval by the U.S. Food and Drug Administration (FDA) and is even covered by Medicare. In order to pay for her treatment after being denied coverage, Cunningham and her husband, Ron Cunningham, were forced to sell their dream home.

Despite mortgaging their home to pay for treatment, Orrana Cunningham died in May 2015 from a viral outbreak following treatment.

“My wife, her goal, was to make this fight,” Ron Cunningham stated. “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.’”

Jurors told The Oklahoman that they had been swayed in their decision by evidence that doctors for Aetna only spent minutes reviewing Cunningham’s case before denying coverage.

“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.”

An attorney for the Cunninghams told jurors that “all your worst suspicions about the health insurance industry have been confirmed in this case.”

The Cunninghams’ attorney further argued that proton beam therapy is not experimental and that the real reason Aetna denied the claim was for profit reasons. He also stated that the doctors making decisions for Aetna were unqualified because they get bonuses based on company profit.

Some juror opinions supported this argument, calling Aetna doctors “rubber stamps” who just do as the insurance company wants them to. The doctors may also have been severely overworked, with evidence in the trial showing that one doctor complained to Aetna about having to review more than 80 cases in a day.

Counsel for the plaintiffs’ says he has hope that this favorable verdict will send a message to other insurance companies and encourage integrity.

“There’s not been a verdict of this size in some time in the state of Oklahoma,” the attorney said in a statement. “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.”