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, over $90,000.
The couple mortgaged their Meeker, TXOK, home to pay for the therapy. Orrana passed away the following year at the age of 54, but Aetna’s denial spawned a fight that continued until November 8, 2018, when a jury awarded Orrana’s family $25.6 million for recklessly disregarding its duty to deal fairly and in good faith with the Cunninghams.
The Cunningham’s attorney, Doug Terry, said that bad-faith wrongful claim denials are more common than policyholders would like to believe.
“Orrana’s case exposes so much of what is wrong with health insurance,” Terry said. “This case gave the jury a look behind the curtain so they could see what goes on at a health insurance company when they deny claims. The evidence showed Aetna’s denial of her claim involved overworked, under-qualified doctors working in the interest of their employer’s bottom line who are compensated in part based on the profitability of the company.”
Terry presented evidence before the jury that Aetna’s doctors spent just minutes reviewing her case, despite the severity and uniqueness of her condition. An Aetnas doctor said the coverage was denied because proton beam therapy was experimental and investigational, though Terry argued 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.
“The denial of a cancer patient’s coverage for a fabricated manufactured reason is the very definition of bad faith,” Terry said. “People hear these stories and they take it personally. We’ve all known someone with a serious medical condition, and we’d like to believe that insurers will hold up their end of the bargain when we really need them.”
Another key part of the plaintiff’s case was the fact that Aetna doctors failed to devote adequate time reviewing cases. In one piece of evidence presented to the jury by Terry, an Aetna doctor complained to Aetna supervisor that they were reviewed more than 80 cases in a single day.
Ron Cunningham told Oklahoma’s News Channel 4 that if their case could stop Aetna from denying coverage to people who need it, the four-year battle he began with his wife would be worth it.
Terry said he believes that the message was clear and applauded the jurors’ willingness to stand up against Aetna.
“Aetna doesn’t want these cases brought before a jury because it exposes their practices for what they are. The members of this jury sent a loud message to Aetna, that ordinary folks are not going to allow insurance companies to treat people this way without being held accountable” Terry said. “We can only hope that fear of future litigation can lead to a reckoning within the ranks of message is heard in the boardrooms and corner offices of insurance companies across the nation.”