COVID-19 UPDATE: We are open! Our team is working and offering consultations via phone, e-mail, and video conferencing.

Jury Awards 25.5M to Family After Aetna Denies Coverage for Therapy

A jury has just awarded a $25.5 million jury verdict to the family of a woman who died from nasopharyngeal cancer.  The jury determined that health insurer Aetna recklessly disregarded its duty to deal fairly and in good faith with Orranna Cunningham, when it denied her claim for coverage for radiation therapy. 

In 2014, Ms. Cunningham requested coverage for proton beam therapy, a type of radiation therapy approved by the FDA to treat nasopharyngeal cancer.  The costs of such therapy is covered by Medicare.  However, Aetna denied her claim asserting that it was “experimental.”  Following the claim’s denial, the Cunningham family experienced financial strain – having to mortgage their home and pay out of pocket to cover the high costs of treatment. 

Representatives of the family argued that the Aetna representatives gave the claim short shrift – the doctors who reviewed the claim failed to spend sufficient time reviewing it, and that they were unqualified, overworked, and biased.  Representatives also argued that the decision to deny the claim was a financial one, rather than one that was in the best interest of the patient. 

The jury agreed, ruling that Aetna recklessly disregarded its duty to deal fairly and in good faith with Cunningham.

Ms. Cunningham, died in May 2015 at the age of 54.

As patient’s advocates, we are hopeful this verdict will send a message to insurers and the need for them to closely review each patient’s case in order to provide the best possible care. 

For more information or if you or a loved one has suffered harm as a result of negligence, please contact the experienced California personal injury lawyers at Bostwick & Peterson, LLP for an immediate consultation.