$25.5M Verdict Against Aetna For Bad Faith Denial Of Cancer Treatment

By November 19, 2018Business Litigation

A jury in Oklahoma awarded $25.5 million ($15.5 million in compensatory damages and $10 million in punitive damages) to the family of a woman who died from brain cancer, for Aetna’s bad faith in denying her health insurance coverage for cancer treatment, finding that Aetna acted recklessly in denying her proton beam therapy to treat her Stage 4 nasopharyngeal cancer that was near her brain stem. Aetna had denied the treatment that her doctors at MD Anderson Cancer Center in Texas ordered because Aetna considered proton beam therapy to be experimental and investigational.

The woman’s doctors had recommended proton beam therapy because the targeted cancer treatment was appropriate for her specific form and location of cancer without the significant risk of blindness associated with traditional radiation therapy. Aetna’s bad faith denial of coverage forced the 54-year-old woman and her husband to mortgage their home and to set up a GoFundMe page to raise the $92,082.19 cost of treatment. Tragically, the woman died in May 2015 due in part to a viral infection that reached her brain.

Aetna’s attorney reportedly told the jury in his closing arguments that Aetna was proud of the three medical directors employed by Aetna who had denied coverage for the woman’s proton beam therapy, even going so far as to turn to the three medical directors who were sitting in the front row in the courtroom to thank them.

The foreperson of the 12-person jury stated after the verdict that expert testimony during trial established that proton beam therapy was not experimental. She also stated that the jury took into consideration that one of Aetna’s medical directors testified about handling 80 cases per day and that the three medical directors spent more time in preparing for the trial than in reviewing the woman’s treatment requests. “No one was looking at her specific case. That’s where we decided that obviously they were in breach of contract and should’ve paid for that treatment. It was medically necessary in her situation.”

A radiation oncologist who testified during the trial stated after the jury’s verdict: “The thing I tried to illustrate to the jury is that proton therapy is not a new, experimental technique, like Aetna wants to claim. Proton therapy is a well-established treatment for cancer and has been for decades … Nobody in the oncology community considers proton therapy experimental for the treatment of cancer.” The radiation oncologist testified that standard radiation therapy to treat the woman’s cancer could have been used in her case but that the risks of such were “severe”: “She would go blind. She would lose a significant portion of her memory on the left side of her brain and still not have a very good chance at a cure. For her particular tumor, [proton therapy] was extremely valuable.” Before the woman died, scans showed that her tumor was shrinking and that the treatment was working.

Aetna’s lead defense attorney reportedly walked up to the woman’s husband after the jury’s verdict to congratulate him and then callously told him he would lose on appeal.

Source

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