An Oklahoma jury has awarded $25.5 million to the family of a cancer patient denied coverage by Aetna, with jurors saying that the insurer acted “recklessly” and Aetna doctors didn’t spend enough time reviewing Orrana Cunningham’s case, The Oklahoman reported.
The jury ruled that Aetna recklessly disregarded its duty to deal fairly and in good faith with Cunningham, who had nasopharyngeal cancer. The award is believed to be the largest verdict in an individual “bad faith” insurance case in Oklahoma history, one court observer said, and could have major ramifications across the country for a form of cancer treatment called proton beam therapy.
The case revolved around the 2014 denial of coverage for Orrana Cunningham, who had stage 4 nasopharyngeal cancer near her brain stem. Her doctors wanted her to receive proton beam therapy, a targeted form of radiation that could pinpoint her tumor without the potential for blindness or other side effects of standard radiation, but an Aetna doctor denied coverage deeming the treatment to be too experimental.
Aetna is considering whether to appeal. Company attorney John Shely said the insurer tries to do the right thing.
“If it’s in our control to change, that’s what we’re going to do,” Shely said. “Aetna has learned something here.”
An Aetna doctor denied Cunningham coverage for proton beam therapy in 2014, deeming it experimental, and two other in-house doctors reviewed and upheld the decision.
Aetna attorney John Shely said in closing arguments that the insurance giant was proud of the three medical directors who denied coverage, even turning to thank them as they sat in the front row of the courtroom.
Ron Cunningham, Orrana’s husband, said this week’s verdict was vindication for the suffering his wife went through. She had filed the initial paperwork to sue Aetna, saying that if her case helped save the life of one person, it would be worth it.
“My wife started the case, and I’m just finishing the fight,” he said. “We did her proud. My wife wanted to make sure that it got out. Her comment was ‘if we could just save one person.’
Cunningham said he had another encounter in court. He said John Shely, Aetna’s lead attorney, walked up to him and congratulated him after the verdict before telling him he’d lose on appeal.