Health Insurance Giant Slammed With $25 Million Verdict For Bad Faith Denial

Insurance is typically a good thing. Policyholders can pay a small premium and receive financial compensation if they end up filing a claim. Without insurance, many people would be unable to pay for car repairs after an accident, a new roof after a storm, or necessary medical treatment. Unfortunately, insurance companies are first and foremost a business, and they sometimes put their own financial interests above their contractual obligations to policyholders.

Bad faith insurance denials in the healthcare industry are all too common, and patients pay the price; however, an Oklahoma court is making an example of insurance companies who wrongly deny claims. Jurors in Oklahoma awarded $25.5 million to the estate of a patient whose health insurance claim was wrongfully denied by health insurance giant Aetna.

In 2014, Orrana Cunningham was diagnosed with Stage 4 Nasopharyngeal Cancer. As devastating as the news was, Orrana and her husband felt fortunate to have health insurance that would allow them to pursue treatment. Her doctors recommended proton beam therapy. Proton beam therapy has been used for decades to target specific tumors because it increases the effectiveness of treatment and comes with fewer side effects than other types of treatment.

The Cunninghams sought coverage under their Aetna health plan, but the company and its in-house medical directors denied the claim. The company claimed proton beam therapy was “experimental or investigational” and therefore excluded from coverage. To call this type of treatment experimental is quite a reach. Proton beam therapy is not only approved by the U.S. Food and Drug Administration (FDA), but it is also a covered treatment under Medicare. The Cunninghams believe Aetna denied the claim for financial reasons, saving the insurer from paying out on expensive claims. They also pointed out Aetna’s in-house medical directors receive profit-based bonuses, exposing them to bias.

Unfortunately, Mrs. Cunningham passed away in May 2015 from complications related to her treatment; however, her struggle was not in vain. The massive $25 million verdict sends a strong message to health insurers: bad faith denials will not be tolerated and insurance companies that operate in bad faith will pay a heavy price.

Bad Faith Insurance Denials

Policyholders that pay their premiums deserve full coverage under their policies. If you or someone you love has received a bad faith insurance denial, contact Feldman & Feldman today to protect your rights and pursue rightful compensation.

Common Bad Faith Tactics Used By Insurance Companies

Nearly everyone has some kind of insurance policy. Whether it’s for your car, home, business, or yourself, insurance policies give us peace of mind knowing that if anything happens, we won’t be left in the dark and coming out of pocket financially. Insurance is a good thing, but only if insurance companies play by the rules. Unfortunately, many insurance companies utilize bad faith tactics to avoid paying out on claims.

Insurance Companies Are Businesses First

Despite what they may claim, insurance companies are businesses first. This means they put their own profits before their customers’ claims payouts. Insurance companies have no incentive to pay out on large claims; so, don’t be fooled by their claims about putting customers first. When any type of loss occurs, insurance companies often try to minimize the claim or find ways to completely deny claims by employing bad faith tactics.

The bad faith insurance lawyers at Feldman & Feldman have helped many policyholders get the compensation they are entitled to under their policies. Through decades of successful litigation experience, we have identified common bad faith tactics insurance companies use when adjusting claims:

  • They claim property damage is due to “normal wear and tear.” Property insurance policies do not cover normal wear and tear that occurs over time. Sometimes insurance companies will wrongfully assert property damage is normal wear and tear, and thus not covered under the policy.
  • Damage is caused by inadequate maintenance. All buildings require regular maintenance. Most policies do not cover damages caused by inadequate maintenance. Insurance companies try to avoid paying out on claims by claiming property damage is caused by inadequate maintenance.
  • Misrepresenting the policy. Oftentimes, insurance companies will completely and blatantly misrepresent policy terms to their policyholders. They might wrongfully claim certain damage isn’t covered, when in fact it is.
  • Undervaluing claims below the deductible. Sometimes insurance companies will accept certain damages, but value the damages at less than the policy deductible so the insurance companies don’t have to pay out on the claims.
  • Causing unnecessary delays. Insurance companies often drag out claims for months. This puts a serious strain on policyholders.
  • Not communicating with the insured. Many victims of bad faith insurance tactics report insurance companies do not timely return phone calls, emails, or other forms of communication, leaving policyholders in the dark about their claims.

All Policyholders Have Rights

Insurance companies count on policyholders being unaware of their rights. All policyholders have the right to a prompt, fair, and equitable settlement of a claim. When insurance companies violate these rights, policyholders will need experienced insurance lawyers by their side. At Feldman & Feldman we can help policyholders protect their rights and get the compensation they are rightfully owed under their insurance policies from bad faith insurance companies. Call us today to schedule an appointment with one of our experienced insurance lawyers.