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.