Oklahoma Jury Delivers $25.5 Million Dollar Verdict Against Insurance Titan Aetna
An Oklahoma jury has decided that the family of a cancer patient who was denied coverage by Aetna will be rewarded $25.5 million. The jurors said that the insurer Aetna, acted “recklessly” and the verdict was meant to serve as a message for Aetna.
The astounding $25.5 million dollar verdict is believed to be the largest “bad faith” case in Oklahoma history one court observer said, and could have a major impact across the U.S. 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.
Cunningham’s claim was denied by Aetna, claiming the therapy was investigational and experimental.
Orrana and her husband, Ron Cunningham, a retired Oklahoma City firefighter, had been together since 1987. Ron was determined to do whatever it took to get the help that his one true love so desperately needed. The couple set up a GoFundMe page and took out a mortgage on their dream house in order to pay the $92,082.19 required to get the therapy doctors had prescribed at MD Anderson Cancer Clinic located in Texas. However, Orrana, 53, died on May 30, 2015 due in part to a viral infection that reached her brain.
Ron Cunningham claimed that this weeks verdict was vindication for all of the sufferings that his wife endured the past few years. Orrana had filed the initial paperwork to sue Aetna, saying that if her case helped save the life of just one person, it would all 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. As far as the money, I’d give it all back to spend just one more day with her.”
John Shely, attorney for Aetna, said during his closing arguments that the insurance titan was proud of the three medical directors that had denied coverage. According to jurors and witnesses, Shely went as far as to turn and thank the medical directors, all who were seated in the front row of the courtroom.
It was a message that did not sit well with the 12 jurors who found that Aetna “recklessly disregarded its duty to deal fairly and act in good faith with the Cunninghams.”
“I just felt like Orrana Cunningham was failed at every turn,” forewoman Ann Schlotthauer said.
She said the verdict “was definitely a message to Aetna. We discussed that in jury deliberations — that we wanted to make a statement. We wanted to make a point and get their attention.”
According to Schlotter, proton beam therapy was not experimental at all as proven by expert testimony. She said jurors were turned off by one Aetna medical director who acknowledged handling 80 cases a day and by the fact that all three medical directors acknowledged they spent more time preparing for the lawsuit than on Orrana’s medical case.
Schlotthauer said she believed that Aetna’s medical directors “rubber-stamped” Orrana’s denial letters rather than doing their due diligence.
“No one was looking at her specific case,” she said. “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.”
“I hope (the verdict) does result in huge changes,” she said. “I hope it results in Aetna re-evaluating how they evaluate appeals and requests.”
Juror, Ora Dale, was in tears as she hugged Cunningham after the trial. Dale was one of two jurors who were of the opinion that the monetary award should have been a great deal higher than the $25.5 million that was handed down.
“I just wanted to let him know that I was on his side,” Dale said. “Those medical directors did not exhaust every measure like they said that they did. They did not spend enough time on her claim. It just kept getting denied and denied. Aetna needed to pay. They were in the wrong, and he deserved everything that he was asking for.”
In spectacular fashion, Cunningham had another encounter in the courtroom following the jury’s decision, as Aetna attorney John Shely approached Cunningham, congratulated him on the verdict and then added that he would lose on appeal.
Cunningham was an Oklahoma City first responder firefighter working on April 19, 1995, when Timothy McVeigh took the lives of 168 Oklahomans and wounding hundreds of others by bombing the Alfred P. Murrah building. The day following the bombing, Cunningham was assigned to the day-care center that was located on the second floor in order to search for the bodies of children. During his searches, Cunningham would spray the found tiny bodies with Lysol disinfectant in order to prevent the spread of bacteria.
It is safe to say that Mr. Cunningham has seen the very worst of the worst, but experiencing all of that tragedy could not prepare him for the exchange with Aetna’s attorney Shely in the courtroom. Cunningham stood dumbfounded and stunned, trying to comprehend what he had just heard.
“That showed how callous these people are,” he said.
Aetna is the third-largest insurer in the nation and maintains that it acted appropriately in denying coverage in the Orrana’s case, stating that there is a “lack of clinical data supporting proton therapy for treating nasopharyngeal tumors.”
“While we have no comment on the ruling, juror motives or a potential appeal, we do want to make it clear that the proper steps under the health plan were followed in this instance,” Aetna said in a written statement. “As our chief medical officer noted in a post earlier this year, it’s never easy to tell an individual or family that a treatment or procedure is not approved — it’s the hardest thing we have to do. However, our guiding principles will continue to be proven effectiveness and member safety, as determined by rigorous scientific studies.”
Lead counsel for the Cunninghams, Doug Terry felt very differently than Aetna stating:
“We believe this case pulled the curtain back on what goes on at a health insurance company when claims are being denied,” Terry said. “The jury’s verdict delivered the message that the public will not stand for insurance companies putting profits before policyholders.”
Ron Cunningham said that his wife would be proud of the verdict. Orrana used to comfort Ron on the hard days.
“She was a rock for me, especially through my bad times,” he said.
He then talked about the three Aetna medical directors; he said each testified that “they wouldn’t change anything they did.” When the jury said Aetna “recklessly disregarded” Orrana’s case, Ron Cunningham said, he finally felt justice.
“When they said that, it was like, ‘I think we did her proud,’ ” he said.
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