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Jury awards $25 million after Aetna denies coverage

The husband of an Oklahoma woman whose insurance company denied her cancer treatment said the jurors in her case "did her proud" by awarding $25.5 million to her family. His wife succumbed to complications of stage 4 nasopharyngeal cancer on May 30, 2015.

The jury determined that Aetna acted "recklessly" when it denied coverage of targeted radiation known as proton beam therapy in 2014. Her doctors sought the treatment that would have been able to isolate the tumor without causing blindness or other detrimental side effects.

Aetna countered that the therapy was considered experimental despite expert testimony that indicated "proton therapy is not a new, experimental technique . . . [but] a well-established treatment for cancer and has been for decades." The expert added that "the oncology community [doesn't]consider proton therapy experimental for the treatment of cancer."

The medical director for Aetna who issued her denial admitted he handled as many as 80 appeals per day. In fact, three medical directors involved in her case testified to spending more time in preparation for the ensuing lawsuit than they had on denying her care.

The jury's award is thought to be the largest verdict returned in a single "bad faith" lawsuit in the state's history.

This is but one example of how a patient or their survivors can hold an insurance company liable for the consequences of denying life-saving treatment to sick patients. Often, hitting them in the wallet is the only way to make a lasting effect. While it is too late for this woman, it is hoped that no other patients will lose their lives due to denials of life-saving therapies by Aetna.

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