Mansell, Engel & Cole

Oklahoma jury sharply rebukes health insurer in bad-faith case

“You need to do something or you’re just going to keep getting sued.”

That was the pure-and-simple bottom line for an Oklahoma County jury that recently awarded damages in a bad-faith insurance case. One of the jurors stated in the wake of a trial concluded earlier this month that conduct engaged in by national health insurer Aetna evidenced “a broken system.” A message needed to be sent, and the jury unquestionably delivered one.

Its main takeaway was this: Reckless disregard for decency and fair play in a contractual insurance matter with a policyholder will not be tolerated. Aetna is now on the hook for a $25.5 million damage award linked with its bad-faith conduct that denied a woman necessary cancer treatments and contributed to her death.

Approximately $10 million of that amount is pegged as punitive damages. Reportedly, multiple members of the jury panel wanted to award even more than that.

Aetna asserted that the claim was legitimately denied because the proton beam therapy recommended by the patient’s medical team was experimental. Several Aetna doctors concurred in that assessment, despite beam therapy being approved by the FDA and paid for by Medicare when used as treatment by its patients. Trial evidence also indicated that Aetna’s in-house medical team is customarily so overworked that the doctors denying the treatment spent very little time reviewing the policyholder’s case.

“She was just failed at every turn,” said the jury’s forewoman following the trial.

Aetna officials cited disappointment with the verdict and said that the company is considering an appeal.

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