Jury Awards $25.5 Million to Family of Deceased Cancer Patient in Bad-Faith Lawsuit Against Aetna

On Nov. 5, a jury awarded $25.5 million to the family of Orrana Cunningham, a patient with cancer who was denied coverage by Aetna for a well-established form of treatment. The insurance company claimed the treatment was “experimental,” according to CNN.

Orrana, who lived in Oklahoma, was diagnosed with stage 4 nasopharyngeal cancer and had a tumor near her brain stem. The treatment she sought, proton beam therapy, is a focalized radiation therapy that allows radiation to target the tumor and prevent more serious side effects from regular radiation like blindness and memory loss.

Aetna denied Orrana coverage in 2014 because its medical directors claimed the therapy was experimental and investigational, despite its use for years. The MD Anderson Cancer Center in Texas, where Orrana received treatment, opened its proton therapy center in 2006. The first proton therapy center in a U.S. hospital was established in 1990. Proton beam therapy is also approved by the Food and Drug Administration.

Orrana and her husband, Ron Cunningham, were forced to take out a mortgage on their “dream” home and set up a GoFundMe page to pay for the $92,000 treatment. Proton beam therapy was working for Orrana, Dr. Andrew Chang, a radiation oncologist who reviewed her scans for the trial but was not involved in her treatment, told CNN.

Though the treatment seemed to be working, Orrana contracted a viral infection that made its way to her brain. She died in May 2015 at the age of 54.

The jurors wanted to “make a statement” to Aetna and its medical directors, who they said did not spend enough time reviewing her claim, according to The Oklahoman. The jury found that Aetna “recklessly disregarded its duty to deal fairly and in good faith” with the Cunninghams.

“[Aetna’s] medical directors did not exhaust every measure like they said that they did,” one juror told CNN. “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 [Ron] deserved everything that he was asking for.”

Aetna stood behind its decision to deny Orrana coverage and said it followed “proper steps.” The company also dug its heels into the claim that proton beam therapy is experimental by stating that the company’s “guiding principles will continue to be proven effectiveness and member safety, as determined by rigorous scientific studies.”

Ron’s lawyer, Doug Terry, told CNN this case will expose what takes place when claims are denied from health insurance companies.

“The jury’s verdict delivered the message that the public will not stand for insurance companies putting profits before policyholders,” Terry said.