Aetna has settled a lawsuit after a company medical director admitted, under oath, to never looking at patients’ records when determining whether to approve or deny coverage. This shocking testimony sparked an extensive investigation led by the California Insurance Commissioner. Though Aetna claimed these comments were taken out of context, the massive health insurance company still fought the case. This disturbing revelation came to light when 23-year-old Gillen Washington had coverage withheld from him based on claims he had not completed the necessary bloodwork. He almost died at the age of 19 as a result. When given the chance to amend his inflammatory comments after reviewing the deposition’s transcript, Dr. Jay Ken Iinuma signed these remarks as “true and correct” under penalty of perjury. Once these statements came to light, he quickly claimed to misunderstand the question. Aetna’s clinical review practices were called into immediate question. Aetna has come under fire for its lack of transparency in awarding coverage. This is a glaring example of insurance bad faith, which refers to when an insurance company denies payment of a sincere claim. Common examples include when an insurance company delays or discredits a payment, refuses to consider a claim, cancels policies requiring treatment, fails to answer in time, attempts to lessen a claim, etc.
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At Williams DeClark Tuschman Co., L.P.A., we firmly believe your insurance company is obligated to honor your rights and act in good faith. If you feel your rights have been infringed upon, our personal injury lawyers will help you fight back for the benefits you rightfully deserve. If you would like to schedule an initial case evaluating with a member of our firm, call (419) 318-0772 at your earliest convenience.