Jury In Aetna HMO Case Awards $120 Million To Widow

27 Jul 2007

January 25, 1999 - Punitive damages amounting to $116 Million were awarded by a superior court jury in San Bernardino, CA, to a widow, Teresa Goodrich, who contended Aetna Health Plans of California, a Health Maintenance Organization (HMO), played a role in her 44-year-old husband's death. Mrs. Goodrich alleged that by declining to pay for a bone marrow transplant and high-dose chemotherapy required to treat a fast-growing, rare form of stomach cancer Aetna substantially contributed to the death of her husband.

The award against an HMO is part of a trend in the U.S. system of justice to combat negligent or improper treatment by holding the provider and the provider's organization legally responsible. It is an example of our court system protecting the rights of individual patients while simultaneously benefiting larger groups of citizens through its decisions.

Unfortunately, members of a majority of employer-sponsored health plans are barred by federal law, the Employee Retirement Income Security Act of 1974 (ERISA), from filing suit against their health plans for anything more than actual medical expenses. However, Mrs Goodrich was able to file suit for punitive and economic damages against Aetna US Healthcare because her late husband had been a member of government-sponsored employee health plans. ERISA lawsuit restrictions do not apply to these members.

Earlier, the jury had granted the widow $3.8 Million for loss of support and companionship and $750,000 for medical damages.

Courts have gradually made inroads into the ERISA restrictions in recent years. As a result it is becoming more and more likely that an HMO can be successfully sued for improper handling of requests for medical care.