Aetna Life Insurance Claim Denial
Aetna Life Insurance Company is one of the major players in the United States insurance industry. A subsidiary of CVS Health, Aetna is headquartered in Hartford, Connecticut. With a long-standing history that dates back to the early 1850s, Aetna offers a wide range of insurance products, including health, dental, and life insurance policies. According to their annual financial reports, Aetna has garnered billions in annual revenues, serving millions of policyholders across the country.
Despite its reputation and extensive reach, however, Aetna is not immune from allegations of bad faith insurance practices and life insurance claim denials. Like many insurance providers, Aetna has faced various lawsuits that accuse the company of unfair claim denials, unreasonable delays in processing claims, repeated requests for unnecessary information, and other ostensibly bad faith insurance practices.
See below for a description of some recent notable lawsuits that have been filed against Aetna for wrongful life insurance claim denials. If your life insurance claim was wrongfully denied or if you find yourself dealing with other bad faith insurance practices by Aetna or other insurance companies in California, reach out to the life insurance claim denial lawyers at Gianelli & Morris for help from a team of seasoned and successful California insurance law attorneys.
Recent Notable Lawsuits and Investigations Against Aetna in California
In just the past decade, Aetna has been the subject of multiple investigations by the California Insurance Commission regarding its practices, and the insurer was also hit with a record-setting verdict in Oklahoma. These lawsuits and investigations reveal that Aetna doesn’t always play by the rules or make decisions in the best interests of its policyholders and their beneficiaries.
In 2014, California’s Insurance Commissioner called out Aetna for implementing rate hikes nearly ten times higher than they should have been. Policyholders saw their premiums go up by as much as 20% over the prior year, despite the Insurance Commission’s determination that an increase of only 2.6% would be called for.
Then, in 2018, the Insurance Commission again questioned Aetna’s practices, this time involving its dubious claim approval process. During that investigation, Aetna’s own medical director testified that he made coverage decisions without reviewing the medical records of patients, instead simply rubber-stamping the recommendations of nurses in the claim review process.
That same year, an Oklahoma jury awarded $25.5 million to the family of a cancer patient who was denied coverage for her doctor-recommended proton beam therapy to treat nasopharyngeal cancer near the brain stem. Proton beam therapy was prescribed as it would have targeted the tumor in this sensitive area with much more precision than other forms of radiation. Aetna called the procedure “experimental and investigational” and denied coverage. The patient’s family mortgaged their home and started a fundraising appeal to pay for the therapy themselves, but the patient died before the procedure could be performed. The jury’s verdict of bad faith on the part of Aetna was the largest such judgment in state history.
Implications for Policyholders in California
For policyholders in California, it’s crucial to be aware of your rights and the responsibilities of insurance companies. The state has stringent laws against bad faith insurance practices. Under California Insurance Code Section 790.03, insurance companies are prohibited from misrepresenting or falsely advertising policy benefits, making false statements to deny or delay claims, and not promptly and fairly settling claims where liability is apparent. This law applies to the processing and payment of life insurance claims as well as other forms of insurance.
California’s strong protections for policyholders can be valuable tools to fight bad faith and other wrongful conduct of insurance companies when these tools are wielded by the hands of skilled and experienced insurance law attorneys.
Contact Gianelli & Morris to Review a Life Insurance Claim Denial in California
If you believe that Aetna, or any other insurance company, has unfairly denied your life insurance claim or engaged in bad faith practices, you may have a strong case for legal action. In such instances, representation by an insurance law firm well-versed in California insurance regulations can prove invaluable. In Los Angeles or statewide, call Gianelli & Morris at 213-489-1600 for a free consultation to discuss your potential claims.
