HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Friday, December 26, 2008

Cigna Sued for Coverage Denial

Associated Press reports on a lawsuit against Cigna for failing to pay quickly enough for a liver transplant for a young teen.  The story states,

The lawsuit filed last week in Los Angeles County Superior Court by the family's attorney, Mark Geragos, alleges breach of contract, unfair business practices and intentional infliction of emotional distress. The suit accuses Cigna of delaying and rejecting valid claims, which resulted in the wrongful death of Nataline Sarkisyan.

The Philadelphia-based insurer eventually approved the transplant after Sarkisyan's family held a rally outside Cigna's suburban Los Angeles office. Nataline, however, died hours after the approval was secured. Chris Curran, a spokesman for Cigna, said the company empathizes with the family but feels the lawsuit is without merit. Curran said Cigna volunteered to pay for the procedure out of its own pocket and not the employer's. . . .

Nataline was diagnosed with leukemia at 14 and received a bone marrow transplant from her brother the day before Thanksgiving 2007. A complication, however, caused the teen's liver to fail. The family had asked Cigna to pay for a liver transplant but the insurer refused, calling the procedure experimental.  In a subsequent letter to Cigna, four doctors from Mattel Children's Hospital at UCLA Medical Center appealed to the insurer to reconsider. They said patients in similar situations who undergo transplants have a six-month survival rate of about 65 percent.

The insurer eventually reversed the decision while about 150 nurses and community members rallied outside its office in Glendale. By this time, however, the teen had fallen into a vegetative state and was taken off life support. She died within the hour.

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