In February, it was disclosed that Aetna’s medical director had been denying medical claims without ever looking at patients’ records. Thanks to a lawsuit, this negligence was brought to the public’s attention.
In his deposition, former medical director Dr. Jay Ken Linuma said he was simply following the training guidelines of the insurance giant. According to Dr. Linuma, this meant nurses would review a patient’s records and make recommendations to him based on their review.
Aetna refuted the doctor’s statement, reporting that their medical directors are trained to review all medical information that is available about a patient.
Dr. Linuma has admitted, under oath, that not once in his three-year tenure as medical director did he look at patients’ records. It’s shocking that this was happening within one of the world’s largest insurance companies.
California Insurance Commissioner Dave Jones was outraged, and he’s not the only one.
The injustice was brought to the state’s attention after a young man, Gillan Washington, was denied treatment for lifesaving blood transfusions that he needed due to an autoimmune illness. Dr. Linuma denied Washington’s claims, and Washington’s condition deteriorated to the point where his lung collapsed. Soon after, the doctor’s testimony revealed the shocking truth — the ignorant denial of claims may have happened on a much grander scale.
Washington has brought a lawsuit against Aetna, and the case will likely be far from the first of its kind. Commissioner Jones is encouraging anyone with a similar story to come forward.
This type of injustice should never happen; yet, all too often, we see insurance companies denying claims and keeping benefits from the people who should be getting them. If you or a loved one have had a claim denied by a workers’ compensation carrier or auto insurance carrier, call the law firm of Pezzano Mickey & Mickey to find out if you have a case.