Insurance Company Denies Coverage For Teen's Transplant

Brooks Schuelke

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This is not necessarily a personal injury story, but it is horrific nonetheless. In California, a 17 year old girl who was battling leukemia received a bone marrow transplant from her brother. After the transplant surgery, her liver failed. On December 11, the girl's doctors determined she needed a transplant and sent a letter to CIGNA insurance. Cigna refused to pay for the transplant. After the girl's friends and family protested, Cigna relented and agreed to pay for the surgery. Unfortunately, it was too late. The girl died a few hours later.

This is another example of how insurance companies have developed an adversarial relationship with policyholders. Unfortunately, as personal injury lawyers, we see these problems all the time. Insurance companies have started looking for new, technical reasons to deny coverage; companies are more aggressive in seeking subrogation recoveries at the expense of their isureds'; health insurance companies deny coverage for car wreck claims hoping that the adverse driver's coverage will pick up the tab.

That's not how it's supposed to be. The law is well settled in Texas that insurance companies have a special relationship with their insureds and that the insurers owe duties to deal with insureds in good faith. Unfortunately, when insurance is provided as a job benefit, the insurance is governed by federal law (ERISA) and those protections go out the door.