A 17 year old California girl desperately needs a liver transplant to save her life. Her parents’ health insurer, Cigna Corp., refuses to pay for what they consider “experimental treatment” that is not covered by their policy. The facts of the case make headlines across the country and after a huge public outcry, Cigna finally relents and agrees to pay. Unfortunately for the girl and her family, Cigna’s reversal came too late…she died nine hours after Cigna announced they would pay after all.
The girl’s parents filed a wrongful death lawsuit against Cigna for their arbitrary refusal to pay for the needed transplant. The suit was summarily thrown out by a federal judge who cited the 1987 U.S. Supreme Court decision interpreting ERISA shielding employer-paid health care plans from damages based on their coverage decisions. The 1974 Employee Retirement Income Savings Act (ERISA) governs employee retirement funds and benefit plans. Since ERISA plans cover over 132 million workers and their dependants, these rulings have in effect slammed the courthouse door on coverage decisions to a huge group of citizens.
As part of the national health care reform debate, overhaul of ERISA should be included. Insurers should no longer be able to hide behind ERISA’s immunity protection for their life and death coverage decisions. The late senator Ted Kennedy unsuccessfully tried to do just that in 2001. Despite his pleas to overturn the total immunity given to health insurers, a shield enjoyed by no other industry, the Republican majority and a well-funded lobbying effort paid for by the insurance industry defeated his reform efforts. It’s high time this protection of the wealthy insurance industry ends.
Although the California parents’ wrongful death claim was dismissed, they may have one last chance at making Cigna accountable in some part for their daughter’s premature death. A few months after her daughter’s death, the grieving mother travelled to Cigna’s corporate headquarters in Philadelphia to ask for an apology from company executives for what they did to her daughter. Employees of Cigna literally jeered and made obscene gestures to the woman as she was escorted from the building by security. She filed suit for her emotional distress and a federal judge recently ruled that ERISA immunities did not apply to her lawsuit. Cigna may soon have to answer for at least part of their callous behavior to this agrieved family.
Richard J. Arsenault, 2011
