Los Angeles Jury finds Health Net responsible for causing insured to become addicted to opiates because of delays in referrals to specialists; Awards $14.42 Million, including $7.5 Million in punitive damages

PR Newswire

LOS ANGELES, Dec. 14, 2022 /PRNewswire/ -- Shernoff Bidart Echeverria LLP announce a Los Angeles Superior Court Jury ordered Health Net to pay $14.42 million, including $6.92 million in compensatory damages and $7.5 million in punitive damages, to a woman who alleged the health care giant caused her to become addicted to opiate pain medication, which she was prescribed only after she had already unnecessarily waited months for Health Net to provide timely referrals to specialists.

"This is an important case for the health insurance industry, especially Medi-Cal recipients. For too long health insurance companies have stood by, complacent that their insureds are prescribed dangerously addictive pain medication while waiting through managed care delays and access to timely specialist care. In Ms. Courtney's case, she cried out for help to Health Net that the pain medication would not fix her problem, begging for Health Net to permit her to timely see the proper specialists. But Health Net did nothing to help her, and unfortunately, she is now another victim of the opioid epidemic. But it did not need to happen if Health Net had just delivered on the obligations it had in its contract." said attorney Travis Corby of Shernoff Bidart Echeverria LLP.

In 2017, Ms. Courtney needed urgent medical care for a pelvic prolapse issue that was causing her extreme pain. In February 2017, Ms. Courtney received an urgent referral to a colorectal specialist for a surgical consult. According to the health plan, an appointment should have been made available within 96 hours. But she was told that the correct specialist was not available to her under her Health Net Medi-Cal plan and she was instead sent back to a general surgeon that she had already seen that was admittedly not specialized to fix her problem. Meanwhile, Health Net had 25 colorectal surgeons available in its Southern California network but refused to allow access to any of them. As a result, Ms. Courtney was made to wait until August 22, 2017 to see a qualified specialist. Even then, she experienced additional delays from the health plan. The specialist doctor's surgical request were then denied on five separate occasions over four months, because of issues with the network. Again, Ms. Courtney repeatedly reached out to Health Net, pleading for help, but it did nothing to overturn the denials.

Ms. Courtney was not able to get in for surgery until December 13, 2017—a ten-month delay. As a result, Ms. Courtney became dependent on opioid pain medication that was only first prescribed to her months into the delay while she waited to Health Net to arrange and provide access to specialists.

During that year, Ms. Courtney suffered immense pain and was given the runaround by Health Net's bureaucracy. All the while, Health Net was on notice that she was unable to care for her four children, that her condition prevented her from using the bathroom without intervention, that she was in extreme pain, and that she had been prescribed the opioid pain medication to manage the pain while waiting for surgery.

"During 2017, Health Net had ample opportunities to step in a deliver the specialist services that are promised to plan members under their contract with Health Net. But Health Net stood by indifferent to the risks to Ms. Courtney's health. Today she has lost everything as a result of her addiction and she is fighting to get her life back. Hopefully this verdict sends a message to Health Net and other health plans." said attorney Travis Corby of Shernoff Bidart Echeverria LLP.

The case is Elaine Courtney v. Health Net, Los Angeles Superior Court, Case No. 18STCV05327.

About Shernoff Bidart Echeverria LLP

At Shernoff Bidart Echeverria LLP, we lead the nation in protecting policyholders from insurance companies' refusal to pay claims. The firm has been protecting the rights of insurance consumers, both individuals and businesses, for over 40 years after having set the legal precedent requiring insurance companies to act in good faith.

Media Contact: Joe Marchelewski, [email protected]

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