Humana Found Guilty in Wrongful Death Suit

July 6, 2005 (PLANSPONSOR.com) - A San Antonio, Texas jury found that Humana Inc. was partially responsible for a former patient's death and must pay part of the $9 million in damages awarded to the patient's family.
By PS

According to a Business Insurance report, Humana’s portion of the damages includes $2.6 million in actual damages and $1.6 million in punitive damages.   A physician and a physician’s group, also implicated in the case, have already paid their part of the award.

The wrongful death suit was filed in May 2003 by the family of Joan Smelik, who claimed Humana Health Plan of Texas Inc. mismanaged Smelik’s health care and failed to carry out the medical case management procedures it set forth in its member handbook, according to the report.   Smelik died of kidney failure in 2001.   Renee McElhaney, an attorney for the family, said Humana failed to provide specific health care management that could have saved Smelik’s life.

McElhaney called the decision “groundbreaking” since Health Management Organizations (HMOs) are rarely held responsible for the promises made to their members.  

The Business Insurance report says Humana denied any wrongdoing and issued a statement saying, “The evidence showed Humana acted responsibly as a health benefits company. We approved every physician and hospital referral and paid every medical claim.”   A spokesman for the company said it plans to “vigorously” appeal the verdict.

-Rebecca Moore

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