Jim Fox v. Health Net
Published: Jan. 8, 1994 | Result Date: Dec. 28, 1993 | Filing Date: Jan. 1, 1900 |Case number: 219692 – $89,128,200
Judge
Court
Riverside Superior
Attorneys
Plaintiff
Mark O. Hiepler
(Hiepler & Hiepler)
Defendant
Experts
Plaintiff
Aziz Khan
(medical)
Roy Jones
(medical)
Defendant
Clifford Ossorio
(medical)
Michael B. Van Scoy-Mosher M.D.
(medical)
Facts
Plaintiff James Fox is the surviving spouse of Nelene Fox, who was denied benefits by Defendant Health Net to pay for the bone marrow transplant for metastatic breast cancer (in 1991). In a bone marrow transplant, the patient's bone marrow is removed and then reinserted after the patient is given high doses of cancer-killing chemicals. The treatment has allegedly resulted in at least a short-term favorable response in 50-60% of cancer patients and 20-25% of women with recurrent breast cancer. The cost of the procedure was $212,000. Defendant Health Net denied coverage, deeming it was experimental and investigational. The decedent and her husband launched a nation-wide campaign to raise $150,000 cash to pay for the transplant. She raised the money necessary within 3 weeks in June, 1992. Mrs. Fox received the transplant in August and died 8 months later, on April 22, 1993. The treatment was not performed by USC until late August, 1992, because of two factors: (1) the need to complete the evaluation of Mrs. Fox, and, (2) medical complications unrelated to the denial which arose and which delayed the treatment. This was not a wrongful death action nor was there any contention by Plaintiff in this action that the denial of coverage by Health Net either contributed to or caused Mrs. Fox's death.
Settlement Discussions
Plaintiff contends they demanded $1,500,000 and Defendants offered nothing. Defendant contends they offered up to $750,000 and Plaintiff's initial demand was in excess of $3,000,000.
Specials in Evidence
$212,000
Damages
Contract damages of $212,000.
Injuries
Emotional distress.
Deliberation
5 hours
Poll
12-0
Length
4 weeks
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