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Lincoln Woman to Get Share of $20 Million Suit Settlement

Lincoln Journal Star.com

Janice Durflinger will soon get a check for $3,783.76 - her share of a nearly $20 million settlement against a Nebraska insurance company for underpayment of claims.

Durflinger is part of a multistate class-action suit against the Central States Health and Life Co. of Omaha for underpaying policyholders who underwent cancer chemotherapy and radiation treatment according to court documents.

The Lincoln woman was surprised to receive a letter about the class-action suit over a supplemental cancer insurance policy that paid some expenses during her husband's illness.

"I never thought about whether they were paying me enough," Durflinger said.

She was too busy worrying about caring for her husband, John, who died in January 2000, she said.

"When you are going through that, the last thing on your mind is whether they are paying correctly or not," she said.

In addition, the couple had coverage through Blue Cross Blue Shield, which picked up much of the costs.

The settlement, approved Tuesday by a federal judge in Sioux Falls, S.D., provides $7.5 million to about 1,200 policyholders or their estates in 29 states for back payments.

In addition, about $9.6 million in benefits will be paid over the next 10 years to policyholders. The three law firms that brought the suit will get about $2.5 million in legal fees.

More than three dozen Nebraskans or Nebraska estates are listed in the suit, including a payment for more than $100,000 to a York woman's estate.

The suit was filed on behalf of a South Dakota woman as a way to get the company to reimburse policyholders for underpayment of claims, said Mike Abourezk, of Rapid City, S.D., attorney who began investigating the company when his sister was dying from cancer.

With the help of an oncology nurse, Abourezk discovered the company was paying only for the toxic chemotherapy drugs that killed cancerous cells. It was refusing to pay for supplies used in the administering the drugs, like needles, syringes, catheters or tubing, or for antinausea drugs and drugs used to make chemotherapy safe.

The company also was paying only for delivering the radiation treatment but not related costs, according to court documents.

Company officials could not be reached Tuesday afternoon for comment.

In an earlier case, brought on behalf of four policyholders, U.S. District Judge Lawrence Piersol ruled that because the policy's language involving treatment was ambiguous, it had to be interpreted in favor of policyholders.

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