On October 13, 2016, a former Aetna medical director sat for a videotaped deposition in Pasadena, California, in a lawsuit pending in Orange County Superior Court. A deposition is sworn testimony taken before trial.
Asked whether he ever looked at patients’ medical records, he answered, “No, I did not.”
He also said why. A nurse read the records and gave him a summary, and that, he testified, was how Aetna trained him to work.
Aetna’s own training is what he named under oath. That is what turned one deposition into a state investigation.
Who he was and what he decided
Dr. Jay Ken Iinuma served as Aetna’s medical director for Southern California from March 2012 to February 2015.
A medical director in this role is the physician who signs off on coverage decisions, including prior authorization, meaning insurer approval required before treatment happens.
His testimony came in a lawsuit brought by Gillen Washington, a college student with common variable immunodeficiency, an immune disorder, who sued Aetna after being denied coverage for intravenous immunoglobulin infusions. The case is Washington v. Aetna, No. 30-2015-00811734, Superior Court of California, County of Orange.
Washington alleged breach of contract and bad faith. Those claims were never tried.
What the transcript says
The exchange that mattered runs a few lines.
Asked whether he needed to see medical records himself, Iinuma said: “I wouldn’t look at the medical records. I’d look at what the nurse provided, the information that the nurse provided.”
Asked whether he ever looked at medical records, he said: “No, I did not.”
Asked whether relying on what the nurse had prepared, instead of looking at the records himself, was his custom and practice in making decisions, he said: “Correct.”
Asked whether that was so throughout his years at Aetna, he said: “My tenure, yes.”
Four answers across two transcript pages, and none of them describes a mistake. They describe a method.
Aetna’s answer, printed in full
Aetna disputed the characterization of the testimony directly.
The company’s statement, as carried by Healthcare Finance News on February 14, 2018: “Dr. Iinuma’s deposition was taken out of context to create media and courtroom leverage, and is a gross misrepresentation of how the process actually works.”
To Fortune, the company said its medical directors “work collaboratively with our nurses” and factor in their input as part of the decision-making process. To CBS Los Angeles it said its medical directors are trained to review all available medical information, including medical records.
Read carefully, the company and the deposition do not disagree much about the mechanics. They disagree about what the mechanics mean.
One side says a doctor who reads a nurse’s summary is doing medicine. The other says not.
Why a transcript became a state investigation
Depositions sit in case files for years without anyone outside the case reading them. CNN reported this one on February 11, 2018.
The next day, California Insurance Commissioner Dave Jones announced an investigation. His statement: “If a health insurer is making decisions to deny coverage without a physician ever reviewing medical records that is a significant concern and could be a violation of the law.”
The scope is the detail that separates this from a press cycle. Jones said his office would examine every denial of coverage or prior authorization made during Iinuma’s tenure at the company.
That is not an audit of one file. That is a sweep of nearly three years of decisions across Southern California.
Within days the inquiry widened. California’s Department of Managed Health Care, a separate regulator that oversees health plans, also began looking at Aetna’s policies and procedures.
What a summary-based review decides
A prior-authorization decision is not a filing task. It decides whether an infusion happens this month, whether a scan is run, whether a surgery date holds.
If that decision is made from a summary, the quality of the decision is the quality of the summary. The chart is the raw evidence. The summary is somebody else’s reading of it.
Aetna’s position, in its statements carried by Healthcare Finance News, Fortune and CBS, is that this is a clinical process, with nurses gathering the records and the medical director applying the criteria to what they gather.
The commissioner’s question was narrower and harder, which is whether the physician whose name and license sit on the denial had personally reviewed enough to own it.
That question is why the scope was every denial, not one denial.
How it ended, and how it did not
Washington’s lawsuit did not reach a jury.
Aetna settled the case in late March 2019, ahead of trial. The terms were not released. A settlement is not a finding of wrongdoing, and Aetna continued to deny that the deposition fairly described its process.
At the time the settlement was reported, the California Department of Insurance said it could not comment because its investigation was still open.
No public conclusion from either California regulator turned up in a check of the Department of Insurance’s press releases on August 30, 2026.
So the file closes on a split. The private claim ended in a private agreement. The public question, whether coverage denials were being made without a physician reading the chart, has no announced answer on the record.
What is documented and what is not
Everything asserted above rests on the deposition transcript, the commissioner’s own statement, and contemporaneous reporting by named outlets.
What is not asserted: that Aetna denied any specific claim improperly, that the practice extended beyond the testimony given, or that any regulator concluded a violation occurred. None of that is established in the record used here.
Asked whether that was how it went throughout his years at Aetna, the physician who decided coverage said, “My tenure, yes.”
The next file in this lane is the Cigna review system that ProPublica reported rejected more than 300,000 claims in two months of 2022, at an average of 1.2 seconds per claim.