It has been just over a year since Bend-based Clear Choice Health Plans paid the family of a Crooked River Ranch man $1.5 million after he sued the insurance company claiming it would not pay for a medical procedure to detect a cancerous tumor that caused paralysis of his legs.

The company paid the settlement to Dale Evans family in August 2008, six weeks after he died. The companys lawyer declined to comment on the case at the time.

Now, 51-year-old Richard A. Paulus has filed a $5 million suit claiming the company repeatedly denied authorization for back surgery and that he is now disabled.

Paulus, of Bend, filed the complaint in Deschutes County Circuit Court, asking for $3.5 million to compensate him for permanent injury, disability, loss of enjoyment of life, pain, suffering, inconvenience, anxiety, mental distress and depression. Paulus suit also requests $1.5 million for medical expenses and lost income.

Representatives of Clear Choice, which changed its name last month to Clear One Health Plans, did not respond to an e-mail seeking comment or return phone calls Monday or Tuesday.

Paulus suit states Clear Choice also denied his doctors written appeal of the companys decision to deny authorization for the surgery. In the appeal, Paulus doctor wrote that Paulus was becoming bed ridden and that his health was deteriorating daily.

Paulus lawyer, Michael Wise, said Tuesday his clients condition has gotten worse since Clear Choice denied his requests in April and May 2007 as well as May 2008.

Hes basically disabled, in constant pain and cant work, and is in much worse condition, we believe, than if the procedure had been done, Wise said.

Paulus complaint states that he was insured by Clear Choice, which provides Medicaid coverage for the Oregon Health Plan and Medicare, and commercial coverage in Oregon, when his Bend neurosurgeon, Dr. Kent Yundt, requested authorization for lumbar surgery in early 2007.

Clear Choice informed Mr. Paulus that it would provide comprehensive personal medical care to Mr. Paulus when needed by him, including medically necessary surgical procedures, with prior authorization of Clear Choice, the complaint states.

After Clear Choice denied the request in April 2007, Paulus sought a second opinion from Dr. Chae G. Ha, who determined that Mr. Paulus would benefit from immediate surgical intervention, according to the lawsuit.

A second request for authorization for back surgery was denied in May 2007, prompting an appeal from Yundt.

Dr. Yundt stated that there was an urgent need for Mr. Paulus requested procedure and that patients symptoms are worsening and he is, for the most part, becoming bed ridden, the complaint states.

The appeal included documentation from two independent physicians who agreed with Yundts assessment of Paulus condition, according to the lawsuit.

That appeal was denied in June 2007.

Nearly a year later, in May 2008, Clear Choice again denied a request by Yundts practice for authorization for back surgery. The request said Paulus was experiencing increased pain and tingling in his legs for hours at a time, according to the complaint.

Paulus suit alleges that Clear Choice was negligent in refusing to pay for his back surgery and breached its contract to insure Paulus. The complaint states the company did not speak to his physicians or have a qualified, non-biased physician timely review the medical necessity of the spine surgery at any time before denying authorization for it.

The law requires health insurance companies to act with reasonable care when deciding what diagnostic services are medically necessary.

Like Paulus suit, Dale Evans claimed in 2007 that Clear Choice failed to use reasonable care when it denied his physicians request for an MRI, or magnetic resonance imaging scan. Evans alleged that Clear Choice allowed a physical therapist, rather than a doctor, to make the decision in early 2007 to deny the test.

Clear Choice approved a different test that checks the blood vessels in the chest the area where Evans experienced pain and turned down three requests from Evans for an MRI.

By spring 2007, Evans tumor had become too large to treat, damaging his nerves and spinal cord beyond repair. Evans was 78 years old when he died.

Clear One had not filed a response to Paulus complaint as of Tuesday. The case is scheduled for a pretrial conference in December.