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Volumn 23, Issue SUPPL. 2, 2004, Pages

The Supreme Court limits lawsuits against managed care organizations

Author keywords

[No Author keywords available]

Indexed keywords

COURT; GOVERNMENT; HEALTH CARE PLANNING; LAW; LAW SUIT; MANAGED CARE ORGANIZATION; MEDICAL DECISION MAKING; MEDICAL LIABILITY; PHYSICIAN; REVIEW;

EID: 17144412545     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.W4.417     Document Type: Review
Times cited : (6)

References (32)
  • 1
    • 17144416600 scopus 로고    scopus 로고
    • Roark v. Humana, Inc., 307 F.3d 298 (5th Cir. 2002)
    • Roark v. Humana, Inc., 307 F.3d 298 (5th Cir. 2002).
  • 2
    • 17144374609 scopus 로고    scopus 로고
    • Aetna Health Inc. v. Davila, 124 S.Ct. 2488 (2004)
    • Aetna Health Inc. v. Davila, 124 S.Ct. 2488 (2004).
  • 3
    • 0344624959 scopus 로고
    • Semi-Preemption in ERISA: Legislative Process and Health Policy
    • D.C. Schaffer and D.M. Fox, "Semi-Preemption in ERISA: Legislative Process and Health Policy," American Journal of Tax Policy 7, no. 1 (1988): 47-69; and L.E. Irish and H.J. Cohen, "ERISA Preemption: Judicial Flexibility and Statutory Rigidity," University of Michigan Journal of Law Reform 19, no. 1 (1985): 112-163.
    • (1988) American Journal of Tax Policy , vol.7 , Issue.1 , pp. 47-69
    • Schaffer, D.C.1    Fox, D.M.2
  • 4
    • 17144411250 scopus 로고
    • ERISA Preemption: Judicial Flexibility and Statutory Rigidity
    • D.C. Schaffer and D.M. Fox, "Semi-Preemption in ERISA: Legislative Process and Health Policy," American Journal of Tax Policy 7, no. 1 (1988): 47-69; and L.E. Irish and H.J. Cohen, "ERISA Preemption: Judicial Flexibility and Statutory Rigidity," University of Michigan Journal of Law Reform 19, no. 1 (1985): 112-163.
    • (1985) University of Michigan Journal of Law Reform , vol.19 , Issue.1 , pp. 112-163
    • Irish, L.E.1    Cohen, H.J.2
  • 5
    • 17144367785 scopus 로고    scopus 로고
    • Alessi v. Raybestos-Manhattan, Inc., 451 U.S. 504, 523 (1980)
    • Alessi v. Raybestos-Manhattan, Inc., 451 U.S. 504, 523 (1980).
  • 6
    • 17144371080 scopus 로고    scopus 로고
    • Shaw v. Delta Airlines, 463 U.S. 85, 96-97 (1983)
    • Shaw v. Delta Airlines, 463 U.S. 85, 96-97 (1983).
  • 7
    • 17144371601 scopus 로고    scopus 로고
    • Ibid., at 105
    • Ibid., at 105.
  • 8
    • 17144381779 scopus 로고    scopus 로고
    • Metropolitan Life Insurance Company v. Massachusetts, 471 U.S. 724, 740-744 (1985)
    • Metropolitan Life Insurance Company v. Massachusetts, 471 U.S. 724, 740-744 (1985).
  • 9
    • 17144392291 scopus 로고    scopus 로고
    • 473 U.S. 134 (1985)
    • 473 U.S. 134 (1985).
  • 10
    • 17144361893 scopus 로고    scopus 로고
    • Massachusetts Mutual Life Insurance Co. v. Russell, 473 U.S. 134, 146 (1985)
    • Massachusetts Mutual Life Insurance Co. v. Russell, 473 U.S. 134, 146 (1985).
  • 11
    • 17144384871 scopus 로고    scopus 로고
    • 481 U.S. 41 (1985)
    • 481 U.S. 41 (1985).
  • 12
    • 17144382582 scopus 로고    scopus 로고
    • Ibid., at 52
    • Ibid., at 52.
  • 13
    • 17144425474 scopus 로고    scopus 로고
    • Ibid., at 56
    • Ibid., at 56.
  • 14
    • 17144376160 scopus 로고    scopus 로고
    • Ibid., at 57
    • Ibid., at 57.
  • 15
    • 17144411251 scopus 로고    scopus 로고
    • 481 U.S. 58, 63-67 (1987)
    • 481 U.S. 58, 63-67 (1987).
  • 16
    • 17144409730 scopus 로고    scopus 로고
    • See Wickline v. State of California, 239 Cal. Rptr. 810 (Cal. App. 1982); and Hughes v. Blue Cross of Northern California, 263 Ca. Rptr. 85 (1989)
    • See Wickline v. State of California, 239 Cal. Rptr. 810 (Cal. App. 1982); and Hughes v. Blue Cross of Northern California, 263 Ca. Rptr. 85 (1989).
  • 17
    • 17144411603 scopus 로고    scopus 로고
    • See Corcoran v. United Healthcare, Inc., 965 F.3d 1321 (5th Cir. 1992)
    • See Corcoran v. United Healthcare, Inc., 965 F.3d 1321 (5th Cir. 1992).
  • 18
    • 17144418220 scopus 로고    scopus 로고
    • Andrews-Clarke v. Travelers Insurance Company, 984 F.Supp. 49 (D. Mass. 1997)
    • This rage is perhaps clearest in the eloquent decision of Judge William Young in Andrews-Clarke v. Travelers Insurance Company, 984 F.Supp. 49 (D. Mass. 1997).
  • 19
    • 17144432397 scopus 로고    scopus 로고
    • 514 U.S. 645 (1995)
    • 514 U.S. 645 (1995).
  • 20
    • 17144409521 scopus 로고    scopus 로고
    • Pegram v. Herdrich, 530 U.S. 211, 235-237 (2000)
    • Pegram v. Herdrich, 530 U.S. 211, 235-237 (2000).
  • 21
    • 17144414243 scopus 로고    scopus 로고
    • Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355, 378 (2002)
    • Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355, 378 (2002).
  • 22
    • 17144408091 scopus 로고    scopus 로고
    • Estate of Frappier v. Wishnov, 678 S0.2d 884 (Ct. App. 1996)
    • Estate of Frappier v. Wishnov, 678 S0.2d 884 (Ct. App. 1996).
  • 23
    • 17144375800 scopus 로고    scopus 로고
    • 57 F.3d 350 (3d Cir. 1995)
    • 57 F.3d 350 (3d Cir. 1995).
  • 24
    • 17144381047 scopus 로고    scopus 로고
    • Cicio v. Does 1-8, 321 F.3d 83 (2003); and Pappas v. Asbel, 564 Pa. 407, 786 A.2d 1089 (Pa. Sup. Ct. 2001)
    • Cicio v. Does 1-8, 321 F.3d 83 (2003); and Pappas v. Asbel, 564 Pa. 407, 786 A.2d 1089 (Pa. Sup. Ct. 2001).
  • 25
    • 17144393047 scopus 로고    scopus 로고
    • Pryzbowski v. U.S. Healthcare, 245 F.3d 266 (3d Cir. 2001) (sec. 502); Haynes v. Prudential Health Care, 313 F.3d 330 (5th Cir. 2002) (sec. 514); Marks v. Watters, 322 F.3d 316 (4th Cir. 2003) (sec. 502); DeFelice v. Aetna U.S. Healthcare, 346 F.3d 442 (3d Cir. 2003) (sec. 502); Thompson v. Gencare Health Systems, Inc., 202 F.3d 1072 (8th Cir. 2000) (sec. 502); and Howard v. Coventry Health Care of Iowa, 293 F.3d 442 (8th Cir. 2002) (sec. 514)
    • Pryzbowski v. U.S. Healthcare, 245 F.3d 266 (3d Cir. 2001) (sec. 502); Haynes v. Prudential Health Care, 313 F.3d 330 (5th Cir. 2002) (sec. 514); Marks v. Watters, 322 F.3d 316 (4th Cir. 2003) (sec. 502); DeFelice v. Aetna U.S. Healthcare, 346 F.3d 442 (3d Cir. 2003) (sec. 502); Thompson v. Gencare Health Systems, Inc., 202 F.3d 1072 (8th Cir. 2000) (sec. 502); and Howard v. Coventry Health Care of Iowa, 293 F.3d 442 (8th Cir. 2002) (sec. 514).
  • 26
    • 0242595945 scopus 로고    scopus 로고
    • What ERISA Means by 'Equitable': The Supreme Court's Trail of Error in Russell, Mertens, and Great-West
    • See Cicio v. Does, 321 F.3d 83, 105 (2d Cir. 2002) (Calabrezi, J., dissenting in part); and Defelice v. Aetna U.S. Healthcare, 346 F.3d. 442, 453 (3d Cir. 2003) (Becker, J., concurring)
    • See Cicio v. Does, 321 F.3d 83, 105 (2d Cir. 2002) (Calabrezi, J., dissenting in part); and Defelice v. Aetna U.S. Healthcare, 346 F.3d. 442, 453 (3d Cir. 2003) (Becker, J., concurring). Both cases cited J. Langbein, "What ERISA Means by 'Equitable': The Supreme Court's Trail of Error in Russell, Mertens, and Great-West," Columbia Law Review 103, no. 6 (2003): 1317-1366.
    • (2003) Columbia Law Review , vol.103 , Issue.6 , pp. 1317-1366
    • Langbein, J.1
  • 27
    • 17144387613 scopus 로고    scopus 로고
    • note
    • Davila also suggests that employers do not have to worry about being held liable for coverage decisions made by employee benefit plan administrators, as they are further removed from treatment decisions.
  • 28
    • 17144429824 scopus 로고    scopus 로고
    • 124 S.Ct. at 2503, quoting Defelice v. Aetna U.S. Healthcare
    • 124 S.Ct. at 2503, quoting Defelice v. Aetna U.S. Healthcare.
  • 29
    • 17144417824 scopus 로고    scopus 로고
    • note
    • It is possible that Davila would not bar a state statute subjecting all managed care plans to liability for the negligent treatment decisions of their contracting physicians. Such a law would clearly be preempted by section 514, however, and would probably not be a law regulating insurance saved from preemption. It is also possible that state litigation could be brought after Davila claiming that an ERISA plan was negligently designed insofar as it created improper incentives for physicians. These claims have rarely been successful, and the Court in Pegram seemed skeptical about plan-design claims against ERISA plans. Also, Davila itself involved a negligent formulary design claim, although the Court did not characterize it as such. Finally, lawsuits against plans for negligent selection of providers might still be possible after Davila, although, again, these claims could be characterized as challenging coverage determinations.
  • 30
    • 17144420956 scopus 로고    scopus 로고
    • 29 U.S.C. 1104(a)(1)
    • 29 U.S.C. 1104(a)(1).
  • 31
    • 1842780071 scopus 로고    scopus 로고
    • A Quiet Revolution: Law as an Agent of Health System Change
    • M.G. Bloche and D. Studdert, "A Quiet Revolution: Law as an Agent of Health System Change," Health Affairs 23, no. 2 (2004): 29-42.
    • (2004) Health Affairs , vol.23 , Issue.2 , pp. 29-42
    • Bloche, M.G.1    Studdert, D.2


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.