Download this Paper Open PDF in Browser

Supreme Court Rules that ERISA Preempts State Law Claims Challenging Utilization Review by HMO

New York State Bar Association Health Law Journal, Vol. 9, No. 3, p. 70, Summer/Fall 2004

5 Pages Posted: 6 Jan 2010  

Beverly Cohen

Albany Law School

Date Written: 2004

Abstract

This article reports on Aetna Health Inc. v. Davila, the 2004 United States Supreme Court ruling that members of ERISA health plans cannot sue their plan administrators for consequential damages for injuries the members suffered allegedly due to the administrators’ coverage decisions. The Aetna ruling confirmed the historical view that ERISA plan participants and beneficiaries are limited to the civil remedies set forth in section 502(a) of ERISA. The Aetna decision squelched several theories advanced by lower courts that had found that such claims for consequential or punitive damages did not fall within ERISA section 502(a), and therefore were not preempted by ERISA. While the Aetna ruling limits potential liability of ERISA plans and thereby helps to conserve their assets, it also leaves members who allegedly suffer physical injury from negligent utilization review largely without a remedy.

Suggested Citation

Cohen, Beverly, Supreme Court Rules that ERISA Preempts State Law Claims Challenging Utilization Review by HMO (2004). New York State Bar Association Health Law Journal, Vol. 9, No. 3, p. 70, Summer/Fall 2004. Available at SSRN: https://ssrn.com/abstract=1531834

Beverly Cohen (Contact Author)

Albany Law School ( email )

80 New Scotland Avenue
Albany, NY 12208
United States

Paper statistics

Downloads
40
Abstract Views
894