The Supreme Court's Limitation of Managed-Care Liability
New England Journal of Medicine, September 2004
6 Pages Posted: 22 Nov 2004 Last revised: 14 Jul 2009
This article summarizes and critiques the U.S. Supreme Court's decision in Aetna Health Inc. v. Davila, which limited managed care organizations' liability for negligent decisions about the care of patients in private employer-sponsored health plans governed by ERISA. It contrasts the Court's dichotomous view of health benefit plans, in which insurers administer contracts and treating physicians make medical judgments, with the more complicated relationships that affect decisions about both coverage and treatment.
Keywords: Managed care, ERISA, health insurance, patient rights
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