ERISA

In Aetna Health Inc., v. Davila, the United States Supreme Court entertained the question of whether the Employee Retirement Income Security Act (ERISA) precludes State lawsuits against Managed Care Organizations administered as ERISA plans. The court held that ERISA preempts damage actions because ERISA itself provides the exclusive remedy for challenging coverage decisions. Aetna Health Inc. v. Davila, 542 U.S. 200 (2004).

Although the Davila case has served as a powerful shield to protect HMOs from liability, our experience reveals that lawsuits initiated under ERISA can still successfully hold HMOs responsible for failure to authorize treatment and/or inadequate reimbursement for services. ERISA litigation in District Courts requires an exhaustive understanding of the intricacies of the 1974 Acts. It should be noted that Federal Court judges have been willing to allow patients the opportunity to bring claims and recover damages under various theories against HMOs.

The attorneys at Abril Law will offer a free consultation to evaluate your case(s) to assess the viability of prosecution where ERISA is applicable.