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June 21, 2004 at 08:00 PM
The U.S. Supreme Court has issued a unanimous decision that protects health plans against tort suits filed in state courts.[@@]
The ruling involves Aetna Health Inc. vs. Davila and Cigna Healthcare Inc. vs. Calad. Both cases resulted from efforts by Texas to allow members of employer-sponsored plans to sue carriers in state court over benefits determination decisions that involve questions of medical judgment.
Other states rushed to enact similar laws. Advocates of the state laws have contended that the states have a right under ERISA and the McCarran-Ferguson Act to regulate benefit plan disputes that involve the “business of insurance.”
The health plans themselves have argued that the state laws violate the Employee Retirement Income Security Act of 1974, which preempts state laws and regulations governing benefit plans. The original authors of ERISA argued that preempting state-level interference with employee benefits would help employees by increasing the uniformity and lowering the cost of benefits.
The Supreme Court has sided with the health plans.
“Allowing respondents to proceed with their state-law suits would ?pose an obstacle to the purposes and objectives of Congress,’” Justice Clarence Thomas writes in the opinion for the court, quoting from a 1987 court decision, Pilot Life Insurance Company vs. Dedeaux.
Federal courts govern benefit determinations even if the decisions involve a mix of medical judgment and eligibility considerations, Thomas writes.
