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Supreme Court wades into ERISA's 'Serbonian bog' again.

Article Excerpt
The U.S. Supreme Court has agreed to answer a question that has bedeviled lawyers, judges, and legislators for more than a decade: Can a health insurance company that denies or delays a patient's medically recommended treatment be sued for negligence? The answer, expected to come this summer, will affect the legal rights of more than 130 million people who are covered by employee or union-sponsored managed health care plans. (Aetna Health, Inc. v. Davila, No. 02-1845 (U.S. Nov. 3, 2003).)

At the center of the debate is the Employee Retirement Income Security. Act (ERISA), which Congress passed 30 years ago to protect workers' interests in employee benefit plans. Because the law includes specific federal remedies for violation of its provisions, it has preemptive effect over state-based causes of action against HMOs--but how much preemptive effect is unclear.

Health insurers argue that preemption is total, citing evidence of congressional in ten t in passing ERISA and early U.S. Supreme Court decisions interpreting the law. But plaintiffs say that because the law was enacted long before the managed-care industry dominated health insurance, Congress could not have meant it to govern all claims against HMOs. And, plaintiffs say, more recent rulings prove that the Supreme Court agrees and has backed away from its earlier total-preemption stance.

The Court has been asked to look at the issue again in a pair of cases that were consolidated for appeal before the Fifth Circuit in 2002. That court held that ERISA did not bar the plaintiffs in each case from suing their HMOs--Aetna Health, Inc., and CIGNA Healthcare for medical negligence in Texas courts. (Roark v. Humana, Inc., 307 F.3d 29...

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