Justia ERISA Opinion SummariesArticles Posted in Health Care Law
Tex. W. Oaks Hosp., LP v. Williams
At issue in this interlocutory appeal was whether the claims of an employee against his employer, both of whom were health care providers, alleging injuries arising out of inadequate training, supervision, risk-mitigation, and safety in a mental health facility, constituted health care liability claims (HCLCs) under the Texas Medical Liability Act (Act). Employer filed a motion to dismiss on the grounds that Employee's claims constituted HCLCs under the Act and that Employee had not served an expert report on Employer as required under the Act. The trial court denied Employer's motion. The trial court affirmed. The Supreme Court reversed, holding (1) Employee here was properly characterized as a "claimant" under the Act and his allegations against his nonsubscribing Employer were health care and safety claims under the Act's definition of HCLCs, requiring an expert report to maintain his lawsuit; and (2) the Act does not conflict with the Texas Workers' Compensation Act. Remanded.View "Tex. W. Oaks Hosp., LP v. Williams " on Justia Law
Munda v. Summerlin Life & Health Ins. Co.
Respondent, an insurer/managed care organization, contracted with an endoscopy center and gastroenterology center (collectively, the Clinic) to provide health care services to its insureds. After the Nevada Health District found that the Clinic engaged in a number of unsafe medical practices, Respondent terminated its contract with the Clinic. Janice Munda was insured by Respondent through her employer's health plan, which was governed by ERISA. Munda was diagnosed with hepatitis C, which the Health District determined she contracted as a result of being treated at the Clinic. Janise and her husband (collectively, Appellants) sued Respondent for negligence, negligence per se, breach of implied covenant of good faith and fair dealing, and loss of consortium. The district court granted Respondent's motion to dismiss, finding that Appellants' claims were preempted by ERISA. The Supreme Court reversed, holding that under the facts, there was no preemption because Respondent's alleged actions were independent of the administration of the ERISA plan. View "Munda v. Summerlin Life & Health Ins. Co." on Justia Law
Cervantes v. Health Plan of Nevada
Appellant Margerita Cervantes allegedly contracted hepatitis C as a result of treatment she received at the Endoscopy Center of Southern Nevada (ECSN). Appellant obtained treatment at ECSN as part of the health care benefits she received through her culinary union. The union operated a self-funded ERISA health care plan and retained Respondents, Health Plan of Nevada and other health and life insurance entities, as its agents to assist in establishing a network of the plan's chosen medical provider. Appellant filed a lawsuit alleging that Respondents were responsible for her injuries because they failed to ensure the quality of care provided by ECSN and referred her to a blatantly unsafe medical provider. The district court concluded that Cervantes' claims were preempted by ERISA section 514(a). The Supreme Court affirmed, holding that state law claims of negligence and negligence per se against a managed care organization contracted by an ERISA plan to facilitate the development of the ERISA plan's network of health care providers were precluded by ERISA section 514. View "Cervantes v. Health Plan of Nevada" on Justia Law