RESUMO
In its June 2008 decision in MetLife v. Glenn, the Supreme Court held that federal courts reviewing claim denials by Employee Retirement Income Security Act (ERISA) employee benefit plan administrators should take into account the fact that plan administrators (insurers or self-insured plans) face a conflict of interest because they pay claims out of their own pockets and arguably stand to profit by denying claims. This paper analyzes the history of the conflict in the courts over this issue; the Supreme Court's resolution of it in MetLife; and the implications of this decision for plans, beneficiaries, and health policy.
Assuntos
Conflito de Interesses/legislação & jurisprudência , Employee Retirement Income Security Act/legislação & jurisprudência , Seguradoras/legislação & jurisprudência , Reembolso de Seguro de Saúde/legislação & jurisprudência , Decisões da Suprema Corte , Pessoal Administrativo/ética , Pessoal Administrativo/legislação & jurisprudência , Employee Retirement Income Security Act/organização & administração , Governo Federal , Humanos , Revisão da Utilização de Seguros , Estados UnidosRESUMO
David Trueman's article reviews the history of ERISA preemption by analyzing seminal Supreme Court cases and predicts the future of ERISA preemption in his analysis of recent federal case law. Traditionally, the ability to hold a managed care entity responsible for its actions has been hampered by a strict interpretation of the preemption clauses of ERISA but as the Supreme Court's jurisprudence has evolved and loosened, several federal courts have allowed suits against managed care companies to go forward. Conflict among the federal circuits has arisen and the Supreme Court has granted certiorari to two cases from Texas in order to clarify ERISA preemption. Mr. Trueman discusses the future of ERISA preemption in light of these decisions.
