NEWS RELEASE

June 21, 2004
PR-04/32
For additional information:
Deanna Johnson Keim, APR
202-289-6700

Supreme Court Ruling on Health Care Claims Raises Important Policy Issues: American Benefits Council Responds to Critics of Today's Davila, Calad Rulings

WASHINGTON, DC — "Employers welcome the Supreme Court’s unanimous ruling today on ERISA preemption of state laws in cases involving benefits determinations," said James A. Klein, president of the American Benefits Council, in a statement in response to critics of today's Supreme Court ruling in the cases of Aetna Health Inc. v. Davila and Cigna Healthcare, Inc. v. Calad.

>Sadly and predictably trial attorneys and their allies are already calling on Congress to unravel today’s decision by the Supreme Court, but they should first ask why the two physicians in these cases did not act swiftly to help make sure their patients got the care they were seeking. In neither case did the patient or their physician seek a further review of the health plan’s initial coverage decision, despite being specifically informed of their right to such a review under federal law." Klein said.

"The refusal of the plaintiffs or their doctors to follow the procedures to either have the plan decision promptly reviewed, or to go forward with their preferred medical course of action — taking a different drug (Davila) and staying an extra night in the hospital (Calad) — even if their eligibility for financial reimbursement was in doubt — makes the plaintiffs' lawsuits far less justifiable," Klein noted.

"These review procedures are available under ERISA to help patients get the care they deserve, quickly and without having to resort to costly and lengthy legal procedures. Clearly, a speedy and factual review aided by the expertise of the physicians involved with these two cases could have avoided the need for the courts to be involved at all," Klein said.

"ERISA is intended to protection patients, not enrich plaintiffs' attorneys. If the objective is to ensure healthy and safe outcomes for patients, then certainly efficient review of claims disputes under ERISA, not inviting litigation, is the way to go," Klein added.

"When Congress considered this issue earlier, there was widespread and bipartisan agreement that a speedy, independent review process would go a long way toward helping patients get the care they deserve and we should build on that consensus," Klein said. "Today, extensive procedures are now in place under ERISA, and patients and physicians should use these review procedures to help resolve benefits disputes and not seek to rekindle the rancorous debate over subjecting employer-sponsored benefit plans to conflicting decisions made by the courts of 50 different states," Klein concluded.

To arrange an interview with Klein, please contact Deanna Johnson Keim, APR, Council director, communications, by phone at 202-289-6700 or via e-mail at djkeim@abcstaff.org.

The American Benefits Council is the national trade association for companies concerned about federal legislation and regulations affecting all aspects of the employee benefits system. The Council's members represent the entire spectrum of the private employee benefits community and either sponsor directly or administer retirement and health plans covering more than 100 million Americans.

http://www.americanbenefitscouncil.org/issues/health/mischealth.htm

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