2004
DOI: 10.1097/01.smj.0000100268.44289.c0
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Utilization Review and Managed Health Care Liability

Abstract: This article explores the development of jurisprudence interpreting application of the Employee Retirement Income Security Act of 1974 to patient care denials by managed care. It identifies quality-of-care protections for patient care under present federal law. If an insurance company utilization review denies care based on patient-specific reasoning, then the patient may have recourse against the utilization review on the basis of a state law claim of malpractice grounded in medical decision-making by the ins… Show more

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