Legal Eagle Eye Newsletter for the Nursing Profession(4)4 Jan 96
Quick Summary: An RN working for the benefit-plan administrator reviewed the patient’s benefits contract and determined it was appropriate to release him from a psychiatric facility. The facility released him, and he committed suicide nine days later.
A lawsuit was filed against the ERISA employee-benefit plan administrator.
The United States District Court for the district of Connecticut ruled that claims over improper processing and/or allocation of employee benefits are "pre-empted" by ERISA, the Employee Retirement Income Security Act.
Pre-emption means, even though this case alleged an improper exercise of medical judgment by the plan administrator’s managed care nurse, in directing this patient’s release, the case had to be dismissed by the court, because it involved questions of benefits under an ERISA benefit plan. No provision was made in ERISA for lawsuits, in state or Federal court, alleging professional malpractice or negligence in rendering employee benefit decisions.
Bailey-Gates vs. Aetna Life Insurance Company, 890 F. Supp. 78 (D. Conn., 1994).Legal Eagle Eye Newsletter for the Nursing Profession Home Page