Aetna Health, Inc. v. Davila: Implications for Public Health Policy

Document Type

Journal Article

Publication Date



Public Health Reports


Volume 119, Issue 5

Inclusive Pages



Employee Retirement Income Security Act--legislation & jurisprudence; Health Maintenance Organizations--legislation & jurisprudence; Insurance Coverage--legislation & jurisprudence; Liability--legal; Malpractice--legislation & jurisprudence; Insurance; ERISA; Quality Improvement


This installment of Law and the Public’s Health discusses the United States Supreme Court’s June 2004 opinion in Aetna Health, Inc. v. Davila1 and considers the decision’s implications for public health policy and practice. This long-awaited case clarifies that the Employment Retirement Income Security Act (ERISA) completely shields health insurers from liability under state law for injuries incurred by patients as a result of medically negligent coverage decisions. At the same time, Davila clarifies that when acting in a health care capacity, health insurers and health maintenance organizations (HMOs) remain liable for the consequences of negligent medical conduct. But because the central business of health insurers is coverage decision-making as opposed to medical care provision, Davila has far-reaching implications for access to remedies by patients who are harmed by substandard coverage determination practices.


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Open Access