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Insurer sues to block HMO malpractice law

August 1, 1997

Insurer sues to block HMO malpractice law

One of the nation’s largest insurers is fighting a new Texas law that allows consumers to sue health maintenance organizations (HMOs) for medical malpractice related to coverage denials or delays. Texans recently became the first in the country to have the right to sue their HMOs for malpractice. The law allows Texas residents to sue for delays or denied treatment and appeal HMO decisions to independent review groups.

Managed care companies opposed the measure, and several vowed to fight it in court if it passed. Aetna is the first to step forward, filing suit in U.S. District Court in Houston to overturn the part of the law that allows malpractice suits against HMOs; it is not challenging the provision that creates a system to mediate conflicts. Aetna claims that the Texas law is preempted by the federal Employee Retirement Income Security Act.