Chapter 4.F.2 (or 2.C)--HMO Liability

Reviewing a host of potential liability theories against an HMO, but rejecting most of them, see  Pagarigan v. Aetna, Cal. Ct. App., No. B167722, 10/25/05 .  This court refused to hold an HMO vicariously liable for the alleged negligence of a contracting nursing home, but it held that the HMO has a duty to select contractors with care, a to avoid payment arrangements that are likely to result in substandard care.

Exploring the tensions between medical standards of care for suing physicians and insurer-restricted standards of "medical necessity" for paying physicians, see Note, 59 Duke L. Rev. 955 (2010). 

Arguing for health insurer enterprise liability (but oddly failing to cite any of the existing literature on this topic), see Note, 121 Harv. L. Rev. 1192-1214 (2008).

For analysis of insurer liability under consumer-driven health plans, see E. Haavi Morreim, High-Deductible Health Plans: Litigation Hazards for Health Insurers, 18 Health Matrix 1 (2008)

---

Return to home page.