Opinion ID: 779893
Heading Depth: 2
Heading Rank: 1

Heading: ERISA Preemption and Medical Malpractice

Text: 10 ERISA contains a broadly worded preemption clause. 4 Section 1144 states that ERISA preempts any and all State laws insofar as they may now or hereafter relate to any employee benefit plan governed by ERISA. 5 Application of this broad text has evolved from a plain language interpretation, in which ERISA would have preempted nearly everything, 6 to a more pragmatic interpretation, in which courts seek to preserve the goals of Congress when it passed ERISA, while maintaining state control in traditional fields of state regulation. 7 11 Medical malpractice is one traditional field of state regulation that several circuits have concluded Congress did not intend to preempt. We join the Third, Fifth, and Tenth Circuits 8 in holding that ERISA's preemption clause, 29 U.S.C. § 1144, does not preempt actions involving allegations of negligence in the provision of medical care, even if the patient procures the care through an ERISA plan. Our decision follows a related decision, Roach v. Mail Handlers Benefit Plan, 9 in which we held that the federal analogue to ERISA, the Federal Employees Health Benefits Act of 1958, 10 does not preempt medical malpractice claims. 12 In accord with our sister circuits and our decision in Roach, we look to the behavior underlying the allegations in the complaint to determine whether ERISA preempts a plaintiff's claims. 11 If a claim alleges a denial of benefits, ERISA preempts it. A denial of benefits involves an administrative decision regarding coverage. Under any of the tests for determining ERISA preemption applied by this court, it is clear that ERISA preempts suits predicated on administrative decisions. 12 Subjecting such decisions to an individual state's laws would subvert the intent of Congress to allow for the uniform administration of ERISA benefits in three ways: by requiring administrators to follow many state laws instead of one federal law; by interfering with the relationship between ERISA administrators and beneficiaries; and by providing an alternative enforcement mechanism for beneficiaries to obtain benefits. 13 Thus, ERISA precludes state law claims predicated on the denial of benefits. 13 If a claim alleges medical malpractice, however, we conclude for several reasons that ERISA does not preempt it and that state law governs. First, under any of the tests applied by this court, it is clear that state medical malpractice standards should not be preempted. They do not mandate employee benefit structures or their administration, do not preclude uniform administrative practices, and do not provide alternative enforcement mechanisms for employees to obtain ERISA benefits. 14 In addition, they are state standards of general application that do not depend upon ERISA. 15 Finally, they will not affect the relationships between principal ERISA participants when acting in their roles as principal ERISA participants. 16 In short, they do not impinge upon Congress's stated goal for ERISA: to ensure uniform administrative enforcement. 17 And medical malpractice standards further another goal of Congress in passing ERISA: to protect beneficiaries. 18 14 Second, if ERISA did preempt medical malpractice claims, the results would be absurd. Physicians would be subject to state standards when treating non-ERISA patients, and to another, as-yet-undefined (and possibly undefinable) 19 standard when treating ERISA patients. Although advantages accrue when ERISA administrators, who often administer plans in many different states, are subject to uniform, nationwide standards; no similar advantages exist when physicians and other care providers are subject to federal standards as well as to state standards, depending on the patient's source of payment. Absent some evidence of clear congressional intent to preempt the long-standing system for determining standards of care through state medical malpractice claims and to replace it with a new, federal system, we decline to conclude that ERISA preempts state medical malpractice standards. 20 15 Accordingly, we conclude that state law standards for medical malpractice apply equally to service providers treating ERISA and non-ERISA beneficiaries. If a claim involves a medical decision made in the course of treatment, ERISA does not preempt it; but if a claim involves an administrative decision made in the course of administering an ERISA plan, ERISA preempts it. We now apply this framework to the particular claims at issue in this case.