Sign In
Events
Newsletters
Search

Close

Close Search

Cancel

SEARCH
MY LAW.COMNEW

Pegram et al. v. Herdrich

Treatment decisions made by a health maintenance organization, acting through its physician employees, are not fiduciary acts within the meaning of the Employee Retirement Income Security Act and HMOs, therefore, cannot be sued by patients under ERISA.

X

Thank you for sharing!

Your article was successfully shared with the contacts you provided.

Petitioners (collectively Carle) function as a health maintenance organization (HMO) owned by physicians providing prepaid medical services to participantswhose employers contract with Carle for coverage. Respondent Herdrich was covered by Carle through her husband’s employer, State Farm InsuranceCompany. After petitioner Pegram, a Carle physician, required Herdrich to wait eight days for an ultrasound of her inflamed abdomen, her appendix ruptured,causing peritonitis. She sued Carle in state court for, inter alia, fraud. Carle responded that the Employee Retirement Income Security Act of 1974 (ERISA)preempted the fraud counts and removed the case to federal court. The District Court granted Carle summary judgment on one fraud count, but grantedHerdrich leave to amend the other. Her amended count alleged that the provision of medical services under terms rewarding physician owners for limitingmedical care entailed an inherent or anticipatory breach of an ERISA fiduciary duty, since the terms created an incentive to make decisions in the physicians’self-interest, rather than the plan participants’ exclusive interests. The District Court granted Carle’s motion to dismiss on the ground that Carle was not actingas an ERISA fiduciary. The Seventh Circuit reversed the dismissal.

Held: Because mixed treatment and eligibility decisions by HMO physicians are not fiduciary decisions under ERISA, Herdrich does not state an ERISA claim.Pp. 5-25.

Trending Stories

 
Reprints & Licensing
Mentioned in a Law.com story?

License our industry-leading legal content to extend your thought leadership and build your brand.

LEARN MORE

More From ALM

Premium Subscription
With this subscription you will receive unlimited access to high quality, online, on-demand premium content from well-respected faculty in the legal industry. This is perfect for attorneys licensed in multiple jurisdictions or for attorneys that have fulfilled their CLE requirement but need to access resourceful information for their practice areas.
View Now
Team Accounts
Our Team Account subscription service is for legal teams of four or more attorneys. Each attorney is granted unlimited access to high quality, on-demand premium content from well-respected faculty in the legal industry along with administrative access to easily manage CLE for the entire team.
View Now
Bundle Subscriptions
Gain access to some of the most knowledgeable and experienced attorneys with our 2 bundle options! Our Compliance bundles are curated by CLE Counselors and include current legal topics and challenges within the industry. Our second option allows you to build your bundle and strategically select the content that pertains to your needs. Both options are priced the same.
View Now
Go to CLE Center
New York Legal Awards 2024
September 05, 2024
New York, NY

The New York Law Journal honors attorneys and judges who have made a remarkable difference in the legal profession in New York.


Learn More
African Legal Awards 2024
September 06, 2024
Johannesburg

The African Legal Awards recognise exceptional achievement within Africa s legal community during a period of rapid change.


Learn More
Consulting Best Firms to Work For 2024
September 12, 2024
New York, NY

Consulting Magazine identifies the best firms to work for in the consulting profession.


Learn More
Go to Events Go to Webcasts
(NEW) COMMERCIAL LITIGATION ASSOCIATE WANTED FOR ELITE LITIGATION BOUTIQUE FIRM (Atlanta, GA OR Miami, FL)

Our client, a boutique litigation firm established by former BigLaw partners, is seeking to hire a commercial litigation associate to join e...


Apply Now ›
Real Estate Attorney

COLE SCHOTZ P.C.Prominent mid Atlantic law firm with multiple regional office locations seeks a senior attorney with commercial real estate ...


Apply Now ›
Attorney

ATTORNEYS WANTED ROCKLAND/BERGEN COUNTYKantrowitz, Goldhamer & Graifman, P.C. Expanding and established multi-practice, mul...


Apply Now ›
Go to Lawjobs
Lawyers of Distinction
06/27/2024
The American Lawyer

Professional Announcement


View Announcement ›
SMGQ Law
06/21/2024
Daily Business Review

Full Page Announcement


View Announcement ›
Blume Forte Fried Zerres & Molinari
06/14/2024
New Jersey Law Journal

Professional Announcement


View Announcement ›
Go to Professional Announcements