The Fourth Appellate District affirmed a judgment. The court held that the survivors of a medical plan subscriber who failed to appeal to the plan the decision of the plan’s contract medical provider not to authorize necessary treatment could not sue the plan, under a theory of vicarious liability, for the provider’s denial or delay of treatment.
Elsie Martin was diagnosed with a cerebral aneurysm in August 2003. Elsie’s primary care physician referred her to a specialist who, in turn recommended a specific treatment. Elsie’s physician forward the recommendation, along with request for authorization, to the utilization review committee for Elsie’s health care provider, Bright Medical Group.
