Cigna Healthcare of Texas, Inc., Dba Cigna Corporation v. Ruby R. Calad et al.

Questions presented

SCOTUS records

Whether the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001 et seq. ("ERISA"), as construed by this Court in Pilot Life Insurance Co. v. Dedeaux, 481 U.S. 41 (1987), and its progeny, completely preempts state-law claims by ERISA plan participants or beneficiaries who assert that a managed care company tortiously "failed to cover" (i.e., pay for) medical care. 03-83 CIGNA HEALTHCARE OF TEXAS v. CALAD Ruling below: CA 5, 307 F.3d 298. QUESTION PRESENTED: Whether § 502(a) of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29U.S.C. § 1132(a), completely preempts a state-law tort claim seeking damages for an allegedly erroneous determination of entitlement to a benefit under an ERISA-governed health benefit plan when the determination is based in part on the exercise of medical judgment. CERT. GRANTED: 11/3/03 Consolidated for one hour oral argument.

Opinion summary

Etalia.ai summary of the majority opinion

The case involved a dispute over the Employee Retirement Income Security Act (ERISA) and whether patients could sue their Health Maintenance Organizations (HMOs) for decisions that affected their medical care. Ruby R. Calad, among others, challenged CIGNA Healthcare's decision-making process regarding her treatment under ERISA guidelines. The plaintiffs argued that they suffered harm due to the HMO’s refusal to authorize certain treatments or hospital stays recommended by their doctors, claiming this violated state laws allowing such lawsuits against HMOs for malpractice-like claims. The Supreme Court had to determine if these state law claims were preempted by federal ERISA regulations which typically limit remedies available in disputes involving employee benefit plans.