HMO Law

HMO law refers to the laws regulating Health Maintenance Organizations (HMOs) and their plan members. An HMO is an organization that contracts with physicians, hospitals, clinics, and employers to provide healthcare to a group of individuals. With this type of insurance, the individual's employer pays for most of the premiums.

Types of HMO Law Cases

There are several types of claims that can be brought against HMOs, including:

Wrongful death: HMOs can be sued when a person dies as a result of the HMO denying coverage for necessary medical treatment.
Bad faith: HMOs can be held liable for denial of valid claims.
Medical malpractice: An HMO may be held liable for medical malpractice on the part of one of its physicians.

HMO Negligence

HMO negligence refers to any action by an HMO that results in the injury or fatality of one of its enrollees. Examples of HMO negligence include denying coverage of necessary medical procedures, denying coverage of necessary medication, and having a doctor in its network that is known to be guilty of medical malpractice.

ERISA

The Employer Retirement Income Security Act (ERISA) was passed in order to require employers to pay pensions to their retiring employees; it covers all employee benefit plans, including healthcare. Lawsuits brought under the ERISA can only be filed in federal court, and since medical malpractice is a state issue, employees who sue HMOs for malpractice will typically have their claims thrown out. Patients with individual HMO plans can sue within their respective states.