MUTED
Aetna Health Inc. v. Davila
542 U.S. 200 (2004) · 2004
Two patients were injured by a denial. The Court agreed they had a right — and no court that could hear about it.
“Any state-law cause of action that duplicates, supplements, or supplants the ERISA civil enforcement remedy conflicts with the clear congressional intent to make the ERISA remedy exclusive and is therefore pre-empted.”
The Ruling
9–0: State-law claims against a health plan for negligently denying coverage are completely pre-empted by ERISA. The patient's remedy is limited to the value of the benefit that was wrongly denied — not the injury that followed from the denial.
The Personhood Argument Not Made
This is the purest execution-gap case in American law. Nobody disputed that Davila and Calad were owed the care. What vanished was standing: ERISA converts the injured patient from a person with a grievance into a claimant for the price of a withheld item. The body that was harmed is not a party to the transaction the statute recognises. A person appears in this system only in the form of a benefit ledger entry, and a ledger entry cannot be maimed.
The Execution Gap Created
The right to the treatment is real and formally intact. The remedy for being denied it is the cost of the treatment. The consequences — the injury, the lost months, the harm to the body — are legally invisible, because the only person the statute can see is a plan participant, not a patient.
Primary sources & research
Related cases
Part of The Personhood Prism, the companion to The Execution Gap by Thomas William Hornig. See all personhood cases →