New Jersey PBOR Becomes Law

The Health Care Carrier Accountability Act allows patients who believe that a health maintenance organization (HMO) decision has placed their lives or health in immediate danger to file suit in state court against the HMO. However, most people will still be required to make their case to a state-appointed medical panel before going to court.

The law provides an immediate right to sue in cases where the HMO’s decision risks:

• death
• the loss of an organ or limb
• serious or permanent impairment
• worsening of a serious or life-threatening disease.

The New Jersey law does not limit damage awards, nor does it bar class actions. It does, however, shield employers and unions from lawsuits based on medical decisions made by health insurance companies.

However, nearly half of those with insurance in the state (2.7 million people) are covered by health plans regulated by the Employee Retirement Income Security Act (ERISA).

Although right-to-sue laws have been enacted in eight other states, they are all relatively new. Texas, the first to pass such a law in 1997, has seen just 20 lawsuits to date. The first was concluded recently ? in favor of the HMO (see HMO Books Victory in Texas Court ).