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Juan Davila Case Study

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, Juan Davila receives health benefits through an insurance plan offered by Aetna Health Inc. Aetna Health Inc refused to provide certain medications to treat his illness. This refusal led to Juan Davila having complications that required him to be hospitalized. Juan Davila sued his health maintenance organization (HMO) in Texas state court under the Texas Health Care Liability Act (THCLA) because they refused to give him the proper medication and fail to exercise ordinary care when making healthcare treatment decisions. The case was moved to the federal court and was dismissed with preconception because the court concluded that the case should be governed under the federal Employee Retirement Income Security Act of 1974 (ERISA). According
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Shea alleged Medica's fraudulent nondisclosure and misrepresentation about its doctor incentive programs limited Mr. Shea's ability to make an informed choice about his life-saving health care” (Shea v. Esensten, 1997). However, Medica removed the case to federal court, claiming that Mrs. Shea’s statement was preempted by the Employee Retirement Income Security Act (ERISA) (Shea v. Esensten, 1997). “Believing ERISA does not require an HMO to disclose its doctor compensation arrangements because they are not "material facts affecting a beneficiary's interests," the district court dismissed Mrs. Shea's amended complaint for failing to state a claim” (Shea v. Esensten, 1997). The case was long a drawn out because of the integrating of common laws brought into the

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