HMO’s have tort duties to third parties for emergency care payment

In Centinela Freeman Emergency Medical Associates v. Health Net of California, Inc., the Supreme Court today holds that, although health maintenance organizations can delegate their responsibility to pay for their members’ emergency medical treatment, they might still be on the hook financially if the delegation was or is negligently made to an entity that cannot make the payment.  The court’s unanimous opinion by Chief Justice Tani Cantil-Sakauye concludes this is an appropriate case to impose an “exceptional” common law tort duty to third parties.  Among other things, the court states, “Forcing others to provide professional services for the benefit of one’s own customers, without any reasonable prospect of payment, is morally blameworthy.”

The court affirms the Second District, Division Three, Court of Appeal.  It disapproves a 2003 decision by the Fourth District, Division One, and a 2001 opinion by the Fourth District, Division Two.