In December 1990, Rhonda Bast was diagnosed with cancer. At least she was not among the uninsured: she had health insurance, provided by her employer. When her doctor requested approval for a procedure which might save her life, Prudential Insurance Company said no. After Ms. Bast got lawyered up, Prudential changed its mind a few weeks later, but by then it was too late – Rhonda Bast died in January 1993.
So her family sued Prudential, claiming that if Prudential had not improperly delayed its approval for her therapy she would still be alive. The Northwest Women’s Law Center submitted a brief in the case, explaining “if insurance companies are not forced to disgorge the unjust enrichment that they gain by such bad faith denials, they will have no incentive to honor legitimate requests from their beneficiaries,” and that instead, insurance companies would “deny expensive treatments hoping that the beneficiary would not sue, or if she or her estate did, they would be left without a remedy.”
Thanks to ERISA, the Basts were indeed left without a remedy: the Ninth Circuit Court of Appeals said “Although moved by the tragic circumstances of this case and the seemingly needless loss of life that resulted, we conclude the law gives us no choice”; the “Basts’ state law claims are preempted by ERISA, and ERISA provides no remedy. Unfortunately, without action by Congress, there is nothing we can do to help the Basts and others who may find themselves in this same unfortunate situation.”
That was in 1998. We are still waiting for action by Congress.
The case is Bast v. Prudential Insurance Company of America, and the citation is 150 F.3d 1003 (9th Cir. 1998). You can look it up.