As Pilot Life challenged a disability insurance claim denial, the equitable remedies that are provided by ERISA might still have been available to Mr. Dedeaux despite this ruling, as ERISA provides several equitable Injunctive remedies to challenge denials of benefit claims, such mandating that the wrongfully denied benefit be provided.The biggest distinguishing factor from Pilot Life in the case of "CIGNA v. Calad" was the fact that it was too late for ERISA's powerful injunctive remedies to benefit the Respondents, who had already suffered damages for which equitable relief could not compensate them for their loss or suffering.Essentially, this Supreme Court decision placed the Respondents' Complaints, in the status known as "Failure to state a claim upon which relief could be granted" and had to be Dismissed on their faces. The facts of the case were never elucidated either by Discovery or Trial, but the cases were Dismissed by Motion, as a matter of law, whereby even examining the facts in the most favorable light in favor of the Respondents, the relief they were seeking could not be granted.

As an example, if the Utilization review nurse had negligently applied the discharge protocol for Hemorrhoidectomy rather than Total Abdominal Hysterectomy, and if Calad had died from Complications resulting from the treatment decision to treat her on an outpatient basis with discharge instructions after only 1 day of hospitilization, the case would still have had to be dismissed; the law does not recognize monetary Damages for negligent actions in Managed Care "administration" of Employer Medical Benefit Plans but does acknowledge that state malpractice laws do apply to treating physicians deciding or administrating the course of a patient's care (see Pegram v. Herdrich).Cigna and Aetna both pointed out in oral arguments what has been referred to in ERISA's judicial history as the "Panoply" of remedies that Calad and Davila might have evoked under ERISA to prevent the damage suffered, to include appeals of the adverse decisions, judicial Injunction to compel Utilization Review to approve treatment, and a new Texas law that allowed for independent arbitration over Managed Care Utilization Review decisions based on Medical necessity.

Under the concepts of Torts under Anglo-American common law (which do not inform the current interpretations of ERISA), these points might best be described as a defense of contributory negligence.Perhaps future decisional law modeled after the Supreme Court's 1966 Ruling in Miranda v. Arizona might inform future laws to ensure that patients not simply "have" legal rights under ERISA to challenge Managed Care Utilization review decisions, but to put the burden on the Managed Care entities to make sure patients are aware of them and have the opportunity to invoke them before life, safety, or health-threatening medical treatment choices governed by Utilization review can cause irreparable damage or death for which ERISA provides no Remedy. Such law might be guided by the wording of the statute, that a patient must be "afforded" the opportunity for full and fair review of benefit claim denial or adverse Utilization review decisions.

Aetna Health
Aetna Health Inc. v. Davila was a 2004 United States Supreme Court case that limited the scope of the Texas Healthcare Liability Act.The effective result of this decision was that the "Texas Healthcare Liability Act" (THCLA) that held Utilization review decisions by Managed Care entities to a legal duty of care according to the laws of Medical practice in Texas, could not be enforced in the case of Health Benefit plans provided through private employers, because the Texas statute allowed compensatory or punitive Damages to redress losses or deter future transgressions, which were not available under ERISA $1132. The ruling still allows Texas to enforce the THCLA in the case of government-sponsored, church-sponsored, or individual health plan policies, which are saved from preemption by ERISA. Ruling:In "CIGNA HealthCare of Texas, Inc. v. Calad et al.", together with "Aetna Health Inc. v. Davila", the Supreme court ruled that Mr. Davila's and Ms. Calad's (the Respondents) state of Texas Causes of Action, (both involving utilization review decisions by Managed Care entities that were alleged to adversely affect patient care, where in both cases Utilization review decisions contradicted the advice of the Respondents' personal physicians), fell within ERISA $1132(a)(1)(B); thus, the Court ruled these complaints were completely pre-empted by ERISA $1132 (Implied Preemption), and removable to Federal Court, therefore giving federal court jurisdiction over resolution of the complaints and defining ERISA as the law to be followed, superseding the applicable Texas statute (the THCLS); thus, the limited (in this case) Equitable Remedies available under ERISA $1132 must be the exclusive remedies available to redress damage alleged to be suffered as a result of these utilization review decisions.

History:The Supreme Court decision reversed a decision of the U.S. Court of Appeals for the 5th Circuit that ERISA did not preempt the state causes of action and could be Remanded to Texas state court to be tried there under Texas law.The ruling was informed largely by ERISA judicial Precedent (Judge-made, or Common law), as established early in ERISA's judicial history, especially Pilot Life v. Dedeaux, 1987. In the latter case, the language of ERISA and other evidence of congressional intent, including ERISA's legislative history; the expansive interpretation of ERISA's preemption clause (i.e. ERISA supersedes state laws that "relate to" private employer-sponsored benefit plans, with no specific guidance in the wording of the clause as to how Congress intended "relate to" to be interpreted); coupled with ERISA's enforcement scheme, which includes Equitable Remedies but not Legal Remedies, led to the conclusion that state law Causes of action for legal remedies under Mississippi common law for Bad faith denial of insurance claims, including compensatory and punitive damages, were not allowed by ERISA.