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16 a coordinate duty to the ERISA obligation to administer the plan as a fiduciary. While the independent review procedure helps to ensure that claims are fairly resolved, the tort remedy serves to promote careful medical decision-making. These are different goals, reached by different means. The independent review process has continued to expand, and has effectively reversed or adjusted many HMO benefits determinations. The tort remedy, however, has not been widely used. Indeed, the only two jury verdicts so far rendered under the THCLA resulted in one jury award of punitive damages and one exoneration. Mark A. Hall & Gail Agrawal, The Impact of State Managed Care Liability Statutes, HEALTH AFFAIRS, Sept. Oct. 2003, at 138, 141. This scant use of the statute refutes Aetna's and CIGNA's warnings that the THCLA and laws like it will ruin HMOs by imposing liability whenever patients are unsuccessfully treated under HMO-provided medical benefit plans. II. CONGRESS DID NOT CLEARLY AND MANIFESTLY INTEND TO DISPLACE STATE TORT LAWS LIKE THE THCLA WITH SUCH PREEMPTIVE FORCE AS TO TRANSFORM THEM INTO FEDERAL ACTIONS UNDER ERISA. Davila's and Calad's THCLA claims do not target eligibility determinations under their respective health plans, but the negligent exercise of medical judgment by their HMOs that affected the quality of their immediate medical treatment. Davila and Calad do not seek redress for the improper processing of benefits claims, or to enforce rights guaranteed them by ERISA, but to recover damages for personal injuries proximately caused by their HMOs' negligent medical judgment and the resulting impairment of their medical treatment. The question presented in this case is whether Congress, in establishing a scheme of civil-enforcement remedies in ERISA 502 a ; , intended to displace state-law claims of this nature with such preemptive force as to transform them into federal actions and escitalopram.

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