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January 20, 2023

Texas Supreme Court Holds that Texas Emergency Care Statutes Do Not Afford Providers a Private Right of Action against Insurers

The Texas Supreme Court held that three sections of the Texas Insurance Code, referred to as the Emergency Care Statutes and requiring a health insurance company to pay non-network physicians for emergency care at the usual and customary rate, do not authorize a private right of action by physicians against insurers for payment of claims that accrued prior to January 2020.  (Since January 2020, the Insurance Code requires out-of-network providers and insurers to complete a mandatory arbitration process before a suit for judicial review may be filed.) The Supreme Court also held that the physician-plaintiffs' claims for recovery in quantum meruit and for unfair settlement practices failed as a matter of law.

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