Laws vary from state to state, but in some states a health insurance carrier, health maintenance organization, or other managed care entity for a health care plan has the duty to exercise ordinary care when making health care treatment decisions and is liable for damages for harm to an insured or enrollee proximately caused by its failure to exercise such ordinary care.

This liability may be created by a specific state statute or by the state's common law (court opinions or case law) under a negligence theory for breach of the standard of care (reasonableness).

In Florida, health insurance carriers, health maintenance organizations (HMOs), and other managed care entities are expected to adhere to a standard of ordinary care when making health care treatment decisions. If they fail to exercise this level of care, they can be held liable for any harm caused to an insured or enrollee as a result. This liability can arise from specific Florida statutes or from common law negligence theories, which are established through court opinions and case law. Under these legal frameworks, if a managed care entity's decision-making is found to be unreasonable and this unreasonableness is the proximate cause of harm to the patient, the entity may be required to compensate the patient for damages. It is important to note that the specifics of liability and the standards of care may vary, and an attorney can provide detailed guidance on the current laws and how they might apply in a particular case.