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 Pennsylvania, 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. While Pennsylvania does not have a specific statute that explicitly imposes this duty, the principle is generally derived from common law under negligence theories. Managed care entities can be held liable for damages if it is proven that they failed to exercise ordinary care and that this failure proximately caused harm to an insured or enrollee. The assessment of whether ordinary care was exercised is based on the reasonableness of the entity's actions in light of the circumstances. Cases involving such claims would typically be evaluated on an individual basis by Pennsylvania courts, taking into account the specifics of the situation and the prevailing standards of care in the medical and insurance industries.