OPINION OF THE COURT
Thе novel question presented by this appeal is whether the Employee Retirement Income Security Act (ERISA) preempts plaintiffs medical malpractice, breach of contract and breach of fiduciary duty claims against a primary care physician who allegedly delayed in submitting a specialist’s referral form for approval by a health maintenance organization (HMO) governed by ERISA. Concluding that ERISA does *215 not preempt plaintiff's claims, we reverse the Appellate Division’s dismissal order and reinstate the complaint against the doctor.
In January 1992, plaintiff’s husband, Glenn Nealy, then 37 years old, was diagnosed with coronary arteriosclerosis and a coronary artery lesion. As a result, Mr. Nealy took disability leave from his job at Photocircuits Corporation and was treated for his condition by a cardiologist, Dr. Stephen Green. His treatment, which included an angioplasty performed by Dr. Green in March 1992, was in large part covered by Blue Cross/ Massachusetts Mutual, the carrier selected by Photocircuits to provide employee medical insurance. Around the time of Mr. Nealy’s angioplasty, Photocircuits replaced its carrier with a choice of three HMOs, including US Healthcare, and informed its employees that coverage would become effective April 1, 1992. Mr. Nealy promptly enrolled in the US Healthcare Versatile Plus HMO, which allowed its members to see nonparticipating physicians, and paid his first monthly premium.
On April 2, and again on April 3, Mr. Nealy visited the offices of defendant, Dr. Ralph Yung, whom he had selected as his primary care рrovider under the US Healthcare HMO. 1 He experienced renewed chest pain and also required follow-up care as a result of the angioplasty. On his first visit, Mr. Nealy was denied an appointment because he had not yet received a US Healthcare identification number. The next day, he spoke with a US Healthcare representative who told him that a copy of his enrollment form could be presented in lieu of an identification number, and he made a second attempt to visit Dr. Yung. Again he was turned away — this time because his enrollment form bore the wrong primary physician number.
On April 10, 1992 — having received his US Healthcаre identification card the previous day — Mr. Nealy was examined by Dr. Yung. During that visit, Dr. Yung took a patient history that noted a history of angina and angioplasty, performed a routine new-patient physical examination, and renewed all the medications that had been prescribed by Dr. Green. At Dr. Yung’s request, Mr. Nealy returned on Aрril 13 to provide blood and urine samples for laboratory analysis. When Dr. Yung informed him during one or both of these visits that he should see a cardiologist, Mr. Nealy requested a referral to Dr. *216 Green, who was not a participating US Healthcare provider. Dr. Yung allegedly assured his patient that he would submit a request to US Healthcare to approve an out-of-plan referral and do what he could to secure approval of the request. It was not until approximately April 20, however, that Dr. Yung completed a nonparticipating provider request form and submitted it for approval to US Healthcare. 2
On May 4th, Mr. Nealy reсeived a copy of a letter from US Healthcare addressed to Dr. Yung denying the request for a referral to Dr. Green. The reason given was that US Healthcare had a participating provider in the area. After the referral to Dr. Green was denied, Mr. Nealy decided to accept a referral to Dr. Carl Spivak, a participating US Healthcare cardiologist. He obtained the referral to Dr. Spivak on May 18 and promptly made an appointment for the next day. Tragically, however, on May 18 Mr. Nealy suffered a massive myocardial infarction and died.
Seeking to recover damages for her husband’s dеath, plaintiff commenced this action in Supreme Court asserting breach of contract, breach of fiduciary duty, wrongful death, negligence and other claims against defendants Dr. Yung, Dr. Richard H. Bernstein (vice-president and director of US Healthcare), US Healthcare and two subsidiaries. Plaintiff also asserted medical malpractice claims against Dr. Yung and Dr. Bernstein. Dr. Bernstein and US Healthcare successfully sought removal of the case to Federal court, where the claims were dismissed on the ground that they were preempted by ERISA (
After service of process and discovery, Dr. Yung moved for summary judgment seeking dismissal of the complaint, alleg *217 ing that ERISA preempted plaintiffs claims against him as well. Supreme Court denied the motion. The Appellate Division, however, reversed and dismissed the complaint, concluding that ERISA preempted plaintiffs claims. We disagree and now reinstate plaintiffs complaint against Dr. Yung.
Discussion
Concerned with employee pension plan abuses and mismanagement, Congress in 1974 enacted ERISA, a comprehensive statute “designed to promote the interests of employees and their beneficiaries in employee benefit plans”
(Aetna Life Ins. Co. v Borges,
869 F2d 142, 144 [2d Cir],
cert denied
ERISA’s preemption provision is central to achievement of its statutory purposes. The provision reаds that ERISA “shall supersede any and all State laws insofar as they * * * relate to any employee benefit plan” covered by ERISA, and it applies to both State statutes and common law (ERISA § 514 [a] [Pub L 93-406, tit 1], 29 USC § 1144 [a]; ERISA § 514 [c] [1], 29 USC § 1144 [c] [1];
Pilot Life Ins. Co. v Dedeaux,
The issue before us is whether ERISA’s preemption clause bars plaintiffs medical malpractice, breach of contract and breach of fiduciary duty claims against her husband’s primary
*218
care physician, Dr. Yung. All of these claims fall within the traditional domain of State regulation. Dr. Yung, therefore, bears the “considerable burden” of overcoming the presumption that Congress did not intend to preempt them
(De Buono v NYSA-ILA Med. & Clinical Servs. Fund,
The simple statutory words “relate to” have been the subject of significant scholarly comment and litigation, including considerable attention from the United States Supremе Court
(see, De Buono, supra,
After many years of broadly interpreting ERISA’s preemption clause, in 1995 the United Statеs Supreme Court adopted a more pragmatic approach, noting that its prior efforts to define “relate to” did not always afford “much help drawing the line”
(Travelers,
In
Travelers
itself, the Supreme Court concluded that a State statute imposing surcharges on hospital bills paid by certain employee benefit plans, but exempting Blue Cross/Blue Shield plans, was not preempted by ERISA. Arguing for preemption, the commercial insurers asserted that the surcharges had an indirect economic effect on choicеs made by insurance buyers, including ERISA plans, and as such, the State statute had a “connection with” those plans. The Supreme Court, however, held that the indirect economic influence of the surcharges did not interfere with the congressional goal of uniform standards of plan administration. The statute did not “bind plan administrators to any particular choice and thus function as a regulation of an ERISA plan itself,” nor did it “preclude uniform administrative practice or the provision of a uniform interstate benefit package” (
Here, plaintiff alleges that Dr. Yung, as a direct provider of medical services, violated the duties and standard of care owed to his patient by improperly assessing the nature and еxtent of his condition and by failing to take reasonable steps to provide for his timely treatment by a specialist. Viewed pragmatically, those claims are not preempted by ERISA. Plaintiff’s allegations of negligent medical care do not “relate to” the adminis *220 tration of an ERISA plan 3 merely because they refer to Dr. Yung’s delay in submitting thе US Healthcare form seeking a referral to Dr. Green. Plaintiff does not allege that Dr. Yung is responsible for delay caused by US Healthcare’s decision-making process with respect to coverage or benefits. Her claim against Dr. Yung is that he failed to take timely action to treat her husband.
Provision of mediсal treatment under an HMO or other managed care plan often requires reference to that plan’s administrative procedures or requirements. In this case, for example, under the terms of the US Healthcare HMO plan, Mr. Nealy’s primary care physician was required to complete and submit a referral form in order to obtain treatment by a specialist for his patient. That alone, however, does not transform Dr. Yung into an ERISA plan administrator, or plaintiffs State law action charging violations of a physician’s duty of care into claims that “relate to” ERISA plan administration. While plaintiffs claims make reference to US Healthcare’s administrative framework, any effect those claims may have on an employee benefit plan is “too tenuous, remote or peripheral” to warrant a finding that they “relate to” such a plan
(Shaw v Delta Air Lines, Inc., supra,
Moreover, considering the objectives of the ERISA statute, it is clear that Congress did not intend to preempt claims such as those now before us. Plaintiffs claims do not bind an employee plan to any particular choice of benefits, do not dictate the administration of such a plan and do not interfere with a uniform administrative scheme. Indeed, plaintiff does not challenge any administrative determination relating to an employee benefit plan or the extent of rights and benefits under such a plan. In short, there is nothing about plaintiffs claims
*221
that “conflicts with the provisions of ERISA or operates to frustrate its [objectives]”
(Boggs v Boggs, supra,
Finally, the Appellate Division would have dismissed plaintiffs complaint on the independent ground that she failed to demonstrate that any deviation from professional standards was a proximate cause of Mr. Nealy’s demise. At this juncture in the litigation, however, we cannot agree with that conclusion as a matter of law.
Accordingly, the Appellate Division order should be reversed, with costs, and the order of Supreme Court reinstated.
Judges Bellacosa, Smith, Levine, Ciparick, Wesley and Rosenblatt concur.
Order reversed, etc.
Notes
. Dr. Yung disputes plaintiffs allegation that Mr. Nealy visited his offices on April 2 and 3, admitting only that he first saw Mr. Nealy on or about April 10.
. The parties dispute whether the nonparticipating referral form— instead of a “Versatile” form — was submitted to US Healthcare at Mr. Nealy’s request or the result of Dr. Yung’s error. A “Versatile” referral would have allowed treatment by a nonparticipating doctor but required Mr. Nealy to pay a $250 deductible. Plaintiff maintains that Mr. Nealy never expressed a desire to avoid payment of the deductible and was motivated only by a desire to see his cardiologist as soon as possible. Dr. Yung claims that Mr. Nealy did not want to pay the deductible, which is why the nonparticipating referral form was submitted.
. We leave for another day the issue whether the US Healthcare HMO was even a “plan” within the meaning of the ERISA preemption provision. The Secretary of Labor, charged with interpreting and enforcing the provisions of ERISA, in a brief supporting plaintiffs position, notes that the US Healthcarе HMO at issue here is not an ERISA plan at all, but rather a service provider to the ERISA plan established by Photocircuits, Inc. ERISA defines an “employee welfare plan” as “any plan, fund or program * * * established or maintained by an employer * * * for the purpose of providing for its participants and beneficiaries, through the purchase of insurance or otherwise * * * medical, surgical, or hospital care or benefits” (29 USC § 1002 [1]). Commentators have observed that there is some “confusion” as to whether this “tautological” definition encompasses HMOs and other managed care organizations (see, Jacobson and Pomfret, op. cit., at 1020-1022). The issue was not raised by the parties and, given the result we reach, would in any event be immaterial.