For decades, physicians have railed against the inequities of malpractice laws, lobbying for statutory changes that would insulate them from injustices, both real and perceived. In an ironic twist, extending tort liability has become the latest weapon against managed care companies and the medical directors who often make utilization review determinations. As a result, managed care companies are now rushing to embrace the once scorned external review and independent appeals processes in a last-ditch effort to stave off reforms requiring them to justify health care decisions in front of judges and juries.