Minnesota: No-Fault Auto Insurer Must Pay Injured Worker’s “Additional” Chiropractic Charges
Where a Minnesota bus driver, who had been injured in a work-related motor vehicle accident, sought and received chiropractic care from one provider, but the workers’ compensation carrier refused to pay for additional services provided by another medical service beyond that initial 12-week period, the additional charges could appropriately be billed to the bus driver’s personal automobile no-fault insurer, in spite of a limiting statute, held the Supreme Court of Minnesota [Rodriguez v. State Farm Mut. Auto. Ins. Co., 2019 Minn. LEXIS 348 (July 3, 2019).
Background
Following her accident, the driver sought and recovered 12 weeks of chiropractic care provided by ChiroFirst from the workers’ compensation carrier. She then sought additional chiropractic care from a different provider, Core Health, but the workers’ compensation carrier refused to pay the additional charges. Generally speaking, under special parameters or rules established pursuant to the Minnesota Workers’ Compensation Act (“the Act”), absent various exceptions that were not at play in this case, a workers’ compensation carrier may not be required to pay for more than 12 weeks of chiropractic care.
It is for that additional care with the second provider that the driver sought reimbursement from her no-fault carrier, State Farm. An arbitrator ruled in favor of the driver, awarding her $16,883—the full amount that she had sought, plus interest and costs. A district court vacated the arbitrator’s award, but the state court of appeals reversed and reinstated the driver’s award. The Supreme Court granted State Farm’s petition for review.
No-Fault Insurer’s Argument
State Farm conceded that the driver’s injuries, and the chiropractic care she received for those injuries, were generally covered under the “medical expense loss” portion of its no-fault policy. State Farm even conceded that had the accident that caused the driver’s back injury not been related to her work, it would have been liable to pay the driver’s chiropractic treatment subject to the limits of the No-Fault Act and its policy.
State Farm argued, however, that the driver was nonetheless barred from no-fault recovery because of the determination, by the employer’s workers’ compensation carrier, that more than 12 weeks of care was excessive, unnecessary, or inappropriate. State Farm insisted that Minn. Stat. § 176.83, subd. 5(c) prohibited any further reimbursement to any chiropractor from “any source” including “another insurer.”
The Limiting Statute
At the heart of the dispute was a portion of the Act, Minn. Stat. § 176.83, subd. 5(c), which provides:
If it is determined by the payer that the level, frequency, or cost of a procedure or service of a provider is excessive, unnecessary, or inappropriate according to the standards established by the rules, the provider shall not be paid for the procedure, service, or cost by an insurer, self-insurer, or group self-insurer, and the provider shall not be reimbursed or attempt to collect reimbursement for the procedure, service, or cost from any other source, including the employee, another insurer, the special compensation fund, or any government program unless the commissioner or compensation judge determines at a hearing or administrative conference that the level, frequency, or cost was not excessive under the rules in which case the insurer, self-insurer, or group self-insurer shall make the payment deemed reasonable [emphasis added].
Supreme Court’s Analysis
The Court acknowledged that, generally speaking, workers’ compensation benefits were considered “primary.” That is to say that if the injury is compensable, the workers’ compensation carrier must provide coverage and pay for medical expenses resulting from the work-related injury. If workers’ compensation benefits do not cover an injury, however, then the no-fault insurer must pay economic loss benefits subject to the restrictions of the No-Fault Act and the particular policy. Despite the primary nature of workers’ compensation benefits, the Act and the No-Fault Act work together.
Agreeing with the driver, the Court held that because the workers’ compensation insurer never made any determination concerning the services of the second chiropractic provider, Core Health, and because the driver never sought workers’ compensation coverage for benefits provided by Core Health, Core Health could not be “the provider” to which the reimbursement prohibitions of subdivision 5(c) applied. In short, Core Health’s provision of care had never been determined (or even claimed) to be excessive.
Importance of the Article “The”
The Court stressed that the article, “the,” could not be ignored in the statute. Its use by the legislature meant the statute was not speaking to “any” provider, but rather to a specific provider—in this case, ChiroFirst, which had provided the initial 12-week treatment.
The Court also stressed that nothing in its ruling would prohibit an employer or insurer from refusing to pay for the 13th week of chiropractic treatment, even it that additional treatment were provided by a different chiropractor, as was the situation here. Accordingly, the Supreme Court affirmed the court of appeals’ decision to reinstate the driver’s arbitration award.