NEWS / Legal News - July 2019

Auto insurers can only deny chiropractic treatment which has already been explicitly denied by the workers' compensation insurer

Rodriguez v. State Farm

Chiropractic Care

An employee was injured in a work-related car crash. As a result of the accident, the employee received chiropractic care. After receiving 12 weeks of chiropractic care, the workers' compensation insurer denied any additional chiropractic care citing the Minnesota Workers' Compensation Treatment Parameters limitation on chiropractic care.
The employee then went to a different chiropractor and submitted the bill to her no-fault auto insurer. The auto insurer denied paying the bill citing Minn Stat. 176.83, subd. 5(c), which states that if it is determined by a workers' compensation payer that medical treatment violates the treatment parameters then the provider is not to be reimbursed from any source unless there is a decision that the treatment did not violate the rules.
The case went to arbitration and the employee was awarded payment for the bill for the chiropractic care, plus costs and interest totaling over $16,000. The District Court vacated the arbitration award.
The Court of Appeals reversed the decision.
The Supreme Court held that the no-fault auto insurer was liable because the workers' compensation insurer only determined that additional chiropractic care with the first chiropractor was in violation of the rules, but made no such determination regarding treatment with the second chiropractor.
The Supreme Court stressed that workers’ compensation is to be the primary payer of medical bills associated with work injuries. In this case had the auto insurer refrained from making a decision on paying or denying the bill from the second chiropractor, and simply directed the employee to submit the bill to the workers’ compensation insurer to make the initial determination regarding payment, the outcome in this case might have been quite different. 
Unfortunately these procedural requirements place added stress on the workers’ compensation system and will likely increase the amount of requests for medical treatment which would have previously been handled solely in the auto insurance arena.   
This case seems to imply that each time the employee seeks chiropractic treatment with a new chiropractor the bill must be presented to the insurer, no matter how many times the insurer has rejected chiropractic treatment in the past. Workers’ compensation professionals will need to make sure they are diligently denying potentially multiple requests for the same medical treatment when appropriate and avoiding any implied authorization due to lack of a timely denial each time a request is made.

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