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The wheels on the bus go round and round

The wheels on the bus go round and round

January 28
09:25 2019

The wheels on the bus go round and round

While driving a school bus for her employer, Jennifer Rodriguez was injured when a stolen vehicle crashed into the bus. Old Republic Insurance Company, her employer’s workers compensation insurer, paid for 12 weeks of chiropractic treatment that Rodriguez received at ChiroFirst, P.A.

Old Republic then notified ChiroFirst that, because additional chiropractic treatment was not indicated under the treatment parameters set forth in the state workers compensation statute, it would not pay for additional treatment except as permitted under a certain provision of the law. In response, ChiroFirst refused to provide additional treatment.

Rodriguez then began receiving treatment from Core Health Chiropractic and provided notice of an uninsured motorist claim to her personal automobile insurer, State Farm Mutual Automobile Insurance Company. Because it appeared to State Farm that Rodriguez was in the course and scope of her employment when she was injured, State Farm sought information about Rodriguez’s injuries and treatment and about what benefits she was requesting under her automobile policy. Rodriguez responded that she was claiming no-fault benefits for her chiropractic treatment, and she requested an application for benefits.

After State Farm failed to pay Rodriguez’s bills for chiropractic treatment, Rodriguez filed a petition for no-fault arbitration. During arbitration, State Farm did not dispute the reasonableness or necessity of the chiropractic treatment that Rodriguez received, but argued that, under the circumstances, the workers compensation system was the exclusive source for any healthcare benefits sought in connection with the accident. The arbitrator ruled for Rodriguez and awarded her the full amount claimed, plus costs and interest.

State Farm moved to vacate the arbitrator’s award on the ground that the arbitrator exceeded her authority. The court concluded that the plain language of the statute precluded no-fault benefits and granted State Farm’s motion to vacate. Rodriguez appealed.

On appeal, the issue was whether the statute relieved an insurer of its obligation to pay no-fault benefits to an insured who was injured in the course and scope of her employment when no determination had been made as to whether the insured was entitled to receive workers compensation benefits for treatment of the injury.

The court noted that Old Republic determined that additional chiropractic treatment was excessive because, according to the standards established by the workers compensation act, treatment beyond 12 weeks was not indicated. Because no authority determined that chiropractic treatment beyond 12 weeks was not excessive under the rules, the act provided that Core Health Chiropractic should not be paid by Old Republic for chiropractic treatment.

The court pointed out that Rodriguez did not seek payment from Old Republic, her employer’s workers compensation insurer; she sought payment from State Farm, her personal automobile insurer. The district court concluded that State Farm was “another insurer” and therefore could not be required to pay for chiropractic treatment that Old Republic determined to be excessive except as provided in the workers compensation act.

The appellate court stated that a conflict existed between the workers compensation act and the no-fault act and cited the provisions of the acts that contradicted each other.

Because no authority had determined whether the treatment that Core Health Chiropractic provided Rodriguez was excessive, the conflict between the general provision in the workers compensation act that Core Health Chiropractic should not be reimbursed by an insurer for the treatment it provided was irreconcilable with the special provisions in the no-fault act that require a no-fault insurer to pay basic economic loss benefits when they are due. The general provision states that State Farm should not reimburse Core Health Chiropractic for the treatment, and the special provisions require State Farm to pay for the treatment; and the provisions cannot be construed to give effect to both. Consequently, the court said, it must construe the special provisions in the no-fault act as an exception to the general provision in the workers compensation act, unless the general provision was enacted later than the special provisions and the legislature had manifested its intention that the general provision should prevail. The court ascertained that this was not the case.

The court held that State Farm must pay Rodriguez’s overdue basic economic loss benefits without a deduction for workers compensation benefits that might become payable, and that State Farm was entitled to reimbursement if it was determined that additional workers compensation benefits were payable.

Rodriguez vs. State Farm Mutual Automobile Insurance Company-Court of Appeals of Minnesota-No. A17-1800-July 2, 2018.


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