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Western National Insurance Co. v. Nguyen

Court of Appeals of Minnesota

September 18, 2017

Western National Insurance Company, Respondent,
v.
Jon Nguyen, Appellant.

         Hennepin County District Court File No. 27-CV-16-14268

          Kelly Sofio, Oskie & Sofio, PLLC, St. Paul, Minnesota (for respondent)

          Charles D. Slane, Isaac I. Tyroler, TSR Injury Law, Bloomington, Minnesota (for appellant)

          Wilbur W. Fluegel, Fluegel Law Office, Minneapolis, Minnesota (for amicus Minnesota Ass'n for Justice)

          Considered and decided by Halbrooks, Presiding Judge; Reyes, Judge; and Florey, Judge.

         SYLLABUS

         Minn. Stat. § 62Q.75, subd. 3 (2016), applies in the no-fault context and may bar an insured's claim for medical-expense benefits from his no-fault insurer if the statute's application results in the insured not suffering a "loss" as defined in Minn. Stat. § 65B.54, subd. 1 (2016).

          OPINION

          HALBROOKS, Judge

         Appellant insured challenges the district court's order vacating his no-fault arbitration award, arguing that the district court erred by applying Minn. Stat. § 62Q.75, subd. 3, to bar his claim for no-fault benefits. Appellant also contends that the district court erred by vacating respondent insurer's obligation to pay arbitration fees. We affirm in part and reverse in part.

         FACTS

         In January 2011, appellant Jon Nguyen sustained injuries in a motor-vehicle accident. The accident occurred during the course of Nguyen's employment while he was driving a company vehicle insured by respondent Western National Insurance Company. Nguyen's employer initially paid for his injury-related medical treatment as part of a workers' compensation claim. After Nguyen's workers' compensation benefits ended, Western National paid no-fault benefits to Nguyen. In May 2012, Western National requested that Nguyen attend an independent medical examination (IME). The examiner concluded that no further medical treatment was reasonable, necessary, or related to any injury sustained in the accident. Based on the IME, Western National notified Nguyen's attorney of its denial of future benefits. Nguyen filed for no-fault arbitration. In January 2013, the no-fault arbitrator denied Nguyen's claim in its entirety.

         In February 2014, Nguyen began treating with a new health-care provider, the Center for Diagnostic Imaging (CDI). CDI submitted a single bill to Western National for one of Nguyen's first visits. Western National responded to CDI by letter in May 2014, denying coverage for Nguyen's treatment based on the previous IME and the January 2013 arbitration. Nguyen continued treating with CDI, but CDI did not submit any additional bills to Western National. When Nguyen finished treatment with CDI near the end of 2014, his treatment charges exceeded $10, 000.

         In April 2016, Nguyen again filed for no-fault arbitration against Western National, seeking payment of the CDI bills. Western National asserted Minn. Stat. § 62Q.75, subd. 3, as a defense to the claim. A different arbitrator conducted a hearing and awarded Nguyen $11, 695.23 in medical expenses, interest, and fees. Western National moved the district court to vacate the arbitration award.

         In January 2017, the district court granted Western National's motion and vacated the award of arbitration fees and all but $1, 027.25 of Nguyen's award for medical expenses and costs. The district court awarded Nguyen the value of the bill that CDI submitted to Western National in 2014. The district court concluded that Minn. Stat. § 62Q.75, subd. 3, applied, and that because CDI had submitted only one bill to Western National within the statutory six-month time frame, CDI could not collect its remaining charges. Thus, aside from the medical expenses for one visit, Nguyen did not experience a loss that would entitle him to no-fault benefits. The district court also concluded that medical-expense benefits never became due because CDI did not submit its claim to Western National pursuant to uniform electronic transaction standards. See Minn. Stat. ยง 65B.54, subd. 1 (requiring health-care providers to submit claims according to approved electronic ...


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