County District Court File No. 27-CV-16-14268
Sofio, Oskie & Sofio, PLLC, St. Paul, Minnesota (for
Charles D. Slane, Isaac I. Tyroler, TSR Injury Law,
Bloomington, Minnesota (for appellant)
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.
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).
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.
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.
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.
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.
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.
§ 65B.54, subd. 1 (requiring health-care providers to
submit claims according to approved electronic ...