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Rodriguez v. State Farm Mutual Automobile Insurance Co.

Supreme Court of Minnesota

July 3, 2019

Jennifer Rodriguez, Respondent,
v.
State Farm Mutual Automobile Insurance Co., Appellant.

          Court of Appeals Office of Appellate Courts

          Matthew J. Barber, James S. Ballentine, Cole J. Dixon, Schwebel Goetz & Sieben, P.A., Minneapolis, Minnesota, for respondent.

          Chris Angell, David M. Werwie & Associates, Saint Paul, Minnesota, for appellant.

          Dale O. Thornsjo, Christopher E. Celichowski, Lance D. Meyer, O'Meara, Leer, Wagner, & Kohl, P.A., Minneapolis, Minnesota, for amici curiae The Insurance Federation of Minnesota, The Property Casualty Insurers Association of America, and The National Association of Mutual Insurance Companies.

         SYLLABUS

         The reimbursement prohibition set forth in Minn. Stat. § 176.83, subd. 5(c) (2018), applies only to "the provider" determined by a workers' compensation payer to have provided excessive, unnecessary, or inappropriate procedures or services. Because the provider of the treatment for which the injured employee sought reimbursement from her no-fault insurer had not been determined by a workers' compensation payer to have provided excessive, unnecessary, or inappropriate services, the no-fault insurer's denial of coverage was improper.

         Affirmed.

          OPINION

          THISSEN, Justice.

         This case requires us to determine whether respondent Jennifer Rodriguez, a bus driver who was injured in a motor vehicle accident while working, may seek reimbursement for chiropractic services related to her injury from appellant State Farm Mutual Automobile Insurance Co. (State Farm), her personal automobile no-fault insurer.

         FACTS

         Following the accident, Rodriguez sought and received chiropractic care at ChiroFirst and reported the accident to her employer. Her employer's workers' compensation carrier, Old Republic Insurance, agreed to pay workers' compensation benefits. But in accordance with the treatment parameters adopted for purposes of the Workers' Compensation Act, Old Republic refused to pay for more than 12 weeks of chiropractic care. Those parameters state that (subject to certain exceptions) more than 12 weeks of chiropractic care is excessive, unnecessary, or inappropriate. See Minn. R. 5221.6200, subps. 3(C), 9 (2017); Minn. R. 5221.6205, subps. 3(C), 9 (2017); see also Minn. R. 5221.6050, subp. 1 (2017). In accordance with Old Republic's decision, Rodriguez's initial chiropractor, ChiroFirst, stopped treatment after providing 12 weeks of care, so Rodriquez sought and received additional care from a different chiropractor, Core Health Chiropractic (Core Health). It is for that care that Rodriguez sought reimbursement from State Farm. State Farm denied coverage.

         State Farm concedes that Rodriguez's injuries, and the chiropractic care she received for those injuries, are covered under its no-fault policy, but argues that Rodriguez is nonetheless barred from no-fault recovery because of Old Republic's determination that more than 12 weeks of care was excessive, unnecessary, or inappropriate. State Farm asserts that, under those circumstances, a provision in the Minnesota Workers' Compensation Act, Minn. Stat. § 176.83, subd. 5(c) (2018), prohibits any further reimbursement to any chiropractor from "any source" including "another insurer."

         After State Farm denied coverage, Rodriguez filed a petition for no-fault arbitration, seeking an award of her expenses for chiropractic treatment beyond the 12 weeks already covered by Old Republic. The arbitrator ruled in favor of Rodriguez and awarded her $16, 883, which was the full amount that she had sought plus interest and costs. State Farm moved in the district court to vacate the arbitrator's award on the ground that the arbitrator exceeded her authority. The district court granted the motion. The court of appeals reversed the district court and reinstated ...


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