From April 2015 through December 2015, Ms. Nichols received several additional treatments at North Memorial. The charges for these treatments were not submitted to State Farm. Instead, North Memorial submitted them to Ms. Nichols' health insurer, UCare. North Memorial submitted each charge to UCare within six months of treatment, and UCare paid each charge.

In July 2016, Ms. Nichols filed a petition for no-fault arbitration, seeking an award of $10,000 from State Farm for the health care expenses incurred for her 2015 treatments.

Following a hearing, the arbitrator awarded Ms. Nichols $10,000 in economic loss benefits for her medical expenses.

State Farm moved in court to vacate the arbitration award.

The court denied the motion, concluding that Minn. Stat. § 62Q.75(3) (“Subdivision 3”) unambiguously required a health care provider to submit its charges to a health plan company within six months of treatment. Because, the trial court ruled, North Memorial had submitted its charges to UCare within six months, North Memorial had complied with the statute and it affirmed the arbitrator's decision.

State Farm appealed, asserting that Ms. Nichols was not entitled to economic loss benefits because her medical provider had not complied with the requirements of Subdivision 3. In particular, State Farm argued that Subdivision 3 barred Ms. Nichols's no-fault claim because the statute required North Memorial to submit its charges to State Farm within six months and North Memorial failed to do so.

For her part, Ms. Nichols contended that Subdivision 3 unambiguously required North Memorial to submit its charges to an insurer within six months and that by submitting its charges to UCare within six months, North Memorial had complied with the statute.

Minnesota Law

Minnesota law provides:

[H]ealth care providers . . . must submit their charges to a health plan company or third-party administrator within six months from the date of service or the date the health care provider knew or was informed of the correct name and address of the responsible health plan company or third-party administrator, whichever is later.

Minn. Stat. § 62Q.75(3) (emphasis added).

The Appellate Court's Decision

The appellate court affirmed.

In its decision, the appellate court explained that Subdivision 3, applicable to no-fault claims, established a timeline for health care providers to “submit their charges” to health plan companies. The appellate court found Subdivision 3 “clear and unambiguous,” and it rejected State Farm's argument that the phrase “responsible health plan company” in the second half of Subdivision 3 modified the phrase “a health plan company” in the first half of Subdivision 3 so that a health care provider had to submit its charges to the responsible health plan company within six months of service.

In the appellate court's opinion, rather than modifying the phrase “a health plan company,” the phrase “the responsible health plan company” related only to the alternative timeline that could extend the six months from the “date of service” to six months from “the date the health care provider knew or was informed of the correct name and address of the responsible health plan company or third-party administrator, whichever is later.”

Put another way, the appellate court continued, Subdivision 3 “unambiguously stated” that the sole obligation for health care providers by this statutory language was “to submit their charges to a health plan company.” It added that the “unambiguously stated timeline for this submission” was either six months from the date of service or six months from the date the health care provider knew or was informed of the correct name of the responsible health plan company, whichever was later.

The appellate court added that, because Subdivision 4 was “clear and unambiguous,” it did not have to consider State Farm's contention that it was “absurd” to consider that the legislature could require a health care provider to submit charges to health plan companies it knew were not responsible for the charges.

Accordingly, the appellate court held that because North Memorial had complied with the requirements of Subdivision 3, Ms. Nichols had suffered a “loss” under the Minnesota No-Fault Act and the trial court did not err in holding that Subdivision 3 did not bar Ms. Nichols' no-fault claim. Therefore, the trial court properly denied State Farm's motion to vacate the arbitration award, the appellate court concluded.

The case is Nichols v. State Farm Mutual Automobile Ins. Co., No. A18-1188 (Minn. Ct. App. April 15, 2019). Attorneys involved include: Charles D. Slane, Nathan M. Maus, TSR Injury Law, Bloomington, Minnesota (for respondent). Chris Angell, David M. Werwie & Associates, St. Paul, Minnesota (for appellant).