In accordance with Old Republic's decision, Ms. Rodriguez's initial chiropractor, ChiroFirst, stopped treatment after providing 12 weeks of care, so she sought and received additional care from a different chiropractor, Core Health Chiropractic.

Ms. Rodriguez sought reimbursement for that care from her personal automobile no-fault insurance carrier, State Farm Mutual Automobile Insurance Company.

State Farm denied coverage.

State Farm conceded that Ms. Rodriguez's injuries, and the chiropractic care she received for those injuries, were covered under its no-fault policy, but argued that Mr. Rodriguez nonetheless was 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 asserted that, under the circumstances, a provision in the Minnesota Workers' Compensation Act, Minn. Stat. § 176.83, subd. 5(c), prohibited any further reimbursement to any chiropractor from “any source” including “another insurer.”

After State Farm denied coverage, Ms. 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 Ms. Rodriguez and awarded her $16,883, which was the full amount that she had sought plus interest and costs.

A Minnesota trial court vacated the arbitrator's award, the court of appeals reversed, and the dispute reached the Supreme Court of Minnesota.

State Farm argued that because Ms. Rodriguez's workers' compensation insurer determined that more than 12 weeks of chiropractic benefits would be excessive, unnecessary, or inappropriate, Core Health (Ms. Rodriguez's second chiropractor) was a “provider” that was barred from being reimbursed or attempting to collect reimbursement from any other source including another insurer such as State Farm.

For her part, Ms. Rodriguez responded that the only “provider” that Minn. Stat. § 176.83, subd. 5(c), barred from seeking additional reimbursement was the specific provider whose services the workers' compensation payer determined to be excessive. She contended that because her workers' compensation insurer, Old Republic, never made any determination concerning the services of her second chiropractic provider, Core Health, and because Ms. Rodriguez never sought workers' compensation coverage for benefits provided by Core Health, Core Health could not be “the provider” to which the reimbursement prohibitions of subdivision 5(c) applied.

The Minnesota Workers' Compensation Acd

Minn. Stat. § 176.83, subd. 5(c), states:

If it is determined by the [workers' compensation] payer that the level, frequency, or cost of a procedure or service of a provider is excessive, unnecessary, or inappropriate according to the standards established by the rules, the provider shall not be paid for the procedure, service, or cost by an insurer, self-insurer, or group self-insurer, and the provider shall not be reimbursed or attempt to collect reimbursement for the procedure, service, or cost from any other source including the employee, another insurer, the special compensation fund, or any government program unless the commissioner or compensation judge determines at a hearing or administrative conference that the level, frequency, or cost was not excessive under the rules in which case the insurer, self-insurer, or group self-insurer shall make the payment deemed reasonable.

The Minnesota Supreme Court's Decision

The Minnesota Supreme Court affirmed the decision of the court of appeals.

In its decision, the court ruled that the phrase “the provider” that “shall not be reimbursed” referred only to the specific provider whose services the workers' compensation payer determined to be excessive, unnecessary, or inappropriate. According to the court, the phrase “the provider” did not refer to any provider who treated an injured worker regardless of whether the worker sought coverage for the treatment from the workers' compensation payer.

Thus, the court concluded, the statutory prohibition on reimbursement under Minn. Stat. § 176.83, subd. 5(c), was limited to the specific provider (here, ChiroFirst) whose services the workers' compensation payer determined to be excessive. According to the court, Core Health was not a “provider” to which the reimbursement prohibition of subdivision 5(c) applied.

The case is Rodriguez v. State Farm Mutual Automobile Ins. Co., No. A17-1800 (Minn. July 3, 2019). Attorneys involved include: 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.