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Auto insurer must pay for bus driver’s work-related injury treatment

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Auto insurer must pay for bus driver’s work-related injury treatment

The Court of Appeals of Minnesota on Tuesday ordered that State Farm Mutual Automobile Insurance Co. must pay for the chiropractic treatments a school bus driver was receiving under her uninsured-motorist personal coverage after her employer’s workers compensation insurer seized to pay for treatments after 12 weeks.

Instead, it is up to the no-fault automobile insurer to seek payment from the workers compensation insurer, if applicable, according to the ruling in Jennifer Rodriguez v. State Farm Mutual Automobile Insurance Co.

Jennifer Rodriguez was driving a school bus when a person driving a stolen vehicle crashed into her bus. Old Republic Insurance Co., her employer's workers comp insurer, paid for 12 weeks of chiropractic treatment, per Minnesota’s treatment guidelines embedded in the state’s workers comp regulations, according to court documents.

She later sought chiropractic treatment under her automobile insurer’s uninsured motorist coverage, which triggered her insurer, State Farm, to investigate the cause of her injury. “Because it appeared to State Farm that Rodriguez was in the course and scope of her employment when she was injured, State Farm sought information about Rodriguez's injuries and treatment and about what benefits she was requesting under her automobile policy.”

Ms. Rodriguez responded that she was claiming no-fault benefits for her chiropractic treatment, according to court documents.

State Farm then failed to pay Ms. Rodriguez's bills for chiropractic treatment, causing her to file a petition for no-fault arbitration. During arbitration, State Farm “did not dispute the reasonableness or the necessity of the chiropractic treatment that Ms. Rodriguez received,” but argued that “under the circumstances of this case, the workers compensation system is the exclusive source for any health care benefits sought in connection with the accident,” court records state. 

The arbitrator ruled in favor of Ms. Rodriguez, awarding her the undisclosed full amount claimed, plus costs and interest, court records state.

State Farm then brought a motion in the district court to vacate the arbitrator's award, claiming the arbitrator exceeded her authority. The district court granted State Farm's motion to vacate.

On appeal, the court Tuesday reversed that decision, finding that the state’s no-fault act requires State Farm to cover her treatment, citing the “one purpose of no-fault act is to provide automobile insurance policies that ‘will provide prompt payment of specified basic economic loss benefits to victims of automobile accidents without regard to whose fault caused the accident.’”

“Because (Ms.) Rodriguez's basic economic loss benefits are overdue, State Farm must pay the benefits without a deduction for workers' compensation benefits that may become payable, and State Farm is entitled to reimbursement if it is determined that additional workers' compensation benefits are payable,” the ruling states.

The court also found that the issue for possible litigation is whether Ms. Rodriguez’s treatment was considered excessive under workers comp regulations: “We also note that the statutory conflict presented in this case arose because neither the commissioner of labor and industry nor a compensation judge has determined whether the chiropractic treatment that Ms. Rodriguez received was not excessive under the workers compensation rules.

“The record does not demonstrate that this issue has been presented to either the commissioner or a compensation judge, and we do not express any opinion about any insurer's ultimate responsibility to provide medical expense benefits for Rodriguez's chiropractic treatment,” the ruling states.

 

 

 

 

 

 

 

 

 

 

 

 

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