Rodriguez v. State Farm Mut. Auto. Ins. Co., A17-1800

• Decision Date: 03 July 2019
• Docket Number: A17-1800
• Citation: 931 N.W.2d 632
• Parties: Jennifer RODRIGUEZ, Respondent, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE CO., Appellant.
• Court: Minnesota Supreme Court

931 N.W.2d 632

Jennifer RODRIGUEZ, Respondent,

v.STATE FARM MUTUAL AUTOMOBILE INSURANCE CO., Appellant.

A17-1800

Supreme Court of Minnesota.

Filed: July 3, 2019

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.

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 Rodriguez’s award. See Rodriguez v. State Farm Mut. Auto. Ins. Co. , 916 N.W.2d 870, 871 (Minn. App. 2018). We granted State Farm’s petition for review.¹

ANALYSIS

This case presents us with a purely legal issue—determining the meaning of Minn. Stat. § 176.83, subd. 5(c). Our review is de novo. See Gilbertson v. Williams Dingmann, LLC , 894 N.W.2d 148, 151 (Minn. 2017). The statutory interpretation question before us turns on the Legislature’s intent when it enacted Minn. Stat. § 176.83, subd. 5(c). The plain language of the statute is our best guide to the Legislature’s intent. See State v. Riggs , 865 N.W.2d 679, 682 (Minn. 2015). If the statutory language is clear, the Legislature’s intent is clear and we follow it. If the statutory language "is subject to more than one reasonable interpretation," it is ambiguous and we look to other interpretative tools to assist our inquiry into legislative intent. Id. (citing State v. Mauer , 741 N.W.2d 107, 111 (Minn. 2007) ). We construe words and phrases " ‘according to rules of grammar and according to their common and approved usage.’ " Id. (quoting Minn. Stat. § 645.08(1) (2018) ).

Rodriguez seeks reimbursement from State Farm under the mandatory no-fault provisions of her personal automobile policy. The No-Fault Act provides that "every person suffering loss from injury arising out of maintenance or use of a motor vehicle ... has a right to basic economic loss benefits" if "the accident causing injury occurs in" Minnesota. Minn. Stat. § 65B.46, subd. 1 (2018). Basic economic loss benefits include up to $20,000 in "medical expense loss." Minn. Stat. § 65B.44, subd. 1(a)(1) (2018). "Medical expense benefits shall reimburse all reasonable expenses for [among other things] necessary ... chiropractic ... services ...." Id. , subd. 2(a)(1). State Farm does not contest that, had the accident that caused Rodriguez’s back injury been non-work related, State Farm would be liable to pay for Rodriguez’s chiropractic treatment subject to the limits of the No-Fault Act and its policy.

But a work-related automobile accident causing an injury complicates matters. In those circumstances, the Workers' Compensation Act and the No-Fault Act both provide benefits for injuries. In this situation, however, the Legislature has made it clear that workers' compensation benefits are primary. The No Fault Act provides:

Basic economic loss benefits shall be primary with respect to benefits, except for those paid or payable under a workers' compensation law , which any person receives or is entitled to receive from any other source as a result of injury arising out of the maintenance or use of a motor vehicle.

Minn. Stat. § 65B.61, subd. 1 (2018) (emphasis added). The "primary" nature of workers' compensation benefits is also reflected in language that precludes a no-fault insurer from coordinating to pay basic economic loss benefits with a workers' compensation insurer. See Minn. Stat. 65B.61, subd. 3 (2018) ("Any legal entity, other than [a no-fault insurer] ... or an insurer or employer obligated to pay benefits under a workers' compensation law , may coordinate any benefits it is obligated to pay ... with basic economic loss benefits." (emphasis added)).

The Legislature’s directive that workers' compensation benefits are primary is sufficient to resolve most disputes. If workers' compensation benefits are available, the worker’s compensation carrier must provide coverage and pay for medical expenses related to the on-the-job injury. If the worker’s compensation benefits do not cover an injury, then the no-fault insurer must pay economic loss benefits subject to the restrictions of the No-Fault Act and the particular policy. See Patrin v. Progressive Rehab Options , 497 N.W.2d 246, 248 (Minn. 1993) (holding that a no-fault insurer must pay benefits when a non-work-related automobile accident is not covered by workers' compensation benefits).²

This case falls into an intermediate zone in which workers' compensation benefits cover some—but not all—of the chiropractic expenses reasonably related to Rodriguez’s injury. Stated another way, this is a case where benefits available under the Workers' Compensation Act are more limited than benefits available under the No Fault Act.

Rodriguez’s injuries are covered by workers' compensation benefits because the accident occurred during the course of Rodriguez’s employment. But here, the scope of those benefits is limited by the workers' compensation treatment parameters promulgated by the Commissioner of Labor and Industry at the direction of the Legislature. See Minn. Stat. § 176.83, subd. 5(a) (2018) (providing the Commissioner with the authority to adopt "rules establishing standards and procedures for health care provider treatment"). The treatment parameters are used "to determine whether a provider of health care services and rehabilitation services, including a provider of ... chiropractic ... services, is performing procedures or providing services at a level or with a frequency that is excessive, unnecessary, or inappropriate ...." Id.

The workers' compensation treatment parameters provide, with certain exceptions,³ that workers' compensation benefits will pay for only 12 weeks of chiropractic treatment. See Minn. R. 5221.6200, subp. 3, 5221.6205, subp. 3. Put another way chiropractic treatment is presumptively not payable under workers' compensation law beyond 12 weeks. Accordingly, under Minn. Stat. § 65B.61, State Farm has primary responsibility to pay for the additional chiropractic expenses reasonably related to Rodriguez’s injuries because those medical expenses are not payable under workers' compensation law.

"Not so fast!" says State Farm, pointing to Minn. Stat. § 176.83, subd. 5(c) —the provision of the Workers' Compensation Act at the heart of this dispute. Subdivision 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.

Minn. Stat. § 176.83, subd. 5(c). State...