If you have ever taken on a auto accident case, you know the general rule that the Michigan No-Fault Act covers all of a person’s medical expenses. But there are some exceptions to that rule. Before you promise your no-fault client that you will get all of his or her medical expenses covered, make sure you get specific about any chiropractic care.
The Michigan No-Fault Act directs insurance companies to pay PIP benefits for reasonable and necessary medical expenses related to an auto accident. But when it comes to chiropractic care, the Legislature decided to get specific. A recent published Michigan Court of Appeals case, Measel v Auto Club Group Insurance Company, goes through all the details.
On August 28, 2012, Jenifer Measel was injured in an auto accident. Three days later, she went to a chiropractor, Dr. Batanjski of Complete Care Chiropractic. Dr. Batanjski performed a new patient examination and prescribed a series of ultrasound and massage therapy for her neck and spine.
The clinic billed both Auto Club and Blue Cross Blue Shield of Michigan for its chiropractic care, but both insurance company denied coverage of those treatments. The auto insurance company claimed the costs were not “reimbursable as an allowable expense under the Michigan No-Fault Act.”
Chiropractic Care Under the Michigan No-fault Act
The question of whether chiropractic care is reimbursable as a PIP benefit depends on MCL 500.3107b:
Reimbursement or coverage for expenses within personal protection insurance coverage under [MCL 500.3107] is not required for any of the following: . . . (b) A practice of chiropractic service, unless that service was included in the definition of practice of chiropractic under section 16401 of the public health code, 1978 PA 368, MCL 333.16401, as of January 1, 2009.
This version of the chiropractic care statute was created in connection with MCL 333.16401, which expanded the definition of the “practice of chiropractic” within Michigan’s Public Health Code. The court indicated that, in passing these two laws, the Legislature addressed tension between chiropractors and insurance providers. When read together, these two laws determine whether an auto insurance company is required to reimburse a medical provider for chiropractic care.
3 Steps to Chiropractic Care Coverage
In deciding whether a particular service is reimbursable, the Michigan Court of Appeals applied three steps.
1. Is the Chiropractic Care Reasonable and Necessary?
For any medical treatment to be covered, it must be reasonable and necessary for the treatment of an injury resulting from the use of a motor vehicle. Chiropractic care is no different. So Step 1 is to determine whether the chiropractic care would be a recoverable medical expense generally.
In Measel, Auto Group agreed that the treatments were reasonable and necessary to treat Measel’s auto-related injuries.
2. Is the Treatment “A Practice of Chiropractic Service”?
The only services that can be excluded based on MCL 500.3107b(b) fall within the definition of “a practice of chiropractic service” under MCL 333.16401. That law includes an exhaustive list of services that fall within the “discipline within the healing arts that deals with the human nervous system and the musculoskeletal system and their interrelationship with other body systems.”
The court ruled that the new patient examination, ultrasound therapy, and massage therapy that Measel received all fall within the current definition of a “practice of chiropractic.” That means the treatments could be excluded from recovery.
3. Was the Treatment Part of the 2009 Definition of Chiropractic Care?
Chiropractic care is not a reimbursable expense unless the treatment fell within the definition of “practice of chiropractic” as of January 1, 2009. The expanded services included in more recent versions of the Public Health Code won’t be covered.
Diagnostic examinations of anything but the spine cannot be covered. Nor can treatments intended to address “whole body systems”. The court decided that these exclusions included the ultrasound and therapeutic massage treatments Measel received from Dr. Batanjski of Complete Care Chiropractic.
Implications of Measel on Chiropractic Care
The court’s decision in Measel has essentially frozen the progress of chiropractic care over 5 years in the past. The interpretation of MCL 500.3107b and MCL 333.16401 together creates a growing gap between the modern practice of chiropractic care and what will be covered by Michigan’s no-fault insurance policies.
Auto accident attorneys need to make sure their clients’ claims don’t fall into the gap. Before promising to get all of a person’s medical expenses covered, make sure you dig deeply into the details of your client’s chiropractic care. If you don’t, your recovery could fall short of your promise.
David Christensen is an auto accident attorney at Christensen Law in Southfield, Michigan. He has over 20 years experience dealing with the intricacies of the Michigan No-Fault Act. If your client has a complicated no-fault matter, contact Christensen Law today for a referral.