A no-fault auto insurer must reimburse reasonable chiropractic expenses not covered by workers' compensation benefits, even if a different provider furnishes the care.
Outcome: Affirmed for respondent.
Rodriguez v. State Farm Mut. Auto. Ins. Co.
What happened
The facts of the case, in plain language.
Rodriguez, a bus driver, was injured in a motor vehicle accident that occurred during her employment.
Old Republic, the workers' compensation insurer, refused to pay for chiropractic care beyond twelve weeks, based on treatment parameters adopted under the Workers' Compensation Act.
After her initial chiropractor (ChiroFirst) stopped treatment at twelve weeks, Rodriguez sought and received additional chiropractic services from Core Health Chiropractic.
Old Republic determined only that ChiroFirst's services were excessive and made no determination concerning the services provided by Core Health.
What the court decided
A bus driver injured in a work-related automobile accident received chiropractic treatment. Her workers' compensation insurer paid for twelve weeks of care but refused to pay beyond that, citing treatment parameters. She sought reimbursement from her personal auto no-fault insurer for additional chiropractic care from a different provider. The no-fault insurer denied coverage, arguing that the Workers' Compensation Act prohibited reimbursement. The Minnesota Supreme Court held that the statute's prohibition applies only to the specific provider whose services were deemed excessive by the workers' compensation payer. Because the workers' compensation insurer had not determined that the second provider's services were excessive, the no-fault insurer must reimburse the injured worker for reasonable chiropractic expenses under the No-Fault Act.
- The reimbursement prohibition in Minn. Stat. § 176.83, subd. 5(c) extends only to the specific provider whose treatment the workers' compensation payer determined to be excessive, unnecessary, or inappropriate; it does not bar a different provider—whose services have never been so determined—from seeking reimbursement from any source, including a no-fault insurer. (*637)
- When workers' compensation benefits do not cover a medical expense because that expense falls outside the workers' compensation treatment parameters, the no-fault insurer has primary responsibility under Minn. Stat. § 65B.61 to pay for that expense, subject to the No-Fault Act's limits. (*636)
How the court reached its decision
The court's reasoning, step by step.
Whether the phrase 'the provider' in Minn. Stat. § 176.83, subd. 5(c) bars any provider of a type of treatment already deemed excessive by the workers' compensation payer from seeking reimbursement, or only the specific provider whose services were actually adjudged excessive. Old Republic, the workers' compensation payer, determined only that ChiroFirst's services were excessive after twelve weeks. Old Republic made no determination that Core Health's services were excessive, and Rodriguez never sought workers' compensation reimbursement for Core Health's services. Accordingly, Core Health is not 'the provider' identified in the conditional clause of subd. 5(c), and is not a provider offering services 'under' the workers' compensation regime for purposes of that subdivision. Core Health is not barred by § 176.83, subd. 5(c) from being reimbursed, and Rodriguez is not barred from seeking no-fault benefits from State Farm for Core Health's chiropractic services.
Whether State Farm's alternative readings—that 'the provider' means any provider delivering a type of treatment already deemed excessive, or that any other reading produces an absurd result—are reasonable interpretations of subd. 5(c). State Farm's 'any provider' reading requires replacing 'the' with 'any'—directly contrary to precedent treating 'the' as a word of limitation—and effectively rewrites the statute to say 'a procedure or service provided to an injured worker' rather than 'a procedure or service of a provider.' Moreover, State Farm's reading would produce a curious, not merely inconvenient, result: it would bar an injured worker from paying for chiropractic care out of pocket, a result the Legislature almost certainly did not intend. This does not rise to the rare case where plain language utterly confounds legislative purpose. State Farm's alternative interpretations are unreasonable and are rejected; the plain language reading neither renders the statute superfluous nor produces an absurd result.
Key quotes from the opinion
Notable passages from the opinion, in the court's own words.
Cases the court relied on
Earlier decisions the court cited as authority for its ruling.
Full opinion
The complete text of the court's opinion as published.
Opinion of the Court
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 *634the 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
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,
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. ,
ANALYSIS
This case presents us with a purely legal issue-determining the meaning of
Rodriguez seeks reimbursement from State Farm under the mandatory no-fault provisions of her personal automobile policy. The No-Fault Act provides that "every *635person 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 ...."
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 ,
*636This 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
The workers' compensation treatment parameters provide, with certain exceptions,
"Not so fast!" says State Farm, pointing to
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.
Rodriguez responds that State Farm ignores the statute's plain language and structure. She argues that the only "provider" that
The statutory interpretation question, then, is this: Does the phrase "the provider" who "shall not be reimbursed" refer only to the specific provider whose services the workers' compensation payer determined to be excessive, unnecessary, or inappropriate, or does the phrase "the provider" refer to any provider who treats an injured worker regardless of whether the worker sought coverage for the treatment from the workers' compensation payer? We conclude that the only reasonable interpretation of
This conclusion is compelled by the language and structure of the statute. Subdivision 5(c) is structured as a conditional statement: If a workers' compensation payer determines that the level, frequency, or cost of a procedure or service of "a provider" is excessive, unnecessary, or inappropriate under the workers' compensation treatment parameters, then "the provider" who was deemed to have provided those services cannot seek reimbursement. See Meyer v. Nwokedi ,
This conclusion is buttressed by the use of the definite article "the" in identifying the person or entity subject to the reimbursement prohibition. We have recognized that the definite article "the" is a "word of limitation that indicates a reference to a specific object." Riggs ,
Old Republic-the workers' compensation payer in this case-determined only that ChiroFirst's services were excessive. It made no such determination for Core Health. Consequently, Core Health is not *638"the provider" that is barred by
Our conclusion is further supported by the fact that the word "provider" as used in subdivision 5(c) is shorthand for the phrase "health care provider" used earlier in subdivision 5.
State Farm counters that the focus of
We disagree. State Farm ignores that the phrase "procedure or service" in the first section of the subdivision is modified by the prepositional phrase "of a provider."
Alternatively, State Farm contends that the phrase "the provider" in subdivision 5(c) really means any provider that furnishes a treatment or service deemed excessive, unnecessary, or inappropriate because any other reading would allow an injured worker to side-step the treatment parameters simply by switching chiropractors every 12 weeks. State Farm asserts that this is an "absurd result" and renders subdivision 5(c) superfluous. We find these arguments unconvincing.
*639First, replacing the limiting definite article "the" with the word "any"-a much broader quantifier that could refer to one or more of something-is impermissible. Such a replacement runs directly counter to our precedent that identifies the word "the" as an important word of limitation, see, e.g. , Struzyk ,
Moreover, we have been reluctant to displace the plain language of a statute on the grounds of "absurdity." See Schatz v. Interfaith Care Ctr. ,
Our plain language reading of the statute neither frustrates the purpose of
Indeed, if anything, State Farm's interpretation of subdivision 5(c) would lead to *640some curious results. In particular, if State Farm is correct, Rodriguez could not pay Core Health for chiropractic services out of her own pocket, essentially barring Rodriguez from ever receiving chiropractic treatment. See
In sum, the plain language of
CONCLUSION
For the foregoing reasons, we affirm the court of appeals' decision to reinstate Rodriguez's arbitration award.
Affirmed.
Following oral arguments, we ordered supplemental briefing on a narrow question: What does the term "the provider" mean as used in
Despite the primary nature of workers' compensation benefits, the Workers' Compensation Act and the No-Fault Act work together. Record v. Metro. Transit Comm'n ,
An insurer may , under certain circumstances, pay for coverage beyond that 12-week limit. See
State Farm is also incorrect when it claims that the workers' compensation treatment parameters serve the incredibly ambitious role of holding down costs across the entire health care industry. In the years leading up to 1983, the Legislature recognized growing concern over increasing workers' compensation premiums. The purpose of establishing the workers' compensation treatment parameters in general was much more targeted: To control or reduce workers' compensation insurance premiums by controlling the growth of health care costs within the workers' compensation system. See Leslie Altman et al., Minnesota's Workers' Compensation Scheme: The Effects and Effectiveness of the 1983 Amendments ,
Continue your research
- Later cases interpreting or applying Minn. Stat. § 176.83, subd. 5(c) reimbursement prohibitions
- Minnesota cases applying the definite-article limitation principle from Riggs and Struzyk to other statutory terms
- Secondary sources on coordination of no-fault and workers' compensation benefits for work-related automobile accidents
Case-law data current through December 31, 2025. Source: CourtListener bulk data.