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A Better Partnership
February 12, 2016

COA – Reimbursement for chiropractic services not required under Michigan No-Fault Act as services did not fall under 2009 definition of “practice of chiropractic service”

Under MCL 500.3107b(b), an auto insurance company is not required to reimburse an insured for certain chiropractic services, even though the services were lawfully rendered and reasonably necessary, because the disputed services they did not fall within the definition of “practice of chiropractic” as the definition existed on January 1, 2009, held the Michigan Court of Appeals in Measel v. Auto Club Insurance Company, No. 324261
 
In 2012, Jenifer Measel, an insured of Auto Club Group Insurance Company (“Auto Club”), suffered injuries from an automobile accident.  As part of her treatment Measel received chiropractic services, including a new patient examination, ultrasound therapy, and massage therapy.  The chiropractic services provider billed Auto Club for the services and Auto Club denied reimbursement claiming that the services “were outside of the scope of chiropractic in Michigan,” and therefore “not reimbursable as an allowable expense under the Michigan No-Fault act.”  Measel then filed this lawsuit.  In its motion for summary disposition, Auto Club argued that the services fell outside the definition of “practice of chiropractic” as it existed on January 1, 2009, under Michigan’s Public Health Code, MCL 333.1101 et seq., and therefore it was not required to reimburse the services under MCL 500.3107b(b).  Measel argued that the services were reimbursable because they fell under the current definition of “practice of chiropractic” under MCL 333.16401, which she argued was enacted to replace the prior definition.  The district court, and on claim of appeal, the circuit court, agreed with Measel that these services were reimbursable under Michigan’s No-Fault Act; Auto Club appealed.
 
On appeal, Auto Club reasserted its argument that it was not required to reimburse the services under MCL 500.3107b(b).  The Court of Appeals agreed.  Under the Michigan No-Fault Act, insurance benefits are payable to cover lawfully rendered and reasonably necessary medical expenses for an insured, MCL 500.3107, subject to an exception, which provides, “[r]reimbursement or coverage for expenses within personal protection insurance coverage . . . 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 . . . as of January 1, 2009.” MCL 500.3107b(b).  Here, the Court concluded, Measel’s chiropractic services did not fall within the January 1, 2009, definition of “practice of chiropractic,” and therefore, reimbursement of the services was not required under Michigan’s No-Fault Act.  Measel also argued that because the services were performed by technicians and therapists, rather than the doctor, they were not chiropractic services.  The Court found her argument unpersuasive because MCL 333.16215(1) allows a licensee to delegate tasks to a qualified individual, thus they were operating under the doctor’s delegation.  The Court of Appeals reversed and remanded the case for further proceedings.      

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