Durant v. State Farm Mut. Auto. Ins. Co., 419 P.3d 400

Plaintiff Brett Durant (State Farm policyholder with PIP coverage) injured in a 2012 auto accident and received ongoing chiropractic and related care beyond an initial target date for maximum medical improvement (MMI).
State Farm denied payment of continued medical bills asserting the policy requires services be “essential in achieving maximum medical improvement,” and relied on MMI as a basis to deny PIP claims.
Durant sued, alleging breach of contract, bad faith, and statutory violations; the federal district court certified a class and submitted two certified questions to the Washington Supreme Court about the use of MMI.
WAC 284-30-395(1) permits denial, limitation, or termination of PIP benefits only if services are not reasonable, not necessary, not related to the accident, or not incurred within three years of the accident.
The Office of the Insurance Commissioner (OIC) filed an amicus brief opposing carriers’ use of additional criteria like MMI; the record showed State Farm applied MMI as a primary criterion to deny benefits.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether an insurer violates WAC 284-30-395(1)(a)/(b) by denying, limiting, or terminating PIP benefits based on a finding of MMI	Durant: WAC 284-30-395(1) lists the only permissible bases for denial; MMI is not among them, so using MMI to deny benefits violates the regulation	State Farm: MMI is a definitional/clarifying limit on “necessary” care (or an approved policy form); OIC approval and other contexts support MMI use	Held: Yes. Using MMI as a basis to deny, limit, or terminate PIP benefits violates WAC 284-30-395(1) because the regulation permits only the listed grounds
Whether the term “MMI” is consistent with the ordinary meaning of “reasonable” or “necessary” in WAC 284-30-395(1)	Durant: MMI is more restrictive than “reasonable” and “necessary”; palliative/maintenance care can be reasonable/necessary and must be covered	State Farm: Analogizes to workers’ compensation and maritime doctrine where MMI ends payment for further treatment that only relieves pain	Held: No. Under the record here, MMI is not consistent with the ordinary meanings of “reasonable” or “necessary” in the regulation; excluding maintenance/palliative care conflicts with PIP public policy

Brady v. Autozone Stores, Inc., 188 Wn.2d 576 (review of certified questions; de novo review)
Carlsen v. Global Client Sols., LLC, 171 Wn.2d 486 (federal certified-question procedure)
Kroeber v. GEICO Ins. Co., 184 Wn.2d 925 (insurer cannot include terms inconsistent with mandated provisions)
Liberty Mut. Ins. Co. v. Tripp, 144 Wn.2d 1 (insurer cannot diminish statutorily mandated coverage by policy language)
Boeing Co. v. Aetna Cas. & Sur. Co., 113 Wn.2d 869 (undefined insurance contract terms get ordinary meaning and can consult dictionaries)
Sherry v. Fin. Indem. Co., 160 Wn.2d 611 (public policy favoring full compensation for automobile accident victims)