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
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
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 ,
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
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.
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
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.
Notes
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 ,
