Western National Insurance Company vs. Nguyen, A17-0314 (Minn. Ct. App. September 18, 2017)
On September 18, 2017 the Court of Appeals of Minnesota released its decision in Nguyen. This decision is of benefit to no-fault insurers throughout Minnesota.
Facts
Nguyen sustained injuries in a January, 2011 car accident. The accident occurred in the course and scope of Nguyen’s employment and while he was driving his employer’s vehicle. Nguyen’s employer initially paid injury-related medical expenses pursuant to Minnesota workers’ compensation law. After those benefits ended, Western National paid no-fault benefits to Nguyen. Fifteen months after the accident, Western National had Nguyen attend an independent medical exam which examiner concluded that no further medical treatment was reasonable, necessary nor causally related to the January, 2011 accident. Western National notified Nguyen and his attorney of the denial of future no-fault benefits. Nguyen filed for no-fault arbitration and in January, 2013, two years after the 2011 accident, the no-fault arbitrator denied Nguyen’s no-fault claim in its entirety.
After the unfavorable arbitration award, some thirteen months later, Nguyen started treating with a new care provider. That care provider submitted its single bill to no-fault insurer Western National. Within two months of its submission, no-fault insurer Western National responded to the care provider, denying no-fault coverage based on the previous IME and the January, 2013 arbitration award denying benefits to Nguyen.
Nguyen continued treating with that care provider but the care provider never submitted additional bills to no-fault insurer Western National. By the end of 2014, Nguyen’s multiple treatment charges exceeded ten thousand dollars ($10,000.00).
Two years later, Nguyen filed for no-fault arbitration against Western National seeking payment for the care provider’s bill. In response, no-fault carrier Western National asserted that Minn. Stat. § 62Q.75 subd.3 as a defense. In the new no-fault proceeding, the arbitrator awarded all of the care and treatment medical expenses, interest and attorneys’ fees.
No-fault insurer Western National moved the district court to vacate the arbitration award. The district court granted no-fault carrier Western National’s vacatur motion on all but $1,027.25 of the care expenses. The only medical bill ordered to be paid was the first bill submitted from 2014. That one bill was the only bill submitted by the care provider to no-fault insurer Western National. The remaining bills were never submitted to Western National pursuant to the Uniform Electronic Transaction Standards. See Minn. Stat. § 65B.54, subd.1. The district court additionally determined that Nguyen was not personally obligated to pay the outstanding bills.
Nguyen appealed.
Issues
Did the trial court “err by applying Minn. Stat. § 62Q.75, subd. 3, to conclude that Nguyen did not suffer a ‘loss’ under Minn. Stat. § 65B.54, subd. 1, that would entitle him to no-fault benefits?”
Answer: No.
The Court of Appeals of Minnesota ruled as follows:
…if the health-care provider does not follow the statutory method for submitting bills to the [no-fault] insurer, that claim is not due….[The care provider] did not submit the bills to [no-fault insurer] Western National, so [the health care provider] could not have complied with the electronic transaction statute standards required by Minn. Stat. §65B.54, subd. 1….[The health care provider] cannot seek payment from Nguyen….The Court of Appeals of Minnesota concluded [that because [the health care provider] did not submit its charges to [no-fault insurer] Western National within the time period required…Nguyen never incurred medical expense and thus a loss never accrued….The charges presented [for arbitration] were [never]…transmitted to [no-fault] Western National [as required by statute], the benefits never became due. Therefore, Nguyen never suffered a loss for which he is entitled to no-fault benefits.
Issue II – Did the district court err by vacating the award of arbitration fees?
ANSWER: Yes.
The record was not clear on whether Western National waived its right to challenge the $300 arbitrator’s fees and whether the $35 filing fee had been paid.
BEST PRACTICE
Health care providers need to promptly submit their bills for services rendered to or on behalf of a no-fault claimant within the time prescribed by law. By no-fault statute and pursuant to the Minnesota Health Plan Contracting Act that means the bills must be submitted within 6 months and the no-fault carrier must pay the submitted bill or deny it within 30 days of receipt. This decision is consistent with Minnesota statutes and Minnesota law encouraging the prompt submission and payment of care bills.
If the care provider fails to submit its bill to the no-fault carrier in a timely manner and/or fails to deny it in a timely manner, there may be no loss found such that the no-fault carrier and its insured owe no sums to that dilatory and miscreant health care provider.
For questions on this or similar cases please contact JLO attorneys Lawrence M. Rocheford or Tessa M. McEllistrem.