| "Michigan's no-fault insurance system has at its core the premise - and the promise, of wide-ranging medical benefits from the available spectrum of providers ..." -Michigan Court of Appeals ruling |
On June 1, the Michigan Court of Appeals ruled unanimously that Farmers Insurance Exchange and Mid-Century Insurance Company violated state law by adding an illegal provision to their no-fault automobile insurance policies. The ruling upheld a circuit court decision involving a case brought against Farmers and Mid-Century by the Michigan Chiropractic Council (MCC - forerunner of the Michigan Chiropractic Association) and the Michigan Chiropractic Society (MCS), which accused the insurers of engaging in "unfair, deceptive and misleading trade practices."
The provision stipulated that Farmers policyholders would receive a 40 percent reduction on their personal-injury protection (PIP) premium if, after being injured in an accident, they chose to obtain treatment from a provider in the insurance company's managed care network. However, if a policyholder chose the network option, but subsequently went out of the network for treatment, he or she would be required to pay a $500 deductible. The deductible would not be charged to policyholders who stayed in the network for the duration of care.
The Michigan Office of Financial and Insurance Service approved the provision in July 2000. However, the MCC and MCS believed that Farmers' provision conflicted with the state's no-fault insurance law, which was enacted in 1972 as a fee-for-service system with regard to health care benefits.
According to the law, every person of driving age in Michigan is required to purchase no-fault insurance to legally operate a motor vehicle. In exchange for this requirement, individuals involved in motor vehicle accidents receive certain insurance benefits in the event of injury, including PIP insurance, which covers "all medical costs and expenses occasioned by injuries sustained in a motor vehicle accident, including expenses for rehabilitation."
In August 2000, the MCC and MCS requested a hearing with the commissioner of financial and insurance service, and alleged that Farmers' provision was unlawful. They also alleged that Farmers' practices were "unfair, deceptive and misleading" and violated state law. However, the commissioner denied the groups' request for a hearing, citing a failure to show probable cause.
In the wake of the commissioner's decision, the MCC and MCS filed a suit in a Michigan circuit court in 2002. Upon review, the circuit court reversed the commissioner's decision and found that Farmers' managed care option was not authorized by law. It further concluded that the authority to incorporate managed care networks into the no-fault system was a matter for the state legislature to decide, not the insurance commissioner. The circuit court's decision was challenged by the insurance companies and sent to the Michigan Court of Appeals for consideration.
The court of reviewed the no-fault law and Farmers' preferred provider option (PPO) endorsement on its no-fault insurance policy. It concluded that the no-fault law inherently provides a series of far-reaching benefits - benefits that could be "fundamentally altered" under the insurance company's managed care network. It also found that Farmers' PPO endorsement was written is a way such that policyholders could be deceived through the reduction in their PIP premiums.
In the opinion of the court [excerpted; emphasis ours]:
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
