In State Farm v. Cavoto, a Pennsylvania appellate court decided a battle between two parties that are always at odds, State Farm and chiropractors. Usually, the skirmishes between these parties are fought by proxy but, in this case they faced off directly.
Essentially, State Farm got fed up with paying chiropractors who were billing for adjunctive procedures performed by support staff who were not licensed. Particularly, and arguably understandably, annoying to State Farm was unlicensed people applying hot and cold packs, turning on and off mechanical devices, using a traction machine and assisting in therapeutic exercises. I’m sure that most infuriating to State Farm is paying for someone without medical training to apply hot and cold packs. If you can’t see why the insurer takes exception to that -regardless of how you view the merits of it – you may have had one drink too many from the plaintiffs’ attorney Kool-Aid.
The appellate court didn’t look at the case quite that way. Instead, the court applied the law that appears to allow unlicensed staff members to provide some treatment. The court reasoned that the real medical care was the decision to give the hot or cold packs and for how long, not who applied them. Similarly, the court reasoned, most elements of applying electrical muscle stimulation, ultrasound, and the like do not require specialized skills, as long as there is a chiropractor making the decisions about the details and how the therapy should be applied. Accordingly, the court remanded the case back to the trial court to “make more specialized findings and determine whether any of the procedures allegedly performed by unlicensed personnel required formal chiropractic education or training, including further inquiry by the court as to the scope of those procedures.”
I think the court made the right ruling. I don’t think State Farm, at heart, disagrees. It has well placed bitterness is towards chiropractors that are not really providing detailed care to patients but are instead running factories where a patient comes in, a factory worker puts ice or heat on where the patient says there is pain, and then a bill for medical services gets generated. The company sees these bills from these providers and they just go ballistic.
I can see why these adjusters finds some of these medical bills over the top. The problem is that State Farm is the ultimate man with a hammer. Every plaintiff and every medical provider (and, oh, yeah, every personal injury lawyer) is a nail.. a money grubbing villain seeking something to which they are not entitled. Because there are some bad doctors and chiropractors and some people are manufacturing or magnifying symptoms, their adjusters conclude that every case – including those with objective injury – is garbage.
Certainly, in large measure, I’m using State Farm synonymously with insurance companies. But this company drinks more than its industry share of “all plaintiffs and personal injury lawyers are our mortal enemies” Kool-Aid. I’m certainly over-generalizing. Every individual adjuster is different and some of the most reasonable adjusters and some of their in-house counsel are the best. But pull up verdict sheets in Maryland sometime and look at who the insurance companies are. These “good neighbors” have a much higher percentage of verdicts than its market share would suggest. As a result, it takes more large verdicts than most insurance companies. But I’ll bet they also get a disproportionate share of defense verdicts. It is feast or famine.
Furthering my point, it appears this entire lawsuit is a part of an ongoing war with some medical providers. In another lawsuit, the named chiropractor defendant in this case is a plaintiff against SF in which the chiropractor alleged civil conspiracy and abuse of process against SF’s lawyers. The chiropractor alleged in that lawsuit that the insurance company’s counsel abused the legal process as a pretext to investigate the chiropractic’s office. Then, the company files a lawsuit and lists this guy as the first defendant. Coincidence? I doubt it. For most insurance companies, it is all business. There is no spite involved and certainly no revenge lawsuit like this appears to be (at least in part). Generally, insurance companies just coldly maximize profits and that’s it. With this one, for whatever reason, it seems more personal.
- Sample demand letters
- The opinion in State Farm v. Cavoto
- Another lawsuit involving State Farm and Cavoto (I guess Assurance did not want to provide a defense for State Farm’s lawyers)
- Speaking of crusades, this is one chiropractor’s lawsuit against State Farm, bringing up all of the junk that McKinsey suggested to them about waging war on plaintiffs. I’ve never fully understood why plaintiffs’ lawyers get so worked up about McKinsey’s advice to insurance companies. If State Farm wants to get tough with plaintiffs, that is its right. That is why we have jury trials.