Michigan Court of Appeals; Docket # 324261; Published
Judges Cavanagh, Riordan, and Gadola; Unanimous; Opinion by Judge Gadola
Official Michigan Reporter Citation: Not Applicable; Link to Opinion 
STATUTORY INDEXING:
PIP Benefits Not Payable for Certain Chiropractic Services [§3107b(b)]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this published Opinion written by Judge Gadola, the Court of Appeals held that chiropractic services provided to plaintiff were not reimbursable under MCL 500.3107b(b), because some of the chiropractic treatment did not come within the “practice of chiropractic,” as that term is defined in MCL 333.16401 (the Public Health Code).
The plaintiff in this case received ultrasound therapy and massage therapy from a chiropractic clinic, after she sustained injuries in an auto accident. Defendant, Auto Club Group Insurance, refused to reimburse the chiropractic clinic for the services it had provided, claiming the charges were for services “outside the scope of chiropractic” and not allowable expenses under §3107. The plaintiff then filed this action, seeking coverage. The trial court held the chiropractic services were reimbursable.
The Court of Appeals reversed, finding that although chiropractic care generally falls under §3107, plaintiff was not entitled to benefits under §3107b(b), which specifically governs chiropractic services.
In so holding, the Court of Appeals explained that §3107b(b) provides that PIP coverage under §3107 is not required for chiropractic services unless those services are included in the definition of “practice of chiropractic” in §16401. Looking to §16401(1)(e)’s definition of “practice of chiropractic,” the court said:
“’Practice of chiropractic’ means that discipline within the healing arts that deals with the human nervous system and the musculoskeletal system and their interrelationship with other body systems. Practice of chiropractic includes the following: (i) The diagnosis of human conditions and disorders of the human musculoskeletal and nervous systems as they relate to subluxations, misalignments, and joint dysfunctions. These diagnoses shall be for the purpose of detecting and correcting those conditions and disorders or offering advice to seek treatment from other health professionals in order to restore and maintain health. (ii) The evaluation of conditions or symptoms related to subluxations, misalignments, and joint dysfunction through any of the following: (A) Physical examination. (B) The taking and reviewing of patient health information. (C) The performance, ordering, or use of tests. The performance, ordering, or use of tests in the practice of chiropractic is regulated by rules promulgated under section 16423. (D) The performance, ordering, or use of x-ray. (E) The performance, ordering, or use of tests that were allowed under section 16423 as of December 1, 2009. (iii) The chiropractic adjustment of subluxations, misalignments, and joint dysfunction and the treatment of related bones and tissues for the establishment of neural integrity and structural stability. (iv) The use of physical measures, analytical instruments, nutritional advice, rehabilitative exercise, and adjustment apparatus regulated by rules promulgated under section 16423.”
Based on this definition, the Court of Appeals said the chiropractic services rendered to plaintiff did not meet the statutory requirements. In so holding, the court explained:
“Considering [the] testimony, it does not appear that [the doctor] limited her examination [of plaintiff] to the spinal source of any subluxations or misalignments. Therefore, the new patient examination exceeded the scope of the definition of ‘practice of chiropractic’ under MCL 333.16401 .... Regarding the ultrasound and massage therapy [plaintiff received], ... our Supreme Court specifically held that ‘the use of ... ultrasound devices for therapeutic purposes ... [was] outside the scope of chiropractic,’ pursuant to former MCL 333.16401. Likewise, our Supreme Court explained that ‘[t]here is nothing in [the] wording [of former MCL 333.16401] which shows an intent to authorize the treatment of areas other than the human spine.’ The notes from [plaintiff’s] massages indicate that during each massage, therapists spent time massaging [her] extremities. Accordingly, the massages do not fall within the former definition of ‘practice of chiropractic’ under MCL 333.16401 because they involved treatment to areas other than [plaintiff's] spine.”
While the Court of Appeals noted the chiropractic services provided to plaintiff fell within §3107 because Auto Club acknowledged the services were lawfully rendered and reasonably necessary for plaintiff’s care, the court held that Auto Club was not responsible for paying the expenses. In this regard, the court concluded:
“[B]ecause each of the disputed services was ‘[a] practice of chiropractic service’ that did not fall within the definition of ‘practice of chiropractic’ under MCL 333.16401 … MCL 500.3107b(b) provides that reimbursement for the services was not required under Michigan’s no-fault act. Reversed and remanded for further proceedings consistent with this opinion.”
