Michigan Court of Appeals; Docket #354653; Published
Judges Rick, Ronayne Krause, and Letica; Per Curiam
Official Michigan Reporter Citation: Forthcoming; Link to Opinion
PIP Benefits Not Payable for Certain Chiropractic Services [§3107b(b)]
In this unanimous, published, per curiam decision, the Court of Appeals affirmed the trial court’s denial of Defendant State Auto Insurance Company’s (“State Auto”) motion for summary disposition, in which State Auto sought dismissal of Plaintiff Precise MRI of Michigan, LLC’s (“Precise”) first-party action against it. The Court of Appeals held that MRIs of State Auto’s insured’s spine and sacroiliac joints were compensable under the no-fault act, even though they were ordered by a chiropractor.
State Auto’s insured, Airee Martin, injured her neck, lower back, and shoulders in a motor vehicle collision. She received treatment for her injuries from a chiropractor, Hassan Reichouni. Reichouni referred Martin for four MRIs—one of her cervical spine, one of her thoracic spine, one of her lumbar spine, and one of her sacroiliac joints—which were performed by Precise. Martin assigned her right to pursue PIP benefits related to the MRIs to Precise, who, in turn, filed a first-party action against State Auto. State Auto moved for summary disposition, arguing that the MRIs were not compensable under the no-fault act because they were ordered by a chiropractor. More specifically, State Auto argued that, “[under] MCL 500.3107b(b), reimbursement [is] not required for a practice of chiropractic service unless that service was included in the definition of ‘practice of chiropractic’ under MCL 333.16401 as of January 1, 2009.’ ” MRI ordering, State Auto’s argument went, was not included in the definition of “practice of chiropractic” as of January 1, 2009, and thus MRIs, if prescribed by a chiropractor, are not compensable under the no-fault act. The trial court disagreed, denying State Auto’s motion.
The Court of Appeals affirmed the trial court’s denial of State Auto’s motion. While this case was pending on appeal, the Court of Appeals decided Skwierc v Whisnant, ___ Mich App ___ (2021), disposing of this exact issue. The Skwierc Court held that the definition of “practice of chiropractic,” as of January 1, 2009, included “spinal analysis,” and the use of “analytical instruments,” including MRIs, to perform such analysis. Therefore, the Skwierc Court held that MRIs of the plaintiff’s spine were compensable under the no-fault act, even though they were ordered by a chiropractor.
Relying on Skwierc, the Court of Appeals, in this case, held that the MRIs Precise performed on Martin’s cervical, thoracic, and lumbar spinewere compensable under the no-fault act. Furthermore, the Court of Appeals held that the MRI Precise performed on Martin’s sacroiliac joints was compensable under the no-fault act. The Court referred to numerous extraneous definitions of the terms “pelvis” and “spine,” and concluded that sacroiliac joints comprise part of the spine.
“Under MCL 333.16401(1)(b)(iii), the practice of chiropractic includes the ‘use of analytical instruments . . . regulated by rules promulgated pursuant to [MCL 333.16423] . . . for the purpose of locating spinal subluxations or misaligned vertebrae of the human spine.’ In Skwierc, this Court noted that, as of January 1, 2009, ‘analytical instruments’ was ‘defined by rule to mean ‘instruments which monitor the body’s physiology for the purpose of determining subluxated or misaligned vertebrae or related bones and tissues.’ ’ Skwierc, ___ Mich App at ___; slip op at 6, quoting 2006 Annual Admin Code Supp, R 338.12001(b); see also Hofmann, 211 Mich App at 85 (citing earlier version of this rule containing the same language). As Skwierc notes, this Court previously described the nature of an MRI as “a scanning technology that permits detailed, potentially three-dimensional viewing of soft tissue structures within the body-such as muscles, nerves, and connective tissue-without using ionizing radiation; as distinct from x-rays or CT scans, which do subject the body to ionizing radiation and are much less useful for visualizing soft tissue.” Chouman v Home Owners Ins Co, 293 Mich App 434, 442 n 4; 810 NW2d 88 (2011). Thus, Skwierc held that, “when used for an analysis of the spine, it is clear that an MRI falls within the scope of chiropractic practice as it was defined in January 1, 2009.” Skwierc, ___ Mich App at ___; slip op at 6-7, citing Hofmann, 211 Mich App at 87-88. This Court therefore concluded that because an MRI ‘satisfies the definition of ‘analytical instrument,’ its appropriate use is within the practice of chiropractic as of January 1, 2009.’ Skwierc, ___ Mich App at ___; slip op at 7.
Accordingly, we conclude that, under Skwierc, at least three of the four MRIs for which defendant refused to reimburse plaintiff are clearly included within the scope of chiropractic because they were limited to an analysis of the spine and were used to detect and diagnose conditions related to subluxations and misalignments in Martin’s spine. Specifically, three of the MRIs focused on Martin’s cervical, thoracic, and lumbar spine. The summaries of the cervical, thoracic, and lumbar spine MRIs indicated there was no evidence of fractures or subluxation, and little to no disc herniation. Because these three MRIs were limited to an analysis of Martin’s cervical, lumbar, and thoracic spine, their use in such a manner is permitted by MCL 333.16401(1)(b)(i) and (iii), and plaintiff may be reimbursed for performing these scans on Martin. Skwierc, ___ Mich App at ___; slip op at 5-7.
. . .
We conclude that the definition of ‘pelvis’ and ‘spine’ in The Attorneys’ Dictionary of Medicine, Hofmann’s discussion of the pelvis, and the Mayo Clinic’s description of the SI joints, lead to the conclusion that the SI joints comprise part of the spine. The summary of the SI joint MRI indicates Martin complained of pain in her SI joints and sacrum. The summary also indicates a finding that the ‘sacrum and coccyx . . . appear[ed] to be intact’ and ‘[n]o abnormal soft tissue structure [was] seen anterior or posterior to the [SI] joints.’ Because the SI joints include the sacrum, a part of the spine, and the MRI was limited to Martin’s SI joint,8 the use of the MRI to analyze Martin’s SI joints is permitted by MCL 333.16401(1)(b)(i) and (iii). Skwierc, ___ Mich App at ___; slip op at 5-7. As such, plaintiff may also be reimbursed for the fourth MRI of Martin’s SI joints.”