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06/25/2008

Appeals Court Case Puts PI Assignments at Risk

A decision earlier this month by the 10th District Court of Appeals in Ohio puts at risk the ability of DC's to receive assignments from patients in personal injury cases.  The Court, in West Broad Chiropractic vs.
American Family Insurance, held that a patient could <u>not</u> assign a potential court award or insurance settlement to a health care provider before that settlement or award is granted.  Ironically, the West Broad case followed an appellate victory for DC's two days earlier in Cartwright Chiropractic v. Allstate, in the 12th District Court of Appeals, covering Butler, Warren, Preble, Clinton, Fayette, Madison, Clermont and Brown counties.

Many DC's in Ohio use assignments in personal injury cases.  Essentially, the patient "assigns" their settlement check to the chiropractic physician to
ensure that the DC is paid for services performed after an accident.  The decision-at least temporarily- will make these assignments  invalid against an "at-fault" insurer  in  Franklin County, but more troubling, it threatens to spur on insurer resistance in other portions  of the state where insurers had dropped resistance, and have been voluntarily complying with these proceeds assignments.

"It surprised us," said Woody Woodward, Executive Director of the OSCA.  "Numerous common pleas and appellate courts in Ohio have ruled that these assignments are legal in cases which are no different from this one."  Prior to this appellate decision, six appellate decisions held that medical proceeds assignments were valid payment mechanisms, and that third party insurers could not ignore them.

OSCA Legal Counsel Tom Froehle has been very active on behalf of OSCA members since the case was decided in early June.  Froehle, who has had
numerous conversations with attorney John Lowry, who was instrumental in creating the assignment program used by many DC's, expects the case to
come before the Ohio Supreme Court.

"In simple terms, West Broad has asked the 10th District Court of Appeals to certify that a conflict exists between their decision and other Courts of Appeals decisions.  If they agree there is a conflict, the matter will go to the Ohio Supreme Court," Froehle explained.  He believes that the 10th District will certify the conflict.  If not, the case could still be appealed directly to the Supreme Court.  "Either way," he said, "Supreme Court action is likely."

Once a legal course of action is set, the OSCA will determine its next steps.  "What we know is that we'll do everything we can to protect our many members who use these assignments," Woodward said.  "That could certainly include briefing the case at the Supreme Court as well as getting other provider groups on board."  As part of that effort, Woodward
and OSCA lobbyist Dan Leite met on Monday with the Ohio Healthcare Provider Coalition to explain the case and begin to seek support.  Representatives of at least eight other health care providers groups are
reviewing the case this week.  Woodward also did not rule out a legislative remedy for the problem should the Supreme Court agree with the 10th District.

For OSCA members currently utilizing assignments, the attached map details what court actions have been taken in this area. (Map-Ohio Counties Upheld Assignment) Doctors utilizing these assignments should be aware that conflicts do exist between appellate districts and that assignments made in Franklin County may not be held up in court against third party insurers. John Lowry has stated to the OSCA that they remain valid against attorneys and the patient's own vehicle insurer in Franklin County, while action is taken to address this recent decision.

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