The present case involves an insurance dispute between Plaintiff Charles Mounce and Defendant USAA General Indemnity Company about subrogated funds and claims handling.
On October 3, 2017, Mounce was injured in a motor vehicle collision while he was riding as a passenger in Pyles vehicle. The vehicle was covered under USAA Policy 024029075G71011 (Hereinafter “USAA Policy”). As such, Mounce was covered under the USAA Insurance Policy. The USAA Policy provides coverage to Mounce in the amount of $10,000 (hereinafter “USAA PIP”).
On October 9, 2017, USAA informed Mounce that he was covered under Pyles’s PIP policy and explained its subrogation interest in damages received from Fox or his insurer, State Farm. Between November 2017 and October 2018, USAA paid Mounce’s medical providers a total of $9,910.45 for his various treatments. State Farm issued USAA payment for the subrogated amount of $9,910.45 in early September 2020.
On February 16, 2021, Mounce sent USAA an Insurance Fair Conduct Act (IFCA) notice stating that “USAA accepted settlement funds from the third party carrier when USAA was not entitled to those funds as Mounce was not fully compensated for his loss,” and “USAA must immediately disgorge those funds and send them to Mounce to help compensate him for his loss.”
Plaintiff Mounce disclosed Michael W. Chan as his chiropractic expert witness to review his medical treatment. Chan was supposed to opine whether the treatment was appropriate and if the associated charges were reasonable. Meanwhile, Defendant USAA General Indemnity Co. filed a motion to exclude specific opinions provided by Michael Chan.
Chiropractic Expert Witness
Michael Chan has been practicing chiropractics since 1999. Besides his expertise as an accident reconstructionist, an injury biomechanist, and a practicing chiropractor, he owns the Integrative Injury Clinic. He pursued his Doctor of Chiropractic from the Palmer Chiropractic College-West in San Jose, California.
Discussion by the Court
Chan’s Experience and Qualifications
Chan drew on his experience as an accident reconstructionist, injury biomechanist, and practicing chiropractor to reach conclusions about Mounce’s alleged injuries and treatment. His experience as the owner of the Integrative Injury Clinic was also relevant since he employed a physical therapist for whom he sets the billing rates.
Chan opined that the October 3, 2017, collision caused injuries to Mounce’s neck and back. He noted that amount of the force seen in this collision was clearly sufficient to result in the injuries that were diagnosed, especially when you take into account the factors that put Mounce more at risk for acute and chronic injuries. Although Mounce had pre-existing musculoskeletal conditions, Chan believed that the treatment Mounce received was causally related to the 10/03/2017 collision on a more probable than not basis. Chan added that the cost was reasonable and within the norms billed by similar providers throughout the country, as well as the Pacific Northwest.
Defendant USAA General Indemnity Co.’s Argument
USAA did not aim to exclude Chan’s testimony entirely. It agreed that he was qualified to provide opinions on chiropractic treatment and its associated costs. However, the company argued that Chan lacked “the requisite knowledge, skill, experience, training, or education” to form the following opinions:
- First, Plaintiff’s March 6 through May 23, 2018 physical therapy treatment was reasonable and necessary due to the October 3, 2017 accident
- Second, the $2,805 that Aurora Village Physical Therapy charged Plaintiff for dates of service from March 6 through May 23, 2018 was reasonable and within the norms billed by similar providers.
- Third, Plaintiff’s December 11, 2018 treatment with Steven Taylor, M.D. was reasonable and necessary
- Finally, the $143 that the Plaintiff was charged for the December 11, 2018 date of service was reasonable and within the norms billed by similar providers.
Analysis
Since Chan was neither a trained nor licensed medical doctor, the Court held that it would be inappropriate for him to offer opinions to a jury about the need for or costs of treatments provided by Steven Taylor, a physiatrist. The fact that Chan’s specialty might share certain medical billing codes with services provided by Taylor did not render Chan qualified to opine about whether medical treatment was reasonable or necessary.
As a chiropractor, Chan employed therapy modalities also used by other physical therapists, and as the owner of Integrative Injury Clinics, he employed and set the billing rates for a physical therapist. Therefore, the Court held that Chan has the required knowledge to reliably opine on the reasonableness, need for, and cost of Mounce’s physical therapy treatments.
Just to be on the safe side, USAA mounts a colorable challenge to Chan’s bona fides as a physical therapy expert, but it does not go to admissibility.
Held
The Court granted USAA’s motion in part. Basically, Chan may not testify that “Plaintiff’s December 11, 2018 treatment with Steven Taylor, M.D. was reasonable and necessary; and (4) the $143 Taylor charged Plaintiff for the December 11, 2018 date of service was reasonable and within the norms billed by similar providers.” USAA’s motion is denied in all other respects.
Key Takeaway:
Because Chan is neither a trained nor licensed medical doctor, the Court emphasized that Chan’s qualifications did not extend to evaluating medical treatment he was not trained to assess. Chan, however, has the requisite knowledge to testify as an expert on the reasonableness, need for, and cost of Mounce’s physical therapy treatments.
Case Details:
| Case caption: | Mounce V. USAA General Indemnity Company |
| Docket Number: | 2:22cv1720 |
| Court: | United States District Court for the Western District of Washington |
| Dated: | November 1, 2024 |
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