Safeco Insurance, V. Folweiler Chiropractic, Ps

CourtCourt of Appeals of Washington
DecidedSeptember 7, 2021
Docket81520-2
StatusUnpublished

This text of Safeco Insurance, V. Folweiler Chiropractic, Ps (Safeco Insurance, V. Folweiler Chiropractic, Ps) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Safeco Insurance, V. Folweiler Chiropractic, Ps, (Wash. Ct. App. 2021).

Opinion

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

FOLWEILER CHIROPRACTIC PS, ) No. 81520-2-I ) Respondent, ) ) DIVISION ONE v. ) ) SAFECO INSURANCE COMPANY OF ) AMERICA AND FIRST NATIONAL ) INSURANCE COMPANY, d/b/a ) SAFECO CVO-WASHINGTON, ) ) UNPUBLISHED OPINION Appellants. ) )

MANN, C.J. — Folweiler Chiropractic, PS, (Folweiler) filed a class action

complaint against Safeco Insurance Company of America, and First National Insurance

Company, d/b/a Safeco CVO-Washington (collectively “Safeco”), alleging that Safeco’s

practice of using a computer database to assess whether the amount billed by medical

providers was reasonable violated Washington law, including the Consumer Protection

Act (CPA), chapter 19.86 RCW.

Safeco appeals the trial court’s order denying its motion to dismiss, as well as the

trial court’s order granting Folweiler’s motion for class certification. Safeco argues that:

(1) a prior class action settlement bars Folweiler’s claims; (2) Folweiler’s equitable

assignment theory does not give it standing to pursue its claims; (3) Folweiler’s patients

Citations and pin cites are based on the Westlaw online version of the cited material. No. 81520-2-I/2

have not suffered a cognizable injury; and (4) express assignment, rather than equitable

assignment, is required for Folweiler to litigate its patient’s statutory claims. Because

the prior class action settlement bars Folweiler’s claims, we reverse and remand to the

trial court to dismiss Folweiler’s claims.

FACTS

A. Background

Washington law requires automotive insurers to offer personal injury protection

(PIP) coverage as an included option in insurance policies. RCW 48.22.085; RCW

48.22.095. PIP coverage includes medical and hospital benefits, which are payments

for medical expenses incurred by or on behalf of the insured in an automotive accident.

RCW 48.22.020(1)(a); RCW 48.22.005(7).

When Safeco receives a medical provider’s bill, it determines if (1) the medical

provider administered treatment related to the automobile accident and (2) if the amount

billed is reasonable. To determine if the amount billed is reasonable, Safeco relies on

the FAIR Health Database—a database that compares the bill to the cost of the same

treatment in a common geographic area. Safeco then pays the bill up to the 80th

percentile in the database.

Safeco’s use of software databases to determine the reasonableness of

providers’ bills has been the subject of much litigation. In 2014, Safeco and its affiliate,

Liberty Mutual, were sued in a putative multistate class action in Illinois. Lebanon

Chiropractic Clinic, PC v. Liberty Mut. Ins. Co., No. 5-15-0111, 2016 IL App (5th)

150111-U, 2016 WL 546909 (Feb. 9, 2016).

-2- No. 81520-2-I/3

The parties reached a class settlement wherein Safeco and Liberty Mutual would

pay PIP claims at the 80th percentile of the FAIR Health Database for five years. 1 In

return, class members stipulated that such payments satisfy all of Safeco and Liberty

Mutual’s legal and contractual obligations, and that class members would not bring

claims alleging otherwise.

Following the Lebanon settlement, Chan Healthcare Group, PS (Chan) brought a

collateral attack against the settlement in Washington, arguing that the interests of the

Washington class members were not adequately represented in the Illinois action.

Chan Healthcare Grp. PS v. Liberty Mut. Fire Ins. Co. and Liberty Mut. Ins. Co., 192

Wn.2d 516, 518, 431 P.3d 484 (2018). The trial court certified a class, sustained

Chan’s due process attack on Lebanon, and held that Washington medical providers

could bring CPA claims barred by the Lebanon settlement. This court reversed on

discretionary review, rejecting the due process argument and enforcing the Lebanon

settlement against Chan. Chan Healthcare, 192 Wn.2d at 523. The Washington

Supreme Court unanimously affirmed, holding that the full faith and credit clause

required it to enforce the Illinois Court’s judgment. Chan Healthcare, 192 Wn.2d at 518.

B. Procedure

Folweiler is a professional services corporation that provides chiropractic care

and massage therapy in King County. On March 12, 2019, Folweiler, a member of the

Lebanon settlement class, filed a class action complaint against Safeco. Despite

Safeco’s compliance with its Lebanon obligations, Folweiler alleged that Safeco’s bill-

review procedures violated the PIP statute, the Office of the Insurance Commissioner’s

1 This settlement is hereinafter referred to as the Lebanon settlement.

-3- No. 81520-2-I/4

regulations governing investigation of claims (WAC 284-30-330, WAC 284-30-395), and

the CPA. Folweiler claimed damages based on the reduced payment of its bills and

administrative expenses derived from the difficulty of managing Safeco’s payment

system.

Safeco moved for summary judgment and dismissal based on the Lebanon

settlement. The trial court granted the motion in part, stating that “the way [it read]

Lebanon is frankly . . . that Dr. Folweiler can’t bring suit on his own behalf.” The court,

however, permitted Folweiler to file an amended complaint.

Folweiler filed an amended complaint claiming that providers have “equitable

assignment” of their patients’ policy benefits, as well as the statutory and WAC rights

that govern the policy. Folweiler claimed it derived this equitable assignment from the

direct billing relationship between the provider and insurer, the payments of which are

authorized by the insured. 2

Safeco moved to dismiss on the grounds that Folweiler was not a valid assignee

of any patient claims and that its new allegations did not overcome the Lebanon

covenant not to bring claims. Folweiler concurrently moved for class certification.

The trial court denied Safeco’s motion and granted class certification to Folweiler.

In doing so, it stated that Folweiler and other providers have standing as equitable

assignees of their patients’ rights under Safeco’s policy and under Washington law. In

addition, the court held that the equitable assignment allows Folweiler to bring per se

CPA claims.

2 Although the authorizing documents permit Safeco to make payments to providers, they do not expressly assign the provider with any legal claims or statutory rights.

-4- No. 81520-2-I/5

In light of the trial court’s decisions, Folweiler again amended its complaint.

Folweiler now includes a per se CPA claim, claims involving the PIP Statute, and WAC

regulations governing the investigation of claims.

Safeco sought, and we granted, discretionary review.

ANALYSIS

Safeco argues that the Lebanon settlement bars Folweiler’s claims, including its

“equitable assignment” claims. We agree.

“We review a trial court’s ruling on a motion to dismiss under CR 12(b)(6) de

novo, as a question of law.” McAfee v. Select Portfolio Servicing Inc., 193 Wn. App.

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