State Farm Agrees to Hear Claims Review Complaints

ARLINGTON, VA - The American Chiropractic Association (ACA) reports that State Farm officials have agreed to meet with any state chiropractic association to hear local complaints about the company's handling of chiropractic claims.

In October 2000, ACA Chairman of the Board Dr. J. Michael Flynn requested a meeting with State Farm officials to discuss how chiropractic patients are treated when they make injury claims after auto accidents. The catalyst for ACA requesting the meeting was the airing of a Dateline NBC investigation into alleged improper auto accident claims handling by State Farm. Dateline was critical of the actions by medical review companies employed by auto insurers that targeted certain providers and denied care for patient injuries.

While State Farm does not believe the Dateline report fairly portrayed its normal claim handling practices for auto accident victims and the doctors who treat them, the company has cited changes in business practices in this area:

• to drastically reduce the number of participating medical review vendors nationwide and set higher standards for medical review companies in claims assessment;

   

• to reinforcing its practice of keeping medical reviewers out of claims decisions;

   

• to implementing regular audits of medical review vendor performance;

   

• hold local claims managers responsible for appropriate referrals to review organizations and require that they first contact the treating doctor for information;

   

• to strengthen formal medical anatomy and injury training modules for claims adjusters by adding various health care professionals, including doctors of chiropractic, to their staff. This allows the claims adjusters to better understand the impact of trauma and the mechanics of the healing process. (Note: State Farm has a DC on its home office staff in Bloomington, Illinois.)

   

• to institute more clarity in communications with patients and doctors, especially how claims are handled and the rationale for payments.

State Farm is also committed to evaluating independent medical exams, through which insureds sometimes must undergo a second opinion evaluation.

ACA relayed its concerns about the specialty and credentials of the second opinion doctor and how the frequency of these exams are unsettling to many patients and their treating doctors of chiropractic. State Farm responded by agreeing to meet with any state chiropractic association to hear about local complaints and to continue to watch their data to make sure these exams do not escalate inappropriately.

State Farm and the ACA have also established contacts to work through the existing transition.

Last year, State Farm approached the ACA about participating in a cervical injury research project. This project has yet to unfold, but ACA indicates it is still interested in the project.

"As important as it is to handle claims fairly, it's also just as crucial to learn how to prevent, treat and heal cervical neck injuries," observed ACA President Dr. James Mertz. "These types of injuries and claims are frequently reported following auto accidents, and the patients who suffer these injuries are often treated by a doctor of chiropractic."