Insurer denies payment for "palliative" care: Breach of contract: Arbitration award

Law Reporter, Oct 2003

DelValle v. Farmers Ins. Co., Wash., Nonjudicial arbitration, Claim No. B6-135193, Apr. 4, 2003.

DelValle was driving when she was rear-ended by another vehicle traveling about 35 miles per hour. Within two weeks, DelValle, 45, developed cervical symptoms that caused severe headaches. She made a claim under the personal injury protection provision of her automobile insurance policy. DelValle underwent chiropractic and massage therapy treatments for about one year.

DelValle's insurance carrier then ceased paying for the treatments. The insurer informed DelValle it would seek a records review from a chiropractor it had selected. Three months later, the chiropractor found DelValle's treatment to be excessive and abusive, characterizing it as "palliative rather than curative." The insurer informed DelValle it would not pay for any more treatments. She incurred about $2,800 in unreimbursed expenses. DelValle invoked the arbitration clause of her insurance policy.

Claimant contended that the policy language made no distinction between palliative and curative care. Claimant testified that the treatments had decreased her pain, making her able to work.

An arbitrator found that claimant's treatments were reasonable and necessary, and ordered defendant to pay the balance of claimant's $10,000 policy limit.

Claimant's Counsel

*Jan Eric Peterson, Seattle, Wash.