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AGLO 1975 No. 83 - September 30, 1975
AGO Opinion Header Image
Slade Gorton | 1969-1980 | Attorney General of Washington

INSURANCE ‑- SERVICES OF CHIROPRACTORS IN CONNECTION WITH CERTAIN DISABILITY INSURANCE POLICIES

(1) Where an individual or group disability income or income replacement insurance policy requires the insured to be under the regular care and attendance of a licensed physician in order to receive payments thereunder, such a requirement is unaffected by either RCW 48.20.412 or RCW 48.21.142 and, therefore, the insurance contract need not now be interpreted also to require payments if the insured is under the care of a chiropractor.

(2) RCW 48.20.412 and RCW 48.21.142 do not require an insurer to accept the determination of a chiropractor that an insured is totally disabled so as to qualify for payments under a disability income or income replacement insurance policy which stipulates total disability as a condition precedent to the insured's eligibility for benefits.

(3) Likewise, RCW 48.20.412 and RCW 48.21.142 do not require an insurer to accept the determination of a chiropractor that an insured is totally disabled so as to call for the payment of benefits under a credit disability policy covered by chapter 48.34 RCW.

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                                                              September 30, 1975

Honorable Karl Herrmann
Insurance Commissioner
Insurance Building
Olympia, Washington 98504                                                                                                               Cite as:  AGLO 1975 No. 83

Dear Sir:

            By letter previously acknowledged you have requested an opinion from this office on three questions which we paraphrase as follows:

            (1) Where an individual or group disability income or income replacement insurance policy requires the insured to be under the regular care and attendance of a licensed physician in order to receive payments thereunder, must the insurance contract now be interpreted also to require payments if the insured is under the care of a chiropractor in view of the recently enacted provisions of RCW 48.20.412 and RCW 48.21.142?

            (2) Do RCW 48.20.412 and RCW 48.21.142 require an insurer to accept the determination of a chiropractor that an insured is totally disabled so as to qualify for payments under a disability income or income replacement insurance policy which stipulates total disability as a condition precedent to the insured's eligibility for benefits?

            (3) Similarly, do RCW 48.20.412 and RCW 48.21.142 require an insurer to accept the determination of a chiropractor that an insured is totally disabled so as to call for the payment of benefits under a credit disability policy covered by chapter 48.34 RCW?

            We answer all three of these questions in the negative as explained in our analysis.

                                                                     ANALYSIS

            By its enactment of § 1, chapter 13, Laws of 1971, 1st Ex. Sess., the legislature added the following new section, now codified as RCW 48.20.412, to chapter 48.20 RCW relating to individual disability insurance:

             [[Orig. Op. Page 2]] "Notwithstanding any provision of any disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health care service performed by a holder of a license issued pursuant to chapter 18.25 RCW if (1) the service performed was within the lawful scope of such person's license, and (2) such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to chapter 18.71 RCW:  Provided, however, That no provision of chapter 18.71 RCW shall be asserted to deny benefits under this section.

            "The provisions of this section are intended to be remedial and procedural to the extent they do not impair the obligation of any existing contract."

            Similarly, by § 2 of this same 1971 act the legislature added a virtually identical section to chapter 48.21 RCW, covering group disability insurance.  Chapter 18.25 RCW, which is referred to in both sections, pertains to the licensing of chiropractors while chapter 18.71 involves the licensing of physicians and surgeons.  In our opinion, however, neither of these two recent legislative enactments has any application to the kinds of disability insurance with which your present questions are concerned.

            Both RCW 48.20.412 and RCW 48.21.142 speak, exclusively, of benefits under a disability insurance contract ". . . for any health care service performed by . . ." a licensed chiropractor.  In other words, if the particular disability insurance contract would have provided for payment for a certain health care service if that service had been performed by a licensed physician, the statutes now purport to require that the same payment shall be made in the event that the health care service is performed by a licensed chiropractor ‑ assuming that the service rendered was within the lawful scope of a chiropractor's license.

            The reason that neither RCW 48.20.412 nor RCW 48.21.142 applies to the kinds of insurance contracts with which you are here concerned is that those contracts do not provide for the payment of benefits for health care services, irrespective of by whom rendered.  Instead, they  [[Orig. Op. Page 3]] insure against other economic consequences of a disability; namely, loss of income and the resulting inability of an insured to pay his debts.  Such insurance contracts, by their own terms, are simply outside of the scope of the two statutes which you have cited in your request.

            Chapters 48.20 and 48.21 RCW relate, respectively, to individual and group "disability insurance"; i.e., as defined in RCW 48.11.030, ". . . insurance against bodily injury, disablement or death by accident, against disablement resulting from sickness, and every insurance appertaining thereto."  Within this classification, however, there are two distinct types of insurance policies; those that provide insurance against the costs of medical or other health care services themselves and those which, instead, are designed to cover losses of income from gainful employment resulting from a disability.1/   Your first two questions relate only to this latter type of disability insurance ‑ commonly referred to as disability income or income replacement insurance.

            Your third question, in turn, deals with an analogous type of insurance known as "credit accident and health insurance."  This type of insurance is covered by the provisions of chapter 48.34 RCW, and the term itself is defined by RCW 48.34.030(2) to mean:

            ". . . insurance on a debtor to provide indemnity for payments becoming due on a specific loan or other credit transaction while the debtor is disabled as defined in the policy;"

            The method of utilization of such insurance is then described in RCW 48.34.090(2), as follows:

            "(2) Each individual policy or group certificate of credit life insurance, and/or credit accident and health insurance shall, in addition to other requirements of law, set forth the name and home office address of the insurer, the name or names of the debtor or in the case of a certificate under  [[Orig. Op. Page 4]] a group policy, the identity by name or otherwise of the debtor, the premium or amount of payment, if any, by the debtor separately for credit life insurance and credit accident and health insurance, a description of the coverage including the amount and term thereof, and any exceptions, limitations and restrictions, and shall state that the benefits shall be paid to the creditor to reduce or extinguish the unpaid indebtedness and, wherever the amount of insurance exceeds the unpaid indebtedness, that any such excess shall be payable to a beneficiary, other than the creditor, named by the debtor or to the debtor's estate."

            Therefore, our direct answer to your three questions is as follows:

            Question (1):

            Where an individual or group disability income or income replacement insurance policy requires the insured to be under the regular care and attendance of a licensed physician in order to receive payments thereunder, such a requirement is unaffected by either RCW 48.20.412 or RCW 48.21.142 and, therefore, the insurance contract need not now be interpreted also to require payments if the insured is under the care of a chiropractor.

            Question (2):

            RCW 48.20.412 and RCW 48.21.142 do not require an insurer to accept the determination of a chiropractor that an insured is totally disabled so as to qualify for payments under a disability income or income replacement insurance policy which stipulates total disability as a condition precedent to the insured's eligibility for benefits.

            Question (3):

            Likewise, RCW 48.20.412 and RCW 48.21.142 do not require an insurer to accept the determination of a chiropractor that an insured is totally disabled so as to call for the payment of benefits under a credit disability  [[Orig. Op. Page 5]] policy covered by chapter 48.34 RCW.2/

            We trust that the foregoing will be of some assistance to you.

Very truly yours,

SLADE GORTON
Attorney General

ERNEST M. FURNIA
Assistant Attorney General

                                                         ***   FOOTNOTES   ***

1/See, 1 Appleman, Insurance Law and Practice, 46, § 17.

2/By our answers to your second and third questions, however, we do not mean to infer that a chiropractor's opinion on the issue of total disability should be in any way considered invalid.   A determination that an insured is so disabled as to qualify for benefits under any given disability insurance policy or the like may be dependent upon the impact of other contractual provisions within such policy and most certainly could be subject to court determination.  The opinion of the chiropractor could be applicable to the former, and certainly would be utilizable in a court proceeding.

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