Mo. Court Strikes Down Managed Care WC Rules

December 15, 2003

A Missouri court has ruled against the Missouri Department of Insurance, enjoining the department from enforcing rules requiring workers’ compensation insurers to pay for managed care organizations’ services, even if the insurers had no contract with the MCO.

In Alliance of American Insurers v. Missouri Department of Insurance, No. 02-CV-325517 (Cole County, Missouri Circuit Court), the Alliance argued that an employer’s right to select a health care provider under Mo. Rev. Stat. ยง 287.140(10) does not equate to an employer’s right to choose its MCO.

Further, even if an employer has the right to choose its MCO, an insurer should not be required to reimburse the MCO for managed care fees for claims involving injured employees unless there is a contract between the MCO and the workers’ compensation carrier. The Alliance also contended that the rules were an attempt to benefit some domestic MCOs.

The Alliance of American Insurers, based in Downers Grove, Ill., is a national trade association representing more than 340 property/casualty insurers.

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