Can Delay Tactics by Insurance Companies Affect Your Practice?


Scott Shawver, Partner and Attorney at Law GLP Attorneys WSCA Leadership Level Corporate Partner


Chiropractic offices play a crucial role in promoting patient wellness, relieving pain, and improving overall quality of life. However, the growing prevalence of questionable practices by insurance companies in handling Personal Injury Protection (PIP) claims has created significant challenges for healthcare providers. These practices, including delayed reimbursements and improper denials, not only place financial strain on chiropractic offices but may also violate well-established insurance laws in Washington state. In some cases, these actions could even be considered bad faith practices, leaving practitioners and patients to deal with the fallout.


One of the most disruptive tactics employed by insurance companies is the delay of PIP payments. By withholding reimbursements that should be paid promptly, insurers are able to invest those funds and generate additional income, effectively profiting from delay tactics. Unfortunately, this practice often leaves chiropractic offices struggling to manage their cash flow. Delayed payments create uncertainty, making it difficult to cover critical expenses such as payroll, rent, utilities, and medical supplies. This financial instability can place undue stress on chiropractors, hinder the growth of their practices, and even threaten the long-term viability of their businesses.


For many chiropractic offices, the burden of navigating these delays is compounded by the administrative hurdles involved in submitting and tracking claims. Insurance companies may dispute claims without valid justification, forcing providers to dedicate significant time and resources to resolving these issues. The process can become even more frustrating when claims are improperly denied based on flawed reports from medical professionals who lack the required expertise in the appropriate specialty, a clear violation of Washington Administrative Code (See WAC § 284-30-395).


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To illustrate some of these issues, it is useful to consider an example from our practice. We represented a client whose case probably sounds familiar to many of you. Our client was involved in a relatively low speed collision, did not receive any broken bones, and there were no cuts, scrapes or bruises. This is the typical case which would be described as “merely” soft tissue injuries.


After the PIP claim was opened, payments to the chiropractor and massage therapists’ offices proceeded smoothly. However, as is often the case, the client required continued treatment for many months, and it was clear that the insurance company’s PIP adjuster did not agree with continued payments.


So, the PIP adjuster took an aggressive approach. Soon, all submitted claims were being denied, and when justification for the denials was requested, “expert” reports were provided which claimed to justify the denials. Once these reports were scrutinized, though, it became clear that many of the denials were flawed. For instance, numerous reports which were submitted were not conducted by an expert of the same specialty, in violation of Washington Administrative Code requirements (see above). In addition, there was often inconsistency in which dates of service were approved and which dates of service were denied. The insurance company agreed to pay for chiropractic treatment one day, but a week later treatment was denied, while the following week the same service was approved. It began to appear that there was no reasonable basis for the denial of payments for services.


After the client was referred to us, one of the first things we did was to file the required notice under the Insurance Fair Conduct


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