As you likely know, your patients have been negatively affected by the Washington State Supreme Court’s decision in the 2024 case of Schiff v. Liberty Mutual. The Schiff case allows auto insurers to use a database called FairHealth to pay no more than the 80th percentile of a treatment cost billed to PIP insurance based on what’s normally being charged in a given geographic area, even if the patient’s full bill amount remains unpaid. Auto insurers are not required to perform any other type of reasonable investigation under the law or the Washington Administrative Code (WAC). Since that decision, all of the PIP insurers in Washington have been using this database to reduce a patient’s bills when processed under PIP. Even worse, there is no uniformity on how this decision is being applied, and even less transparency when insurers are pushed to explain how they are using this database.
We at Adler Giersch have been hard at work pushing to make changes to the Washington Administrative Code to make it much more difficult for PIP insurers to use the Schiff decision as the sole reason to reduce a patient’s bill when submitted under PIP.
Since the Summer of 2025, we have been working directly with Washington Insurance Commissioner Patty Kuderer and the Washington State Chiropractic Association (WSCA) to effect change. We have been advocating rule changes to correct this problem, and below are the proposed revisions (underlined) that are set to take effect in June 2026, unless the committee decides to make additional revisions:
WAC 284-30-330 Specific unfair claims settlement practices defined.
(4) Denying or refusing to pay claims in part or in full without conducting a reasonable investigation. A reasonable investigation may not rely solely on the use of a database, which includes, but is not limited to, estimating software and benchmarks gathered from one or multiple databases.
WAC 284-30-380 Settlement standards applicable to all insurers.
(8) If an insurer uses a database, survey, estimating software, or benchmarks to account for either material pricing, labor rate, or both, and upon request of the claimant, the insurer must provide the claimant with the date the data was collected, where the data was collected from, and which businesses provided the cost data to the database, survey, estimating software, or benchmarks.
We need you to take action! Public comments on these proposed rule changes are open until June 11, 2026. We urge you to let your voice be heard as consumers and healthcare providers. Please leave a comment supporting the new proposed rules by going to the link below and clicking on “Submit a comment”:
We are hopeful that after the closure of the comment period, these new rules will be adopted and will bring forth sweeping changes on how PIP insurers can limit payment of patient bills.
Not surprisingly, the insurance industry in Washington state is pushing hard to prevent these changes. If you click on the link above and then click on “Proposed rulemaking filed March 18, 2026,” you will also see the previous comments by the insurance industry, Washington Defense Trial Lawyers Association, and various insurance defense law firms opposing these rule changes.
The attorneys at Adler Giersch continue to push hard for patient rights and are pushing hard to make sure these rule changes are adopted. If you or your patients are having trouble getting PIP to pay the bills, contact us directly and let us know. (206) 682-0300.
