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J. A21015/11 2011 PA Super 250 STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY AND STATE FARM FIRE AND CASUALTY COMPANY, Appellants v. ROBERT J. CAVOTO, JR.,FISHBONE ADVERTISING, INC., CAVOTO CHIROPRACTORS, P.C., MARGARET FISHER-CATRAMBONE, PENN CENTER PAIN MANAGEMENT, INC., TIPROF, INC., AND INTERNATIONAL HEALTH ALLIANCE, INC., Appellees : : : : : : : : : : : : : : : : : : : IN THE SUPERIOR COURT OF PENNSYLVANIA

No. 3098 EDA 2009

Appeal from the Order September 24, 2009 In the Court of Common Pleas of Delaware County Civil Division at No(s): No. 05-10716 BEFORE: STEVENS, P.J., MUSMANNO, and FITZGERALD*, JJ. Filed: November 21, 2011

OPINION BY STEVENS, P.J.:

Appellants, State Farm Mutual Automobile Insurance Company and State Farm Fire and Casualty Company, file this interlocutory appeal from the order entered in the Delaware County Court of Common Pleas, which denied Appellants' post-trial motion for relief. On appeal, Appellants

challenge the court's decision to find in favor of Appellees, Robert J. Cavoto, Jr., Fishbone Advertising, Inc., Cavoto Chiropractors, P.C., Margaret FisherCatrambone, Penn Center Pain Management, Inc., Tiprof, Inc., and

* Retired Justice specially assigned to the Superior Court.

J. A21015/11 International Health Alliance, Inc.,1 on Count I of Appellants' amended complaint regarding Appellants' obligation to pay for services provided by unlicensed chiropractic personnel. We hold that the Chiropractic Practice Act ("CPA")2 and the Motor Vehicle Financial Responsibility Law ("MVFRL")3 permit licensed chiropractors to delegate certain adjunctive procedures to unlicensed support personnel and seek reimbursement from insurers, as long as such procedures are performed under the direct supervision of a licensed chiropractor. However, such determinations must be made on a

case-by-case basis, in which the trial court must evaluate whether the procedure, or an aspect of the procedure in question, requires formal education or training in the practice of chiropractic. Accordingly, we affirm in part, vacate in part, and remand. The facts of this case are largely not in dispute. For a period of time, Appellants reimbursed Appellees for certain adjunctive procedures which Appellants later learned were performed by unlicensed members of the support staff. These procedures involved applying hot and cold packs,

turning on and off a mechanical, intersegmental, traction machine, assisting in therapeutic exercise, providing electrical muscle stimulation, utilizing the

1

Hereinafter, the appellees who operate as chiropractic offices will be referred to as "Appellees." 63 P.S.

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