Chiropractic care is an area of workers’ compensation medical treatment that often brings forth negative emotions by the employer. Any employer who has handled numerous workers compensation claims can recall the injured employee who had what seem like an endless number of visits to a chiropractor.
Inability to Limit Chiropractic Care Plagues Employers
Chiropractors differ from doctors as they do not perform surgical interventions, and in most jurisdictions are not allowed to prescribe medications. Chiropractic care, like acupuncture and massage, are healing arts. Chiropractic care focuses on the musculoskeletal system, with spinal manipulation being the primary medical service provided.
The issue that has plagued chiropractic care in the workers’ compensation system is the inability of many chiropractors and many employees to limit the medical treatment to what is needed, especially with employees who have had previous chiropractic care. Chiropractic care is a symbiotic relationship where both the chiropractor and the employee benefit. The chiropractor benefits from a steady stream of income from the workers’ compensation insurer. The employee benefits from feeling better, even if very temporary, following the chiropractic treatment. When either the employee or the chiropractor begins to abuse the workers’ compensation system by receiving treatment or by providing treatment that is no longer necessary, the negative emotions of the employer begin to come into play.
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In response to the abuse of the workers’ compensation system, some states, for example California, have passed laws limiting the number of chiropractic visits an injured employee can have that are paid for by workers’ compensation. When a state limits the number of chiropractic visits to a set number, for example 24, and a disproportionate number of injured employees reach full recovery on the 24th visit, it reinforces the belief of employers who have a negative opinion of chiropractic care.
Chiropractor Should Provide Plan With Expected Number of Visits
Employers sometime begin to experience the negative emotions about chiropractic care too early because of previous episodes of chiropractic care abuse. While every injury is different and medical complications vary, there are some general boundaries that can be applied to chiropractic care. Following the initial visit, the chiropractor should be able to provide a treatment plan that will include the number of probable visits. In general:
One month of treatment 8 to 10 visits
One and ½ months of treatment 12 to 14 visits
Two months of treatment 15 to 20 visits
Three months of treatment 22 to 28 visits
If state law does not limit the number of chiropractic visits, and the chiropractor is treating the injured employee on a daily basis, or for more than three months, the employer should discuss the situation with the claims professional and with the nurse case manager. If the injured employee medical needs are severe to need daily care or if the care last more than 3 months, the medical care should be transferred to an orthopedic. Also, an independent medical evaluation is an option that should be considered.
There are other instances when the employer, claims professional and nurse case manager should consider interfering with the chiropractic care and obtaining orthopedic care for the employee. This includes:
- When the employee does not show significant improvement within the first month of care.
- There has been no tapering off of the frequency of chiropractic visits.
- Moist packs, hot packs or cold packs being provided after the first month of chiropractic care
- The medical treatment reports do not reflect consistent injury recovery progress.
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The employee’s chiropractic care attendance becomes erratic or the number of visits increases instead of tapering off.
Employers Need To Take a Proactive Approach
Employers, instead of shaking their heads when they learn the employee is starting chiropractic care should take a proactive approach. Upon learning an employee is treating with a chiropractor should:
- Inquire as to the expected duration of the chiropractic care
- Identify the specific body part being treated (if not done, cervical care can expand to include lumbar care and vice-versa).
- Inquire as to the frequency of treatment
- Verify that the treatment is not for on-going medical care that existed prior to the work related injury
- Obtain the work restrictions the chiropractor is imposing and advise the chiropractor of the modified duty work available to the employee within the work restrictions.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.
Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.
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