Handling Chiropractic Claims in Workers’ Compensation

Chiropractic care continues to cause claim management teams problems in workers’ compensation claims. Based upon these issues, it is important to even the most seasoned claim handler to understand how to deal with these matters.

What is a Chiropractor?

A chiropractor is medical professional whose practice takes on an emphasis in the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system. The concern of people trained in the chiropractic arts is the belief that the nervous system plays a major role in all processes found within the body. As a result, a majority of their care involves a holistic approach to healing.

Chiropractic care is often described as an “alternative medicine,” or a “pseudoscience.” In the United States, chiropractors have one of the following degrees: Doctor of Chiropractic (D.C.), DCM, BSc, or MSc degree.

Common Concerns with Chiropractors

One of the most common concerns when dealing with chiropractors in the context of workers’ compensation claims is they emphasize ongoing care and treatment. Based on this perception, there is a belief that a chiropractor will rarely discharge their patients if a treatment modality is not effective or does not provide long-term relief. This has often resulted in state workers’ compensation systems with medical treatment parameters to limit the length of care under a chiropractor, require specific benchmarks be met before additional treatment should be considered and a requirement of specific objective medical findings before prolonged care can be approved.

Warning Signs When Dealing with Chiropractors

As with any medical claim in workers’ compensation, people who handle and manage claims need to be diligent for waste and abuse within the system.

• Review chiropractic records for improvement with each session. Signs of “reasonableness and necessity” in medical care and treatment are often dependent upon indications a patient is getting better with each successive treatment. Claim handlers should question the effectiveness of prolonged care with no signs of improvement.

• Connections between chiropractors and other medical specialists. In some instances, chiropractors share office space or a common entry with other medical specialists. When reviewing medical records and billing statements, it is important to note if care is taking place between these types of facilities on the same days. It is also important to determine if the injured worker is given multiple options by their chiropractor and any “coordination of care” between these parties.
• Understand terminology used by chiropractors. It is not uncommon for chiropractors to use the term “subluxation” in a medical report. This is a term that can mean different things in a medical context, but is likely used by chiropractors to document the misalignment of two bones on the spine. While a work injury can cause subluxation, it can also occur by stress, toxins in the body and everyday events. Use of an expert deposition may be required to determine accurately the actual cause of this condition.

Conclusions

Regardless of the perception, it is important to remember that chiropractors have a legitimate role in the delivery of medical care and treatment in workers’ compensation cases. Notwithstanding this reality, it is essential that members of the claim management team better understand this profession and how they operate.

Author Michael Stack, Principal of Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool. As the senior editor of Amaxx’s publishing division, Michael is on the cutting edge of innovation and thought leadership in workers compensation cost containment. http://reduceyourworkerscomp.com/about/. Contact: [email protected].

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.