Cost Mitigation Techniques for Chiropractic Work Comp Claims

Chiropractic care remains a popular medical treatment modality for workers’ compensation claims involving the spine, joints and other injuries. It is important to members of the claims management team to be proactive on these claims in order to avoid paying for excessive care and to make whole the injured worker.

While most chiropractors are thoughtful medical providers, there is an opportunity for abuse. This article explores areas of concern and evaluation.

Evidence of a reasonable treatment plan: Every medical provider must set forth a reasonable treatment plan. This includes care an employee receives at a chiropractor. It should be demanded that a chiropractor provide a plan that is reasonable from the onset of care.

Documentation of the details of the treatment: This includes a detailed description of the medical care and treatment provided. Evaluate carefully those records that tend to have repetitive treatments.

The degree and duration of the relief resulting from the treatment: Scrutinize records that show a trend of improvement that is then followed by an exacerbation of symptomology requiring ongoing care. Be cautious of unexplained events that happen and question the veracity of such claims.

Whether the frequency of treatment was warranted: All medical care and treatment needs to be justified. This includes the recommendations for future medical care and treatment. This issue can be challenged via an independent medical examination.

The relationship of the treatment to the goal of returning the employee to suitable employment: This is another area that is ripe for review via an independent medical examination. A careful review of the first several weeks should give claim management team members and idea if the chiropractor in question has the best interests of the injured worker in mind.

Potential aggravation of underlying conditions by additional chiropractic treatment: Evidence of this element is common when people overuse chiropractic care. If the injured worker is not receiving lasting relief after several weeks, it may be time to try a different form of care.

The cost of treatment in light of relief provided: Chiropractic care can become expensive over time. Carefully review and scrutinize all billing statements. Pay particular attention to applicable medical fee schedules for services rendered by a chiropractor.

If discovery rules permit, obtaining the employee’s deposition testimony at some point can be helpful when defending a claim involving ongoing chiropractic care. Areas to explore at a deposition or through other means of discovery should include the following:

The employee’s testimony about the relief obtained;

Whether scheduling is on a regular basis as opposed to an as-needed basis;

The period of relief from pain received with ongoing treatment;

The use of alternative medical providers in the event of continuing pain; and

The employee’s overall activities and the extent of the employee’s ability to continue to work;

A recommendation of long-term chiropractic care into the future which suggests a maintenance program rather than treatment of the injury; and

Hints of a psychological dependency for chiropractic care.

Conclusions

Members of the claim management team need to play an active role when defending claims involving chiropractic care. Claims that are not properly managed can get out of control fast. On the other hand, a proactive approach can result in employees making a fast return to work and the discontinuance of medical care and treatment.

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: [email protected].

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