Chiropractic care continues to be a source of problems and confusion for the workers’ compensation claim management team. This is due to several factors that result from the reputation of several bad practitioners that have captured the headlines over the years. While it is a legitimate form of medical care, interested stakeholders should remain vigilant regarding this treatment modality when it is included as any part of the medical care received post-injury. There are also many factors to consider when approving ongoing medical care with a chiropractor to ensure it is reasonable and necessary to cure and relieve the effects of the work injury.
Fundamental Factors to Review for Any Medical Care
All medical care provided to an injured employee following a work injury must be reasonable and necessary to cure and relieve the effects of the work injury. In interpreting this standard, courts from across the county will generally review whether the medical care being provided is advancing the employee toward resolution of the injury or a healing plateau.
When reviewing medical records for any medical care, it is essential to determine if the healthcare provider in question is preparing documentation that outlines what care is being performed and advancing the care of the employee.
- Do the medical record outline the employee’s subjective co, points of pain and/or disability, and demonstrate “progressive” improvement in the condition? When reviewing records as a whole, the employee needs to be taking steps toward recovery;
- Do the medical records outline objective evidence of progressive improvement based on measurements and other factors that outline healing?
- Do the medical records outline the employee’s vocational activities and outline progressive improvement?
All medical care must, at some point, reduce the nature of restrictions on the employee’s activity and allow for a return to work at some point. Medical records not outlining the above evidence must be highly scrutinized and challenged.
Considerations For Additional Medical Care
Some jurisdictions have medical treatment parameters that outline definitive limits for a specific treatment modality, including chiropractic care. If treatment parameters are not included in statute or admittance rules, a high level of scrutiny needs to occur. Areas of investigation in any jurisdiction must include:
- Timely communication from the chiropractic requesting a departure from the treatment parameters, if applicable;
- Documentation and information that supports the request for additional chiropractic care. This should include objective findings that support the subjective pain complaints and
- A treatment plan that outlines the goals of the additional chiropractic care.
All healthcare providers must monitor their patients for drug and alcohol addiction and ensure their patients have been referred for chemical dependency care where needed.
Departures from Recognized Treatment Parameters
Some jurisdictions have stated instances where departures from the treatment parameters are permissible. The chiropractor must provide complete documentation when the employee seeks additional medical care. Care should be approved once scrutinizing the following:
- There is medical documentation of a complication or aggravation in the employee’s medical condition. This complication should be documented in the contemporaneous records that clarify what occurred.
- Chiropractic care provides greater function when performing daily living activities and regaining the ability to return to work.
- The medical treatment improves subjective and/or objective complaints and increases the employee’s overall functional status.
Never take the chiropractor’s word for an aggravation of the work injury, increased functional ability, or improvement in the employee’s subjective and/or objective pain complaints. Proactive claim handlers and defense attorneys must undertake these areas of in-depth inquiry. Never be afraid to question the employee about statements in chiropractic records and communicate with defense counsel about a plan of inquiry at a deposition or recorded statement. These areas can also be avenues to explore in written interrogatories or other forms of discovery.
Chiropractic care will continue to be a much sought-after form of medical care and treatment in workers’ compensation claims. While it is a legitimate treatment modality, there are often grey areas that require scrutiny from interested stakeholders who want to reduce workers’ compensation program costs.
When reviewing medical care to determine if it is reasonable and necessary to cure and relieve the effects of a work injury, the claim management team and other defense interests must scrutinize the medical records supporting this treatment. It also requires follow-up in the form of discovery efforts to ensure all care is moving the employee toward their best post-injury status.
Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.
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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.