Workers Compensation Coverage of Chiropractic Variances

The Workers' Compensation Board Medical Treatment Guidelines for the lumbar and thoracic spine make it extremely difficult for patients to receive chiropractic manipulation beyond a period of 3 months.

Medical Treatment Guidelines D.10.a makes reference to manipulation.  Most chiropractors will recommend treatment beyond the 3-month limitation found in the Guidelines.  However, many do not know what they need to do in order to have this treatment approved.

Coverage for Extended Chiropractic Treatment

Extended durations of treatment, according to the Guidelines, "may be necessary in cases of re-injury, interrupted continuity of care, exacerbation of symptoms, and in those patients with co-morbidities."

This particular Guideline also references the fact that "continuous of treatment will depend on functional improvement."

Documenting Functional Improvement

Chiropractic variance requests should focus on documenting, as detailed as possible, how there has been functional improvement.  This documentation should include results of physical examinations/range of motion testing and any other objective findings that demonstrate concrete improvement.  Statements indicating that a patient has experienced symptom relief are NOT helpful in having a chiropractic variance granted.

Specifically, referencing an aggravation, interrupted continuity of care, or a patient's co-morbidity will also give the Judge more latitude in granting the variance.

Indicate the Expected Outcome of Continued Treatment

Our experience has been that a Law Judge will also want to see a statement indicating the requesting chiropractor's opinion regarding the expected outcome should the variance be granted.  In particular, what functional improvement and/or treatment goals are anticipated should the variance be granted.

Get the Variance Request Approved Before Treatment

A final point is that the treating chiropractor should not request a variance after the treatment has already been provided. The variance needs to be submitted for consideration before the treatment is offered.  Otherwise, it will not be considered and will be deemed inappropriate.

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