The Employer May Have to Pay for Acupuncture under the Virginia Workers Compensation Act
Acupuncture is a type of alternative medicine where a practitioner places thin needles into the body. It is used for pain relief and to treat medical conditions including low back pain, knee pain, shoulder stiffness, and plantar fasciitis.
Acupuncture has become popular in America. As a Richmond disability lawyer and Virginia workplace accident attorney handling work injury and Social Security claims, I’ve spoken to many injured workers who have tried acupuncture for their musculoskeletal problems. Some swear by it, while others had limited relief.
This article, however, is not about the effectiveness of acupuncture to treat work-related injuries and chronic pain. It’s about explaining when the Commission will require the employer and its insurance company to pay for acupuncture to treat your work injuries.
If you have any questions about filing a workers comp claim or change in condition application with the Workers Compensation Commission, contact Corey Pollard today. We help injured employees get all the workers compensation benefits they deserve, including lifetime medical care, temporary total disability payments, and a lump sum workers comp settlement.
Is the Acupuncture Reasonable, Necessary, and Related to Your Work Accident?
In our experience defendants will often dispute and deny responsibility for acupuncture to treat work injuries. When this happens you’ll have to file a change in condition claim seeking payment and authorization for acupuncture.
Whether an employer is responsible for medical expenses depends upon: (1) whether the medical service was causally related to the industrial injury; (2) whether such other medical attention was necessary; and (3) whether the treating physician made a referral … [of] the patient. Volvo White Truck Corp. v. Hedge, 1 Va. App. 195, 199, 336 S.E.2d 903, 906 (1985). The injured employee has the burden of proving that acupuncture treatments are reasonable, necessary, and causally related medical treatment.
In Slota v. Eastern Airlines, Record No. 0048-97-4 (Va. Ct. App. May 27, 1997) the employee sought payment and authorization for 40 additional acupuncture treatments to his finger. The Commission denied the request, finding that:
In February 1996, Dr. Eckmann approved a two month trial of acupuncture therapy. On March 11, 1996, the claimant commenced acupuncture under the care of Yeh Chong Chan, O.M.D.C.A. After forty treatments, the claimant experienced some relief. Mr. Chan recommended that the claimant should continue with the acupuncture, since he was experiencing some relief after fifteen years of severe pain, and in such difficult cases, there should be a minimum of eighty treatments to see significant improvements.
Dr. Eckmann declined to approve the additional treatments because Mr. Chan “cannot give me a very good idea of what maximum benefit might be nor how long it would last.”
On appeal the Court of Appeals affirmed the Commission’s denial of the claim.
Though acupuncture treatments were denied in Slota, they have been approved in other Virginia workers compensation cases. Slota provides insight on what an injured employee may need to get the treatment approved. Here are tips on how to get your treatment approved:
- An injury by accident arising out of and in the course of the employment. In other words, a compensable accident covered under the Act.
- A referral for acupuncture from the authorized treating physician. Get the referral in writing.
- A narrative report from the authorized treating physician explaining why acupuncture is being recommended and what benefits are expected. The report should explain why this treatment is being suggested over other available methods. For example, your doctor should explain what you have tried to date and whether it was successful.
Without supportive evidence from your treating physician explaining why acupuncture is reasonable and necessary, you’re unlikely to win your claim.
Need help? Call us today. We help injured employees across the state, including those in Roanoke, Charlottesville, Chesterfield, Fairfax, Prince William County, Newport News, Williamsburg, Norfolk, and Virginia Beach. If you’re unable to return to work, we’ll do everything we can to help you get the medical care you need to get better.