Chiropractors and Workers Compensation: What You Need to Know
Chiropractic Care is Covered under Workers Comp. But You May Need to Fight the Insurer for It.
Chiropractic care can be an effective way to heal after a work injury – especially if you hurt your back or neck, or suffered a head injury resulting in post-concussion syndrome and headaches. Many injured workers use it as an alternative to prescription drugs and surgery for a herniated disc, such as a discectomy or spinal fusion.
This article discusses the role of chiropractors in the workers compensation claim process. After reading the article, you will know what a chiropractor does, how to get chiropractic treatment covered by your employer and its workers comp insurer, and its benefits.
Keep reading to learn more about chiropractic treatment after a work accident.
If you have any questions about workers compensation law or are looking for a top-rated work injury attorney, call me: (804) 251-1620 or (757) 810-5614. I’ve helped hundreds of injured workers get the lifetime medical care they needed and workers comp settlements they deserved. And I want to help you.
What is a Chiropractor?
A chiropractor is a health care professional who focuses on diagnosing and treating the musculoskeletal system.
Though they are not medical doctors, chiropractors complete at least four years of professional study after receiving an undergraduate degree.
Chiropractors use non-surgical methods, such as hands-on spinal manipulation, to reduce pain and increase function after a work injury. Many take a holistic approach: focusing on treating the entire body, not just the work injury.
Chiropractors do not prescribe medication.
What is Chiropractic Treatment?
Chiropractic treatment includes many techniques.
Examples of chiropractic treatment modalities include:
- Spinal manipulation and mobilization
- Joint manipulation and mobilization
- Use of a percussion instrument to adjust the vertebral subluxation
- Soft tissue massage
- Laser treatment
- Electrical muscular stimulation using a TENS unit
- Hydrotherapy
- Diatherapy
- A prescription for exercise
- Dietary and nutritional counseling
- Taping and bracing
- Activity modification recommendations
- Heat, ice, and ultrasound
What Body Parts will Benefit from Chiropractic Treatment?
Several studies have found chiropractic care useful for conditions involving:
- Low back pain
- Mid-back pain
- Neck pain
- Cervicogenic headaches, such as those that develop after a whiplash injury
- Shoulder injuries such as shoulder girdle pain and adhesive capsulitis (frozen shoulder)
- Lateral epicondylitis (tennis elbow)
- Osteoarthritis of the hip or knee
- Patellofemoral pain syndrome
- Plantar fasciitis
Though there is not as much evidence, some people have found chiropractic treatment useful for:
- Ankle sprains, but not fractures
Does Chiropractic Treatment Work?
Several studies suggest that chiropractic medicine is helpful and a safe alternative to opioids and physical therapy, or even treatment with an orthopaedist.
The evidence shows that visits with a chiropractor are most helpful in the two to three months right after the accident. They can help reduce your disability from work and permanent impairment and help you avoid surgery.
There is no doubt that specific injuries – fractures or spinal cord trauma resulting in cauda equina syndrome or paralysis – require treatment with an orthopedic surgeon or neurosurgeon. But many soft tissue injuries, including muscle strains and ligament sprains, may heal better with chiropractic care.
Can a Chiropractor be My Authorized Treating Physician in a Workers Comp Case?
Yes.
There are three situations where a chiropractor can serve as your authorized treating physician in a workers comp case.
The first is if you and the workers comp claim adjuster agree that a chiropractor will be your treating doctor.
The second is if the workers comp insurer offers a panel of physicians that includes at least three medical doctors and a chiropractor, and you choose the chiropractor.
The third is if your authorized treating doctor – usually an orthopedic surgeon, neurosurgeon, or neuropsychologist – refers you to a chiropractor.
Though it sometimes happens, it’s rare for a chiropractor to be your sole treating physician. You will usually receive chiropractic care in combination with orthopedic care for a physical injury or mental health treatment for traumatic brain injury.
Will Workers Compensation Pay for My Treatment with a Chiropractor?
You can use your Workers Compensation Award Letter for visits to the chiropractor – as long as you meet your burden of proof.
Under the Workers Compensation Act, your employer is responsible for medical treatment for your work injuries for the rest of your life – if the Workers Compensation Commission finds that treatment reasonable and necessary. However, there is an exception to this rule. The employer is not responsible for reasonable and appropriate treatment if you accept a workers comp settlement that includes a cash buyout of future medical expenses or a Medicare Set Aside (MSA).
Covered medical treatment includes palliative care – health care focused on providing relief from your symptoms, even if the relief is temporary. Chiropractic treatment and acupuncture are common types of palliative care.
The employer may have to pay for chiropractic services during the initial treatment phase, as well as for visits to the chiropractor after you have reached maximum medical improvement (MMI) or received a permanent impairment rating following a functional capacity evaluation (FCE). There is no time limit on when you can get chiropractic care for your work injury.
Though workers comp covers chiropractic medicine, don’t be surprised if the insurance company refuses to authorize it and issues a medical treatment denial. Or if the insurer suddenly stops paying for visits to the chiropractor after covering them initially.
There are several reasons that insurers and third-party administrators such as Sedgwick and Gallagher Bassett fight so hard to prevent injured workers from treating with a chiropractor. In my opinion, the two main reasons are:
- You may benefit from chiropractic adjustments and treatments for the rest of your life. Though the frequency will likely taper off, intermittent chiropractic care may help relieve your pain and improve your functioning. Insurers know that the charges for your visits to the chiropractor will add up and cost them more money. And they will do whatever they can to avoid a situation where you may continue to treat.
- Compared to orthopedic surgeons, physiatrists, and other medical doctors involved in the treatment of injured workers, chiropractors are more flexible on payment arrangements with patients and not as beholden to insurance companies. If an insurance company doesn’t have a contract with the chiropractor or a good relationship, it may have to pay higher fees for the chiropractor’s services.
- Studies show that medical costs are 15 to 25 percent higher in workers comp claims involving chiropractic treatment.
Is There Any Advantage to Treating with a Chiropractor from a Workers Comp Litigation Perspective?
Yes.
There are several advantages to treating with a chiropractor, though I recommend seeing both a medical doctor and a chiropractor and not relying solely on the chiropractor’s opinions. This recommendation is based on the bias that some judges have against chiropractors because they are not as familiar with them as they are medical doctors, not my opinion
Many injury claims are won and lost on the medical evidence.
As a personal injury lawyer who handles both workers comp and car accident claims, I find chiropractors to be strong advocates for their patients and cooperative with their patients’ attorneys.
The best way for an attorney to develop the medical evidence is to talk with your health care providers about the issues in the case, explain what the provider needs to discuss in their expert report or medical narrative, and prepare the providers for depositions and in-court testimony. All of this takes time.
Compared to medical doctors, chiropractors are more likely to take the time necessary to discuss the critical issues with the attorney and to do this without charging an unreasonable fee. This results in more persuasive evidence and better testimony from the chiropractor, which increases the likelihood that you get the temporary total disability, permanent partial disability benefits, or settlement you deserve.
Another advantage of treating with a chiropractor is that the chiropractor can tip the balance of the evidence in your favor if there is conflicting medical evidence.
Suppose your treating orthopedic surgeon or neuropsychologist says you are unable to return to work and are capable of only light-duty. But the employer files an application to stop workers comp benefits because an IME doctor says you should be released to full duty. You can use the chiropractor’s opinions to persuade the Commission to accept your treating doctor’s opinion over that of the IME doctor.
A third advantage of treating with a chiropractor is that they are more likely to treat you on a lien basis when your case is pending.
Usually, you need medical evidence to prove you are entitled to workers comp payments. But if the employer raises defenses to your claim and refuses to pay for treatment without going to trial, you may have a difficult time getting medical evidence. The Commission may then deny your case based on this lack of evidence.
Many health care providers will refuse to treat you when your claim is pending. Some will even refuse to treat workers compensation patients with accepted claims because they don’t want to deal with the hassle created by many claim adjusters.
Often, chiropractors are the only health care professionals willing to treat you when your claim is pending or initially denied. This means a chiropractor may be the only health care provider who is ready to provide the evidence necessary to get workers compensation benefits.
I’ve found that chiropractors are more likely to provide care when your case is disputed and to hold off on collection efforts or receiving payment until the case is done.
What Can I Do if the Insurance Company Refuses to Pay for Chiropractic Care?
If your employer refuses to pay for chiropractic treatment, you have one option – file a workers comp claim seeking authorization and payment of visits to the chiropractor. This is called a change in condition application.
To win your claim for payment of chiropractic services under workers comp, I recommend doing the following:
- If you are treating with a medical doctor for your work injury, ask your doctor to write a report explaining why chiropractic care will help.
- Ask the chiropractor you want to see to write a report describing how the treatment could help and giving examples of how their treatment has helped injured workers with similar conditions in the past.
- Issue discovery to the insurer, including interrogatories and requests for document production, asking it to explain the basis for its denial of chiropractic services.
- Ask for an in-person workers comp hearing to testify about your current symptoms, including pain, and your desire to treat with a chiropractor instead of relying on medication for chronic pain. If you’ve had chiropractic care for the work injury already, tell the court how it helped.
While you are waiting for the trial, you can try to treat with the chiropractor using other means. These include private health insurance if you have it, out-of-pocket if you can afford it, or a Letter of Protection asking the chiropractor to treat you on a lien basis.
If you choose one of these options, keep receipts for all payments you make and copies of all invoices you receive. You can ask the Commission to order the employer to reimburse you or to make the payment.
How Much Does Chiropractic Treatment Cost?
The average cost of chiropractic care in a workers compensation case is from $1,500 to $20,000 or more. Make sure you include a reasonable amount for future chiropractic treatment when determining a fair settlement value.
In general, chiropractic services cost from $30 to $250 per appointment. The charge varies depending on your location, the chiropractor’s experience, and the treatment types.
Usually, chiropractors recommend multiple appointments – anywhere from 12 to 20 visits, or more – at first. You may need to undergo chiropractic adjustments over numerous visits many times.
Is There a Limit to How Much Chiropractic Treatment I Can Receive for My Work Injury?
Whether or not there is a limit to chiropractic treatment for your case depends on what state has jurisdiction over the claim.
Some states, such as California, limit the number of chiropractic visits you can receive per injury.
However, Virginia has no such limit. You can receive as much chiropractic treatment as you need for your work injury – as long as your treating physician says the chiropractic care is reasonable, necessary, and providing a benefit.
What if I Need Help with My Workers Comp Case?
The workers comp process is frustrating and complicated. But you don’t have to go through it alone.
The statute of limitations for workers comp claims is only two years from the date of the accident. Call me today for a free consultation: (804) 251-1620 or (757) 810-5614. See why I’ve been voted one of the best workers comp lawyers in America – and how I can help you get the medical treatment you need.
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