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Why reasonable chiropractic care should be on the table By Jonathan M. Brand, ESq. Attorney at Law It is now time to increase the number of chiropractic visits available for injured workers. I take this position not as an advocate for chiropractors, but as an advocate for injured workers. In 2004, California law established that an injured worker was entitled to no more 24 chiropractic visits per case.1 The legislative limitation was in response to a perceived excess and abuse by the chiropractic profession.
Chiropractic care had exploded in the context of the treating doctor’s presumption, along with ineffective utilization review procedures and limitless access.2 It may be that there were abuses by the chiropractic profession prior to the reforms of 2004. However,
it would be a mistake not to recognize the significant benefits of chiropractic for the care of injured workers.
I am constantly amazed that our just say no to drugs society readily accepts powerful and dangerous prescription drugs as the preferred method for the treatment of industrial injuries.
Chiropractors alone are able to diagnose and treat acute and chronic pain without medications. In my practice, I have observed firsthand the negative impact that prescription drugs have on injured workers. Many injured workers can
not return to work because of the side effects of medications, and long term use results in complications that can include damage to internal organs, gastrointestinal issues, and even death. My thesis is that in the context of today’s system, and specifically SB 863, increased access to the chiropractic world benefit injured workers and decrease costs. With the system in place now, along with the introduction of Independent Medical Review (IMR) and other changes under SB 863, there is little chance that chiropractic care will get out of hand going forward. First, Medical Provider networks became a fact of life in California Workers’ Compensation in 2005. Carriers have a great deal of control over who gets into the network. Economic profiling is allowed and legal. Therefore, chiropractors who want to be a part of workers’ compensation solutions must be mindful of providing conservative treatment, conservative and reasonable ratings, and making conservative and reasonable referrals. Doctors who violate these principles will find themselves out of the networks and out of workers’ compensation. Next, Utilization Review (UR) and IMR together will keep the number of visits under control. Chiropractors who fail to document and justify requests for authorization will not be successful in obtaining authorization. However, I would hope that when chiropractic care is justified in helping to manage pain while reducing the reliance on drugs, additional care would be authorized. There are also major changes to lien recovery under SB 863. In the past, out-of-network and unauthorized chiropractic care resulted in liens. Under the new rules, MPN disputes will be resolved by way of expedited hearings. Liens are no longer a remedy
for unauthorized care. IMR should just about eliminated the availability of liens for chiropractors. With respect to costs, an argument can be made that reasonable chiropractic care is far less expensive than pain medications. It is especially true when you take into account the complications that arise from pain medications. The cost of a year of chiropractic at one visit per month is $888.00 or about $74.00 per visit. In addition, a study has shown that employers who offer chiropractor care to their employees can realize a significant reduction in utilization in connection with the management of low back pain.3 Injured workers could return to work earlier if they could rely more
The benefit of Chiropractic as an alternative to narcotic drugs for pain management. on chiropractic to manage pain. In some cases, the effect of medications contributes to additional time off work. Police officers, drivers, and construction workers are just a few workers that can’t function on many medications. Chiropractic has no side effects that would prevent a return to work. A 2012 study published in the Journal of Occupational and Environmental Medicine found: For patients with occupational injuries having chronic pain, more frequent and longer-term use of narcotics may lead to addiction, increased disability, work loss, or even death. Consequently, the health risks and financial impact of workers’ compensation claims resulting from the use of opioids to treat chronic pain are a significant issue.4
What won’t happen, but what could happen. In my opinion, the current law should be amended to allow up to 24 visits for the first year and up to 12 visits per year thereafter. This would be similar to the restrictions in many health care plans. I also believe that Labor Code Section 3751(b) 5 should be modified to allow injured workers to pay for additional chiropractic care out of their own pocket. But who knows when the California legislature will take up workers’ compensation reforms again. Regardless, I suggest that adjustors and defense attorneys take another look at chiropractic anyway. Current law allows additional care beyond 24 visits if authorized by the employer. Authorization for a reasonable number of visits beyond 24 (i.e., no more than 12 per year) can be a win-win. Many injured workers prefer to manage their pain without harmful medications, which result in dependence and other negative consequences. However, when chiropractic care is denied, many injured workers are forced to turn to more harmful and expensive alternatives. In the context of current reforms, claims managers can allow additional chiropractic when appropriate without the risk that it will get out of hand. It is time to take another look at chiropractic - not for the chiropractors but for the injured workers.
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The choice of health care is a fundamental part of being a free person.
brandpeters@jb-law.com (888) 245-6507 | jb-law.com
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Jonathan M. Brand, ESq. Attorney at Law Jonathan Brand graduated from John F. Kennedy Law School in 1986. Mr. Brand founded The Law Offices of Jonathan Brand in Walnut Creek, California, in 1989 to pursue his interest in personal injury cases. Shortly after that, the firm expanded to handle workers’ compensation. Mr. Brand is a frequent lecturer in the chiropractic community and has been a strong advocate for alternative medicine. As the founding attorney at The Law Offices of Jonathan M. Brand, he has handled thousands of Personal Injury and Worker’s Compensation cases in his nearly 30 years of practice. He takes excellent care of his clients, making sure they get the best treatment, personalized attention, and ultimately, the justice they deserve. He understands what it takes to get the best recovery possible for your personal injury claim. He doesn’t shy away from “tough cases,” as some other attorneys may. 1. Cal. Lab. Code § 4604.5(d)(1) “Notwithstanding the medical treatment utilization schedule or the guidelines set forth in the American College of Occupational and Environmental Medicine’s Occupational Medicine Practice Guidelines, for injuries occurring on and after January 1, 2004, an employee shall be entitled to no more than 24 chiropractic, 24 occupational therapy and 24 physical therapy visits per industrial injury.”
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2. Cal. Lab. Code § 4062.9 replealed 2004, provided that the opinions of the primary doctor were presumed correct. 3. The study sponsored by American Specialty of San Diego and conducted by independent health services research organization Health Benchmarks Inc. is the largest ever done comparing back treatment costs for individuals with and without chiropractic health plan coverage. 4. JOEM - Volume 54, Number 8, August 2012. The Effect of Opioid Use on Workers’ Compensation. 5. Cal. Lab. Code § 3751(b) “If an employee has filed a claim form pursuant to Section 5401, a provider of medical services shall not, with actual knowledge that a claim is pending, collect money directly from the employee for services to cure or relieve the effects of the injury for which the claim form was filed, unless the medical provider has received written notice that liability for the injury has been rejected by the employer and the medical provider has provided a copy of this notice to the employee. Any medical provider who violates this subdivision shall be liable for three times the amount unlawfully collected, plus reasonable attorney’s fees and costs.”
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