One of the most contested and litigated issues resulting from implementation of the Medical Treatment Guidelines involves chiropractic manipulation of the back and neck.

While it is clear that the Workers’ Compensation Board has implemented the Guidelines with one goal in mind, cutting costs to employers and carriers, certain steps may be taken by attending chiropractors to protect their patients’ rights to ongoing chiropractic manipulation treatment.

When all is said and done, a Law Judge’s determination and Workers’ Compensation Board’s ruling on Appeal will determine whether chiropractic care can be covered. However, the attending chiropractor can help his patients’ cause by following the Guidelines and specifically documenting FUNCTIONAL IMPROVEMENT. Without functional improvement, treatment beyond four weeks may be suspended.

The Medical Treatment Guidelines indicate a maximum duration of chiropractic manipulation of three months. However, addition manipulation may be necessary in cases of “re-injury, interrupted continuity of care, exacerbation of symptoms, and in patients with co-morbidities.”

Therefore, in order to have any chance of extending manipulations beyond three months it is crucial that the attending chiropractor document an “exacerbation” of symptoms, re-injury, or co-morbidity. The most common and logical factor seems to be an exacerbation of symptoms. Presumably, that is why ongoing chiropractic treatment is needed. However, clear written documentation may go along way to having variances granted under the Medical Treatment Guidelines.