The Medical Treatment Guidelines, in our opinion, are the most destructive and damaging change that has been made to the Workers’ Compensation system in the last 50 years. Point blank, they prevent injured workers from getting proper medical treatment.
With regard to chiropractic manipulation, the Guidelines are only recommended for treatment of acute and sub-acute back pain “tied to objective measures of improvement.” What this statement should mean to treating chiropractors is that it is crucial to document objective improvement in the medical records. Future treatment may depend on proper documentation.
The Guidelines further require documentation that the manipulation has produced a beneficial effect between the first and sixth treatments.
The Guidelines allow for treatment up to three times per week for the first month and then twice a week for the next month. Treatment thereafter depends on functional improvement.
It is crucial that the treating chiropractor document functional improvement if there is any chance that additional treatment will be approved.
For chiropractic care beyond three months clear documentation demonstrating “re-injury, interrupted continuity of care, exacerbation of symptoms, and proof of co-morbidity” must be demonstrated.
Scheduled, prophylactic treatment will never be approved under the new Guidelines.
What all of this boils down to is documentation. While the Workers’ Compensation Board clearly can prevent treatment beyond the Guidelines if they want, specifically documenting the criteria outlined above, will at least offer the patient a chance of having a variance granted.
We strongly recommend that treating chiropractors use the specific language found in the Guidelines when requesting a variance and documenting each treatment and examination.
If you are a claimant struggling to get chiropractic treatment approved or a chiropractor trying to have additional treatments approved for your patient, feel free to contact our office.