With the implementation of the Medical Treatment Guidelines in New York State Workers’ Compensation cases, on going chiropractic care has been extremely difficult to secure. Once the chiropractor has exhausted the number of visits allowed by the Guidelines, a variance must be requested.

It has been my experience that almost all of the variances requested the chiropractors are denied. The main reason for this denial is failure to specifically document the information needed to demonstrate that a variance is necessary and appropriate. The Guidelines specifically state that chiropractic manipulation should not be used as a chronic treatment.

When requesting a variance it is crucial that the attending chiropractor specifically document any and all evidence of functional improvement. Objective measurements are the most persuasive in demonstrating functional improvement.

We strongly recommend that the attending chiropractor provide a brief narrative statement detailing how prior chiropractic treatment has benefited the patient, the specific objective findings proving this, the expected future goals and expected number of visits needed to accomplish those goals.

Complete examination notes including range of motion testing and all other objective findings should be provided with the variance request. Summarizing the objective findings that may demonstrate functional improvement with chiropractic treatment can by most helpful in having the variance granted.