We have many clients who suffer on the job injuries and develop chronic or long-lasting conditions in their spines and other body regions. Many of those same clients receive chiropractic treatment for their injuries. The Bureau of Workers’ Compensation (or “BWC“) is generally obligated to pay for treatment of such conditions (even many years down the road) provided that the treatment is (a) reasonably related to the industrial injury; (b) reasonably necessary for treatment of the allowed condition(s) in the claim; and (c) the costs thereof are medically reasonable. This is otherwise known as the “Miller Criteria”. Most of the debates on treatment focus on the first two prongs.
Proving That Treatment of the Chronic Condition is Reasonably Related and Reasoanbly Necessary
Documentation of the chronic condition is key to ensuring that chiropractic treatment continues to be approved. The Ohio BWC has adopted the “Guidelines for Chiropractic Quality Assurance and Practice Parameters” (i.e. the “Mercy Document”) to evaluate the appropriateness of chiropractic care generally. (Also see: “The Chiropractic Manual” published by the Ohio State Chiropractic Association for discussion on chronic conditions.) A “chronic condition” is generally defined as one that persists beyond three (3) to four (4) months. Supportive chiropractic care (i.e., generally 1-2 times per month) is defined as treatment/care for patients having reached maximum therapeutic benefit, in whom periodic trials of therapeutic withdrawal fail to sustain previous therapeutic gains that would otherwise progressively deteriorate.
Some of the information used to document the necessity of supportive care include, but are not limited to: (1) abnormal range of motion; (2) atrophy; (3) postural distortion; (4) orthopedic findings; and (5) diagnostic test results.
It is very important that physicians document the necessity of ongoing chiropractic treatment. Failure to do so may result in denial of much needed care.
McKenzie & Snyder LLP represents injured workers in the Greater Cincinnati Area, including: Colerain, Mt Healthy, Middletown, Hamilton, Fairfield, Dayton, Fairborn, Springboro, College Hill, Lebanon, Mason, Monroe, Reading, Forest Park, Oxford, Ross, Westwood, Cheviot, and more.
Written by Andrew Tobergte