Cincinnati Workmans Comp: Chiropractic Treatment for Chronic Conditions
Chiropractic Treatment for Work Injuries
Many clients suffer on-the-job injuries and develop chronic or long-lasting conditions in their spines and other body regions. Many of these 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. This is provided that the treatment meets specific criteria, known as the “Miller Criteria.”
Understanding the Miller Criteria
For treatment to be covered, it must meet three conditions:
- It is reasonably related to the industrial injury.
- It is reasonably necessary for the treatment of the allowed condition(s) in the claim.
- The costs are medically reasonable.
Most debates on treatment coverage focus on the first two points.
Proving Treatment is Related and 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.
For further discussion on chronic conditions, refer to “The Chiropractic Manual” published by the Ohio State Chiropractic Association.
Defining Chronic Conditions and Supportive Care
A “chronic condition” is generally defined as one that persists beyond three to four months. Supportive chiropractic care is defined as treatment for patients who have reached maximum therapeutic benefit.
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.
This care is for individuals in whom periodic trials of therapeutic withdrawal fail to sustain previous therapeutic gains that would otherwise progressively deteriorate.
Documenting Necessity for Ongoing Treatment
Some information used to document the necessity of supportive care includes, but is not limited to:
- Abnormal range of motion
- Atrophy
- Postural distortion
- Orthopedic findings
- Diagnostic test results
It is very important that physicians document the necessity of ongoing chiropractic treatment. Failure to do so may result in the denial of much-needed care.
