Renee Heitger and Jeffery Friesen our firm recently won affirmance of a judge’s decision denying excessive chiropractic care. The Workers’ Compensation Board’s Medical Treatment Guidelines encourage providers to use various treatment modalities to assist injured workers in recovery and maintenance. At the same time, the guidelines place limits on how much of a given treatment insurance carriers and employers should be responsible for. The main focus is a requirement that the treatment produces measurable, sustained results in improving an injured worker’s ability to function and not be simply palliative. Treatment beyond limits prescribed by the guidelines requires that a provider apply for a variance to extend the treatment. In the case of chiropractic care, there is a specific exception to the variance requirement for initial treatment of an exacerbation when the care provided is consistent with the guidelines. The chiropractor must meet specific requirements for the exacerbation exception to apply. The provider must fully document the exacerbation including when and how it occurred, the objective changes from baseline function, the expected type and frequency of treatments anticipated to return the injured worker to baseline function, and the worker’s response to treatment through documented measures of objective functional improvement.
In Renée’s and Jeff’s case, the treating chiropractor alleged that the claimant experienced serial exacerbation’s of her condition throughout 2023. Our client began objecting to bills for chiropractic treatment for an alleged exacerbation later on in the year, asserting that the provider had failed to provide sufficient medical evidence to support his conclusion that the claimant experienced an exacerbation. The chiropractor based his contention on changes from the claimant’s baseline range of motion measurements taken in September 2023 to those from September 2022. In affirming the law judge’s decision denying payment for the bills, the Board Panel noted that despite frequent chiropractic treatment, little change to the claimant’s subjective complaints and objective physical examinations were noted throughout the course of her treatment. The panel also noted there was no evidence that the claimant ever returned to baseline range of motion in the year of continuous chiropractic treatment she received.
The Board Panel observed that it is not sufficient for a treating medical provider to simply say a claimant had an exacerbation without providing medical evidence to support such a conclusion, crediting our firm’s argument. This result demonstrates our firm’s commitment to ensuring that the board’s limitations on treatment are strictly enforced to contain the cost of claims for our clients.
