Chiropractors And Workers’ Compensation: What You Need To Know

This article will discuss Chiropractors and their role within the California Workers’ Compensation System.   This article will discuss how Chiropractors are employed as treating physicians.  It will discuss the nature and extent of treatment that can be received from a Chiropractor. It will discuss chiropractic treatment and its benefits.  It will discuss the ability of Chiropractors to be Medical-Legal Evaluators.

What Is A Chiropractor?


Per the Department of Industrial Relations, “Doctors of Chiropractic (chiropractors) care for patients of all ages, with a variety of health conditions. Chiropractors are especially well known for their expertise in caring for patients with back pain, neck pain, and headaches. They may use manipulations or mobilizations (chiropractic adjustments). They also care for patients with a wide range of injuries and disorders of the musculoskeletal system, involving the muscles, ligaments, and joints. Chiropractors also counsel patients on diet, nutrition, exercise, healthy habits, and occupational and lifestyle modification. Chiropractors receive a Doctor of Chiropractic (DC) degree after four to five years of education following their college education.”

Can A Chiropractic Be A Qualified Medical Evaluator?


Yes. A Chiropractor can be a Qualified Medical Evaluator (QME).  This specialty is offered as a QME choice.

What Is Chiropractic Treatment?


Chiropractic Treatment involved a variety of modalities and can be applied to various body parts.  For basic musculoskeletal problems, “chiropractors use 4 broad categories of therapeutic interventions: (a) joint manipulation and mobilization, (b) soft tissue manipulation and massage, (c) exercise and physical rehabilitation prescription, and (d) home care and activity modification advice. In addition, nutritional and dietary counseling, physical therapy modalities (eg, heat, ice, ultrasound, electromodalities), and taping/bracing are also used as adjunct procedures.” Evidence-Based Practice and Chiropractic Care Ron LeFebvre, MA, DC,1 David Peterson, DC,1 and Mitchell Haas, MA, DC‘’ J Evid Based Complementary Altern Med. 2012 Dec 28; 18(1): 75–79. Published online 2012 Sep 3. doi: 10.1177/2156587212458435

Is Chiropractic Treatment Effective?


There have been studies concerning the effectiveness of chiropractic care.   Since chiropractic care covers many body parts, there is also an interest as to which body parts/conditions chiropractic care is most effective towards treating.

“The most common conditions treated by chiropractors are back pain, neck pain, and headaches. The best available evidence supports manipulative therapy as a reasonable option for many of these complaints. Manipulative therapy also holds potential value for the treatment of a variety of extremity conditions. Chiropractic practice is far broader than spinal manipulation alone, typically including other evidenced-based interventions such as massage, exercise therapy, and activity modification advice. “ Evidence-Based Practice and Chiropractic Care Ron LeFebvre, MA, DC,1 David Peterson, DC,1 and Mitchell Haas, MA, DC‘’ J Evid Based Complementary Altern Med. 2012 Dec 28; 18(1): 75–79. Published online 2012 Sep 3. doi: 10.1177/2156587212458435

Is Chiropractic Care Allowable For Workers’ Compensation Treatment?


Yes. Labor Code Section 4600 provides for authorization for chiropractic treatment for workers’ compensation injuries in the State of California.

Labor Code Section 4600(a) provides that:

“(a) Medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve the injured worker from the effects of his or her injury shall be provided by the employer. In the case of his or her neglect or refusal reasonably to do so, the employer is liable for the reasonable expense incurred by or on behalf of the employee in providing treatment.” [emphasis added]

Such chiropractic care is subject to Utilization Review by the Insurance Company as well as Independent Medical Review.

Are There Any Limitations Concerning Chiropractors As Treating Physician For California Workers’ Compensation Cases?


Yes. Labor Code Section 4600(c) provides that “[a] chiropractor shall not be a treating physician after the employee has received the maximum number of chiropractic visits allowed by subdivision (c) of Section 4604.5.”

In sum, once the Chiropractor has completed the total visits allowable, they can no longer remain as the treating doctor.

Are There Limits To Chiropractic Treatment For My Claim?


Yes. Per Labor Code Section 4604.5 (c) (1) [n]otwithstanding the medical treatment utilization schedule, for injuries occurring on and after January 1, 2004, an employee shall be entitled to no more than 24 chiropractic, 24 occupational therapy, and 24 physical therapy visits per industrial injury.  Further, per LC 4604.5(c)(3), paragraph (1), this shall not apply to visits for postsurgical physical medicine and postsurgical rehabilitation services provided in compliance with a postsurgical treatment utilization schedule established by the administrative director pursuant to Section 5307.27.

In sum, there are 24 visits allowance unless there is chiropractic treatment that is allowable per LC 4604.5(c)(3).

What Are Common Body Parts That Receive Chiropractic Treatment? Is It Effective?


Common body parts for which chiropractic treatment is employed are the low back, neck, mid-back, headaches and extremity conditions.

For low back pain, Spinal Manipulation is an effective care option for acute, subacute, and chronic low back pain. Likewise, Spinal Manipulation was found to be effective for acute and subacute neck pain.  For mid back pain, however, the evidence to date is inconclusive in a favorable direction for the use of thoracic spinal manipulation for mid back pain. For headaches, a Spinal Manipulation is an effective option for migraine and cervicogenic headaches. The evidence was found inconclusive for tension-type headaches. For extremity conditions, both upper and lower, “manipulation of extremity joints is used for a variety of conditions. However, there are fewer trials than for back pain, neck pain, and headaches. Effectiveness was found for shoulder girdle pain, adhesive capsulitis, lateral epicondylitis, hip and knee osteoarthritis, patellofemoral pain syndrome, and plantar fasciitis. Inconclusive evidence in a favorable direction was observed for rotator cuff pain, shoulder pain, carpal tunnel syndrome, ankle sprains, Morton’s neuroma, hallux limitus, and hallux abductor valgus. The only definitive negative finding was for ankle fracture rehabilitation, while several other forms of post-surgical rehabilitation had inconclusive evidence leaning in the negative direction.” Evidence-Based Practice and Chiropractic Care Ron LeFebvre, MA, DC,1 David Peterson, DC,1 and Mitchell Haas, MA, DC‘’ J Evid Based Complementary Altern Med. 2012 Dec 28; 18(1): 75–79. Published online 2012 Sep 3. doi: 10.1177/2156587212458435.  There is also a nonmusculoskeletal condition for which chiropractic treatment has been found to provide a positive result.   It involves spinal manipulation for cervicogenic dizziness. Supra.

Is Chiropractic Treatment Safe?


“Manual therapies including spinal manipulation are generally safe. Side effects tend to be benign: minor and self-limiting with short duration (eg, mild post manipulation soreness). Severe complications have been associated with spinal manipulation but are extremely rare. For example, cauda equina syndrome can be as rare as 1 in 100 million following lumbar manipulations. Cassidy et al reviewed approximately 100 million person-years of records to evaluate stroke risk associated with cervical spinal manipulation and medical care.” Evidence-Based Practice and Chiropractic Care Ron LeFebvre, MA, DC,1 David Peterson, DC,1 and Mitchell Haas, MA, DC‘’ J Evid Based Complementary Altern Med. 2012 Dec 28; 18(1): 75–79. Published online 2012 Sep 3. doi: 10.1177/2156587212458435.

What Is Your Personal Experience With Chiropractic Care?


Overall. I have found chiropractic treatment for my medical conditions to be effective.   I believe I went to a very good chiropractor. I found his treatment for the low back and neck to be very good.  I found treatment for the mid back to be not effective at all.  Overall, I was satisfied with the treatment that I received as a result of chiropractic care and would go back for further treatment to those parts if indicated.

What If I Need Advice?


If you would like a free consultation regarding your workers’ compensation claim, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 26 years. Contact us today for more information.

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