Physicians: Chiropractors

Parmer v. State Fund [6/9/00] 2000 MTWCC 33Demand that insurer cover ongoing chiropractic care and pay back chiropractic bills rejected. Under section 39-71-1101 and -1103, MCA (1997), claimant's right to select an initial treating physician pursuant to subsection (1) was subject to the provisions of (3), which in turn provided that a non-MCO (managed care organization) physician cannot provide treatment, unless authorized by the insurer, if the injury results in total wage loss or an impairment rating. Here, the claimant experienced a wage loss and was referred to the MCO and the MCO physician became his treating physician, per (4). Thereafter, except for emergency treatment, the insurer was responsible for treatment by a chiropractor only if it authorized those treatments. WCC would still review denial of chiropractic treatment, but found claimant had not proven that he sought chiropractic care through the MCO or that such care was superior to services available through the MCO. Where claimant had reached MMI, chiropractic services did not constitute "primary medical services" within 39-71-704, MCA (1997). Chiropractic care may qualify as secondary services, but must meet the requirement of "clear demonstration of cost-effectiveness of the services in returning the injured worker to actual employment" in 39-71-704(1)(b). Further, claimant has not demonstrated that chiropractic treatments should be prescribed as palliative care which would, under 39-71-704(1)(g) "enable the worker to continue current employment or that there is a clear probability of returning the worker to employment."

Thirsk v. State Fund [5/11/99] 1999 MTWCC 34 Claimant sought compensation for 56 chiropractic adjustments over 9 month period, all incurred after insurer informed him it would no longer cover chiropractic treatment for him. Persuasive medical evidence, along with statements made by claimant, indicated claimant had reached maximum medical healing and the chiropractic treatments were maintenance treatments, not actually leading to improvement in claimant. WCC held that under section 39-71-704, MCA (1993), the insurer was responsible for primary and secondary medical services as defined in the statute. Under the circumstances of this case, the chiropractic treatments were not primary medical services. The insurer was liable for secondary medical services only upon a clear demonstration of cost effectiveness of the services in returning the injured worker to actual employment. Claimant did not make this demonstration. Indeed, the evidence showed the treatments provided no more than temporary relief and did not improve his condition.

Jones v. Reliance National Indemnity Co. [3/17/99] 1999 MTWCC 22 Although chiropractor testified about appropriate impairment ratings for claimant following 1983 and 1987 injuries, statutes in effect at time of those injuries are not satisfied by chiropractor's testimony; thus, impairment awards cannot be based on that evidence. See, Weiss v. Division of Workers' Compensation, 232 Mont. 218, 220, 755 P.2d 1385, 1386 (1988).

McGillis v. State Fund [11/2/98] 1998 MTWCC 79 The parties' dispute over an impairment rating under the 1995 WCA was resolved in the insurer's favor based upon the Court's finding that the particular testimony of two chiropractors was not persuasive in comparison to the testimony provided by two medical doctors. The Court was not required to reach the question whether either chiropractor was statutorily authorized to render an opinion on impairment.

Murphy v. CIGNA Companies [10/15/98] 1998 MTWCC 73 A 73-year old claimant receiving PTD benefits following severe 1979 back injury sought coverage of chiropractic treatment on as-needed basis for flare-ups of back condition. Chiropractor testified flare-ups were inevitable and treatments provided only temporary relief. WCC followed Synek v. State Compensation Mutual Ins. Fund, WCC No. 9401-6989, Order on Appeal (August 26, 1994), aff'd 272 Mont. 246, 900 P.2d 884 (1995), which applied section 39-71-704, MCA, and ARM 24.29.2003 and -2004, to find not compensable chiropractic treatments providing only temporary relief and not restoring claimant to either a preclinical or stationary status.

Wieglenda v. State Compensation Insurance Fund/Department of Labor and Industry, No. 97-045 (1997) (Unpublished opinion) In an unpublished, nonciteable opinion, Supreme Court affirmed WCC determination that section 39-71-704(1)(f), MCA (1993) did not deny equal protection or due process by providing that insurer was not required to furnish maintenance care, in this case chiropractic care, to injured worker.

Wieglenda v. State Fund [10/23/96] WCC No. 9606-7562 Section 39-71-704(1), MCA (1993), and other statutory and regulatory provisions, do not deny equal protection or due process by providing that an insurer is not required to furnish maintenance care. (Note: WCC was affirmed by the Supreme Court in an unpublished, nonciteable opinion, Wieglenda v. State Compensation Insurance Fund/Department of Labor and Industry, No. 97-045 (1997).)