While workers’ compensation benefits pay for many kinds of medical care, alternative medicine treatments may not qualify. Injured employees interested in seeking alternative treatments for their medical conditions should carefully determine whether the treatments will be paid for by the insurance company.
Workers’ compensation insurance companies that pay injured workers’ medical expenses only have to pay for those charges that are “reasonable and necessary” to treat work-related injuries. In other words, the system is designed so that insurance companies can dispute any out-of-the-ordinary treatment options. Minnesota law lists specific treatment parameters limiting the amount of treatment the company has to approve for those services that are considered reasonable and necessary.
Any treatment that is not generally accepted by the medical community may not be considered reasonable and necessary, at least by the insurance company. Minnesota workers’ compensation law does deem chiropractic services, a common treatment for back injuries, to be reasonable and necessary in some circumstances. Courts have established a list of factors for determining whether the services are reasonable and necessary:
- Documentation of the treatment itself and of the details of a reasonable treatment plan;
- Whether the frequency and duration of the treatment is warranted, in light of the potential for psychological dependency;
- The degree and duration of the relief itself that is obtained from the treatment;
- The relationship of the treatment to the goal of returning the employee to suitable employment and non-work activities;
- Appropriate referral to medical providers in the event of continuing problems, in light of the possibility that the chiropractic treatment itself may be causing the problem; and
- The cost of the treatment in light of the relief provided and the results obtained.
Importantly, the courts established these factors, not the insurance companies. Insurance companies may deny charges for chiropractic services regardless of whether the factors weigh in favor of the services being reasonable and necessary. The same is true for other alternative medicine treatments.
The duration of chiropractic treatment is limited to twelve weeks of sessions. A patient can receive an additional twelve sessions if:
- The employee is released to work or is permanently totally disabled.
- The chiropractic treatment progressively improves or maintains the functional status gained during the initial 12 weeks of treatment.
- The treatment is not given on a regularly scheduled basis.
- The chiropractor documents a plan to “encourage the employee’s independence and decreased reliance on health care providers”.
- The chiropractor uses active modalities such as exercise, posture and work method training, worksite analysis and modification, and education.
Minn. Rules 5221.6200, Subp. 3.
Again, it is even more difficult to get charges for other alternative treatments besides chiropractor visits approved by the insurance company. If you are interested in seeking alternative medicine options for your workplace injury, consult a knowledgeable attorney first.
Need help getting workers’ compensation for your injury? Joe Osterbauer, Esq. and the Osterbauer Law Firm stand up for injured Minnesota workers’ rights. Joe’s 27 years of workers’ compensation experience and his team’s speedy service combine to get clients the results they need. To schedule a free consultation, visit Osterbauer Law Firm online or call Joe’s office at (612) 334-3434.