Chiropractic Treatment Not Reasonable or Necessary in PA Workers’ Comp because it Failed to Improve Condition
As long time readers of our blog know, Utilization Review is the process either party can use to address whether medical treatment for a PA work injury is reasonable or necessary. Though the Courts in Pennsylvania have made it clear that treatment can be reasonable and necessary while merely “palliative” (relieves symptoms though not curing the condition), we have seen the Commonwealth Court of Pennsylvania find treatment unreasonable and unnecessary because it did not significantly improve the condition.
This concept was again tested by the Commonwealth Court of Pennsylvania in Leca v. Workers’ Compensation Appeal Board (Philadelphia School District). Here, the injured worker hurt his low back and received chiropractic treatment for a period of years. The workers’ comp insurance carrier filed for Utilization Review. A Utilization Review Determination found the chiropractic treatment reasonable and necessary.
The workers’ compensation insurer filed a Petition for Review of Utilization Review Determination. In the litigation before a Workers’ Compensation Judge (WCJ), the insurer presented deposition testimony of the injured worker’s treating orthopedic surgeon, and its Independent Medical Examining (“Independent” being used loosely in this context) orthopedic surgeon. Both of these physicians testified the chiropractic treatment was not reasonable or necessary because, though it may have provided temporary relief, the chiropractic treatment did not improve the condition of the injured worker. No evidence from a chiropractor was offered. In response, the injured worker only offered the Utilization Review Determination (the injured worker did not even testify on his own behalf).
The WCJ granted the Petition, finding the experts presented by the workers’ comp insurance carrier credible. The chiropractic treatment was found unreasonable and unnecessary. Upon appeal, the Workers’ Compensation Appeal Board affirmed, as did the Commonwealth Court of Pennsylvania. The Court noted that the testimony of orthopedic surgeons, as opposed to a chiropractor, was perfectly acceptable, and that the WCJ had ample evidence to find the treatment at issue unreasonable and unnecessary.
While I am not certain the insurance carrier ever established the treatment was anything more than proper palliative treatment (no different than medications or injections), I am somewhat unclear why the injured worker did not present evidence regarding how the chiropractic treatment helped him. Why would the injured worker not testify regarding the benefits he derived from the treatment? Why would the chiropractor not testify, or at least submit a report, to address why he continued to provide this treatment? Not being involved in the case, I cannot say why these decisions were made, though it does make one wonder.