What if the claim is several years old and the injured worker has already received more than the recommended amount of chiropractic treatment? Do the Guidelines apply?
Yes. All existing cases will not have the full documentation on objective functional improvement, therefore medical providers and carriers must follow the general principles and the Treatment Guidelines as if it is a new case. For example, an injured worker has been receiving chiropractic treatment 2 times per month for over a year prior to December 1, 2010. As of December 1, 2010, the Medical Treatment Guidelines apply, therefore the injured worker must be evaluated at the end of a 3 week period to determine if there is continuing objective functional improvement. If the injured worker shows no objective functional improvement, additional chiropractic treatment would not be consistent with the Medical Treatment Guidelines. • If a procedure or test that requires pre-authorization was approved by the insurance carrier prior to December 1, 2010, but the procedure or test cannot be scheduled until after December 1, 2010, does the procedure or test have to comply with the Medical Treatment
Related Questions
- What if the claim is several years old and the injured worker has already received more than the recommended amount of physical therapy treatment? Do the Guidelines apply?
- Can an injured worker voluntarily pay a medical provider for medical treatment that is not recommended in the Medical Treatment Guidelines?
- If the Medical Treatment Guidelines clearly indicate that a certain procedure is not recommended, is a request for a variance appropriate?
