Workers’ Compensation: Understanding Treatment Parameters

If you are dealing with a workers’ compensation claim, or have dealt with one in the past, you will probably agree that there are some areas that are pretty confusing. One of the more complicated areas is the topic of Treatment Parameters. Today’s article will focus on this topic and hopefully provide a bit more information in hopes that they will be less confusing in the future.

The treatment parameters are set forth in the Minnesota rules governing workers’ compensation. In its most basic form, treatment parameters are essentially guidelines for medical treatment in an accepted workers’ compensation claim. I often explain it to my clients that in order for the workers’ compensation insurer to authorize certain medical treatment, you must jump through their hoops. For example, if the admitted work injury is a knee injury, the workers compensation insurer is going to make the injured worker go through conservative treatment before authorizing an MRI. Conservative treatment may include a steroid injection and/or physical therapy. If conservative treatment is unsuccessful, then the MRI will likely be approved.

The most common complaint I hear regarding the treatment parameters deals with chiropractic treatment. The treatment parameters limit chiropractic treatment to 12 weeks. This means that you cannot receive more than 12 weeks of authorized chiropractic care from the workers’ compensation insurer. Injured workers’ get very upset when they hear from their adjusters that they will not approve additional chiropractic care after 12 weeks even if the injured worker is still complaining of pain and the chiropractic is recommended additional visits. Once the 12 weeks is exceeded, I often encourage my clients to see if they can get an orthopedic referral for further assessment. This same logic applies to physical therapy.

With the 12 week limit in mind, that doesn’t mean that the injured worker automatically gets 12 weeks chiropractic care for an admitted injury either. All medical treatment on a workers’ compensation claim must be reasonable and necessary in healing the work injury. If after a couple weeks of chiropractic care, the injured workers’ symptoms plateau, the adjuster will review the medical notes and likely not authorize additional visits. That’s why it’s very important the injured worker accurately communicates their symptoms to the chiropractic before and after the visits. It also helps to have a QRC on the file (discussed in my last article) to assist the injured worker symptoms are accurately laid out in the records.

Please send any request for topic suggestions to rene@breenandperson.com.  Although we cannot give you legal advice through the column, we can provide some general information that may be helpful for you to know.  Our purpose is to educate and we hope that you can take something new away from this column each time you read it.