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CHIROPRACTIC

Chiropractic (chiro- "hand" + praktikos "practical", means "done by hand.") is a complementary and alternative medicine health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. The main chiropractic treatment technique involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes exercises and health and lifestyle counseling.

"Chiropractic practitioners licensed by California state law and within the scope of their practice as defined by California state law" are included in the definition of "physician" under Labor Code §3209.3. They must be included in Medical Provider Networks: "The provider network shall include an adequate number and type of physicians, as described in Section 3209.3" Labor Code §4616

SB 863 amended Labor Code §4600(c) to add this sentence: "A chiropractor shall not be a treating physician after the employee has received the maximum number of chiropractic visits allowed by subdivision (d) of Section 4604.5." That section limited chiropractic visits to 24 "per industrial injury" and was introduced in AB 228 effective 1/1/2003, and applicable to injuries on or after 1/1/2004. The SB 863 amendment of Labor Code §4600(c) also added "or contracted with" a medical provider network.

It appears that the preclusion of a chiropractor as a treating physician does not apply to treatment under an MPN. The new regulations are thus problematic.

Efforts to attack Labor Code §4604.5 as unconstitutional failed (see the Facundo-Guerrero v. WCAB (Nurserymen's Exchange) case below), and it is likely that SB 863's change to Labor Code §4600(c) will be found to be constitutional on the same reasoning.

SB 863 also changed the Qualified Medical Evaluator requirements for chiropractors. Labor Code §139.2 now requires that the "doctor of chiropractic and has been certified in California workers’ compensation evaluation by a provider recognized by the administrative director. The certification program shall include instruction on disability evaluation report writing that meets the standards set forth in paragraph (1)."

Label Item Links Comments
Labor Code "Physician" includes "chiropractic practitioners licensed by California state law and within the scope of their practice as defined by California state law."

"(c) A chiropractor shall not be a treating physician after the employee has received the maximum number of chiropractic visits allowed by subdivision (d) of Section 4604.5."

24 chiropractic visits per injury

They must be included in Medical Provider Networks

QME requirements
LC §3209.3



LC §4600




LC  §4604.5

LC §4616

LC  §139.2
 
 
Regulations/Rules Treatment regs


QME-related: eligibility requirements: 8 CCR §§11 & 14
Treatment limited


8 CCR §11
8 CCR §14
 
Cases Facundo-Guerrero v. WCAB (Nurserymen's Exchange) (2008) 163 Cal.App.4th 640 upheld the Legislature's right to limit the number of chirporactic treatments that the employer had to pay for. In sum,the Court held that LC §4604.5 was not unconstitutional and did not violate applicant's rights to equal protection of law. That decision was appealed to the State Supreme Court, which denied the petition for review on September 10, 2008. Facundo-Guerrero v. WCAB
Forms  
 
Websites California Chiropractic Association calchiro.org  
   
Practice Tips  
Articles
   
Magazine Articles Chiropractic: Interview with Tami S. Auerbach, D.C. Auerbach  
Roundtable  
Miscellaneous    

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