You read a case like Leca v. Workers' Compensation Appeal Board (Philadelphia School District), No. 679 C.C. 2011, 03/07/2012 and you can't help but shake your head at how some abusive professionals take advantage of workers' compensation, damaging the system for other reasonable, moral providers.
John Leca, a police officer for the Philadelphia School District, injured his back while trying to break up a fight on April 14, 2004. The employer accepted liability and issued a notice of compensation payable.
Four years and 450 treatments later (what took so long?) the employer sought utilization review (UR) of Leca's ongoing chiropractic treatments.
Four years with 450 visits of chiropractic... Really?? That's 3.25 chiropractic visits every week for four years!
The original UR was by a chiropractor who said that despite the fact that Leca wasn't improving the treatment was reasonable because it was keeping him off drugs...
The employer/carrier obtained reports from some orthopedists who opined that the ongoing chiropractic was not justified because there was no evidence that Leca was improving or stabilizing, calling the treatments "palliative".
A workers' compensation judge found the orthopedists to be more credible and granted the employer's petition. The WCAB affirmed. Leca appealed.
In its majority opinion, the Commonwealth Court noted that the claimant argued the workers' compensation judge erred by relying on medical experts who did not review the records related to chiropractic treatment. Leca based this argument on Brookside Family Practice v. WCAB, a 2006 decision by the Commonwealth Court that held a workers' compensation judge erred by relying on testimony from an employer's experts who did not offer any evidence related to the effectiveness of the use of a spinal cord stimulator, which was the specific procedure under review.
But the Brookside decision is not applicable to Leca's case, the Commonwealth Court said. Leca's treatment was repetitive and ongoing, unlike the two specific procedures that were at issue in Brookside. Moreover, the physicians who testified for the employer addressed the specific chiropractic treatment under review and "credibly and persuasively opined" that the treatment was unnecessary.
The court also rejected the claimant's argument that the workers' compensation judge should not have relied on testimony from orthopedists about treatments performed by a chiropractor. The court said it is well established in Pennsylvania law that the opinion of medical doctors may be considered, even if they are not specialists in the specific field under review.
What the court was really saying is that it wasn't going to put up with abusive practices, regardless if a peer says that it is okay.
3.25 chiropractic visits every week for four years is abusive and I don't care how good it makes one feel. There is no reasonable support for this kind of activity and you can bet that if Leca had a co-pay or some other financial obligation there would not even be an issue.
The entitlement mentality fostered by free medical care, and the willingness of professionals to abuse that entitlement for their own interests is a cultural illness that is at the root of systemic problems with workers' compensation.