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The California Chiropractic Association says the predesignation regulations to be considered by Division of Workers' Compensation today gives claims adjusters leeway to refuse to accept chiropractors as primary treating physicians "Although we believe the regulation is not intended to prevent doctors of chiropractic from being primary treating physicians, we believe it will create unnecessary confusion and lead to delays in patient care, which would substantially increase costs," ...

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Comments (10):
“The truth is, these regulations do not change the Labor Code requirements for pre-designation. They only define them. It has always been that in order for an employee to pre-designate a personal treating physician that physician had to be a Physician AND Surgeon under the Bussiness Codes. This has always excluded chiropractors from being predesignated to treat as of the date of injury. SB 899 added the requirement that this physician and surgeon must also be the primary care physician. Chiropractors have either misrepresented or misunderstood Labor Code 4601 (b) into thinking that it allowed an employee to treat with his/her chiropractor as of the date of injury. That is NOT what Labor Code 4601 states. Labor Code 4601 deals with changing physicians. You cannot change a physician until you are treating with a physician. If you are treating with the employer's physician and want to change, you can make the requested one-time change of physician. If you feel you should treat with a chiropractor, you can make that request. However, it opens a medical issue as to whether or not your condition is appropriate for chiropractic treatment. If it is determined that the condition is appropriate for chiropractic treatment, then you can obtain treatment through a chiropractor. THEN Labor Code 4601 comes into play. If you have pre-designated a personal treating chiropractor, you can treat with that chiropractor. Keep in mind that SB 228 limited chiro treatment to 24 sessions. Therefore it does not make sense to transfer treatment/care completely to a chiropractor. The more sensible thing to do is to keep an M.D. as the treating physician and allow the M.D. to monitor the chiro treatment. This way you do not have to transfer the employee again when the 24 visits are up. Lastly, the MPN regulations created a major problem with the employee's right to pre-designate a personal chiropractor under 4601 (b). As the MPN treatment is controlled by 4616.1 - 4616.7 and not 4601, then it appears that the Legislative intent of SB 899 was to block the right of the employee to pre-deisgnate his.her treating chiropractor where the employer offers a medical provider network. It does not block chiropractice treatment as a whole because the MPN must offer chiropactors on the panel. In some cases the chiro on the panel may be the personal treating chiropractor. However, since the employee is free to change to any provider in the MPN panel after the first visit, this pretty much made the need to pre-designate a chiropractor obsolete. --Dennis Knotts-- Instructor for IEA”
By: dennis knotts, 12/15/2005 04:45:01 pm

“<<<>>>> Let's remember that not all chiros use up the 24 visits with treatment. Some prefer to manage the case as the PTP to the end and use other treatment vehicles (outside physical therapy, pain management docs, orthopedists, occupational therapists etc) after 12 chiro visits. I have found that many claims administrators will even authorize additional visits over the 24 caps IF diligence has been established and your out of visits. ChiroGeek”
By: Douglas Gillard, 12/15/2005 06:24:22 pm
“Well Dennis, If what you say is true than ANY physician that does not provide surgery is NOT allowed to be predesignated. This would leave basically an orthopedic doctor as the sole physician that can be chose. (podiatry and a few exceptions)Furthermore, few physicians refer to chiros regardless if the problem is chiro appropriate. Pepsi would never tell you to drink coke!!!!”
By: Brian Burk, 12/15/2005 06:53:47 pm
“Dr Miller, for a 'Dr" you are rather ignorant. A physicians surgeons certificate is what all MD's are given.”
By: Reynold J. Roth, 12/15/2005 07:54:20 pm
“Comment - No put coke will fire you if you drink pepsi - (that was on the news last year) NOW to get serious- Chiros work miracles I mean the state deems that 24 visits and the injured work is cured and needs no additional treatment. Oh well such as life as the saying goes. I go and receive quality medical care under appropriate Federal Rules - I can even have the VA do surgery and bill the WC Insurance carrier - that drives them nuts when a few vets have done it and they have to pay - ”
By: Republic1 Republic, 12/16/2005 03:29:41 pm
“If the state of california has recognised me as a physician I should be able to be a primary treating physician. To have TWO separate ter systems is discriminatory at best. Furthermore, according to the AMA own research chiro care is very affective for several condition. To be put back underneath a physician that is ignorant to our profession and to what I am able to do is assinine!!! Wonder how many will sue as I will to gain equal rights under the law.”
By: Brian Burk, 12/15/2005 06:59:43 pm
“The state has not recognized you a physician, that is why your are treated differently under the Business and Professions Code.”
By: Mario Yep, 12/15/2005 07:46:54 pm
“Can't ANYONE spell these days? Or use correct grammar? ”
By: Susan Rodriguez, 01/31/2006 05:27:03 pm
“Mr. Knots: The California Chiropractic Association didn't "misunderstand" Labor Code 4601. Our concern with the proposed regulation is that the definition of "primary care physician" is unnecessarily limited to medical doctors. There is no need to limit the definition of "primary care physician" to medical doctors because 4600 (d)(1)(B)(2)(A) specifies that a personal physician must be licensed pursuant to the medical practice act. We think that if the definition is not changed, it will be misinterpreted by claims administrators to prohibit doctors of chiropractic from serving as primary treating physicians and cause more delays ultimately increasing costs to the system.”
By: Cris Forsyth, 12/16/2005 01:19:55 am
“The only impact this regualation has is the limitation on the specialty of a MD for the purpose of a predesignated physician under LC 4600(d). Since Chiropractors are already excluded from that definition, this regulation has no impact on their abiliy to practice at all. The final sentance in this regulation is in reality the crux of the regulation. If "Primary Care Physician" is to have any different meaning that "Primary Treating Physician" there needs to be a regulation that provides such a definition. The AD is adopting the definition that is commonly used for most health care organizations. The practitioners who are most affected by this regulation are not chiropractors but medical doctors who do not otherwise meet the definition of primary care doctor and are now excluded from serving as a predesignated physician. This excludes orthopedic surgeons, neurosurgeons, neurologists etc who could previously have been predesignated and will now be excluded from consideration. This section is clearly designed to allow an employee to select as a initial treating physician for an industrial injury the physician they have established a relationship with as part of their group health plan,”
By: Richard Jacobsmeyer, 12/16/2005 09:00:29 am
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