Worker's compensation in NJ has been a good old' boy network of large clinics, mediocre care, unnecessary tests, surgeries, and bureaucracies. The problem has worsened with hospital and medical group consolidation. The rates for disability per week have increased as did the cost of a medical report or expert fee as well if you decide to sue the carrier for non payment of medically necessary care. In 1990, the worker's compensation insurers passed a law allowing the insurer to choose who the employee visited They boycotted chiropractors for many years and instead referred injured workers for costly tests, and risky surgeries for conditions such as back shoulder, and neck pain. Patients sent for many for months of rehabilitation often had little to show for it other than higher costs for employers that continued through the use of pain management and addition injections or surgeries that were ineffective or worse, resulted in permanent disability. Now with consolidation, their costs are exploding as are their disability and legal costs too. In late 1999 Johnson and Johnson began studying Active Release Techniques as a method of reducing the cost and effectiveness of care for carpal tunnel syndrome also known as RSI or Repetitive Stress Injuries. Patients wishing to avoid carpal tunnel surgery were treated for dozens of visits without improvement by therapists and they were willing to look at things differently. In 1994, I was trained in Active Release Techniques by its founder and the staff they assembled in NJ to teach doctors this new method for treating carpal tunnel syndrome and many other painful conditions. Our office was part of that study in 1999 and after a short period, Dr. Cole, the Workers Comp doctor for the region asked us to treat more cases, as they were thrilled with our results. Over two years, most of the cases they sent improved in 10 or fewer visits. I was asked to speak to the staff at Ortho at their annual nurse's meeting and treated a patient I did not know and never met before the meeting. The patient improved while those at the meeting watched with interest and the nurses were thrilled with how the patient responded and how I evaluated and treated the patient after a thorough history. In 2002, their new medical director stopped using us but then began sending their top executives instead after he got to understand how we worked and that our goals were aligned. He has since retired but Johnson and Johnson continue to recommend our office based on the nurse's previous experiences. Chiropractic care has a long history of reducing pain and disability at a lower cost while avoiding the overuse of tests such as the MRI by keeping it simple and evaluating holistically. Insurers must place chiropractors at the front of the line for these patients to reduce costs in NJ. Studies support these claims as well including Here is a sample of those studies Chiropractic Care for Workers with Low Back Pain Workers Compensation Research Institute (May 17, 2022) This study describes the prevalence of chiropractic care and provider patterns of physical medicine treatment for workers with low back pain. It provides some evidence as to how different provider patterns of physical medicine treatment are associated with variations in overall medical and indemnity costs, and the duration of temporary disability. The study also looks at the utilization of medical services, including magnetic imaging studies, opioid prescriptions, and pain management injections. Claims with care provided exclusively by chiropractors were associated with lower costs and shorter duration of temporary disability than a set of claims with similar characteristics where care was exclusively provided by non-chiropractic providers. Guideline Adherence and Lost Workdays for Acute Low Back Pain in the California Workers' Compensation System PLoS One 2021 (Jun 17); 16 (6): e0253268 ~ FULL TEXT When workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers. Guideline Adherence and Lost Workdays for Acute Low Back Pain in the California Workers' Compensation System PLoS One 2021 (Jun 17); 16 (6): e0253268 ~ FULL TEXT When workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers. Initial Return to Work and Long-term Employment Patterns: Associations with Work-related Permanent Impairment and with Participation in Workers' Compensation-based Return-to-work Programs Am J Ind Med 2021 (May); 64 (5): 323–337 ~ FULL TEXT State wage files provide an efficient approach to identifying RTW patterns. Workers with permanent impairment were at substantially higher risk of poor employment outcomes. WC-based RTW programs may promote better employment outcomes. This is a small sample. Google chiropractic worker's compensation studies or use the link chiro.org, and you will see there are hundreds of studies supporting chiropractic as a first approach for worker's compensation injuries. Why direct care to chiropractors instead of the good old boy networks? Lower disability costs as patients are back to work sooner. A holistic approach to care is more thorough and leads to a better diagnosis. Manipulation of the spine, extremities, and soft tissues gets patients out of pain faster for many conditions. For example, that shoulder problem may be a lower back problem if only the doctor asked this in the history and examined the entire patient, rather than just the main complaint. Exercises are often instructed during those same visits. Chiropractors keep it simple; Do we need a first doctor, then rehab, then a specialist when all you need is a chiropractor doing all of this simply and getting results sooner? Better rating systems so companies do not pay higher insurance rates when sending their patients for needed care. This will incentivize companies to use chiropractors either in-house or refer them initially. What can an insurer do to reduce costs other than just passing it on to the employer? Directing care to chiropractors first can help markedly. Many chiropractors are trained to help people holistically and keep them working which lowers costs, improves outcomes, and improves their relationships with the companies who insure them. Patients who get more effective care avoid often risky procedures that are routine in worker comp while getting back to work saving the system $$$. Partner with the ANJC which is the main chiropractic society in NJ. They can use them as a credentialing agency to help pick the best doctors in each region and help develop rational guidelines for care that keep employees working while keeping the cost of disability to a minimum. The cost savings alone with chiropractic can also help reduce lawsuits from surgeries gone bad, pain management that can be avoided by having functional workers, and more efficient paths of care by forward-thinking chiropractors who want to get the injured back to work too. Develop partners within the chiropractic profession and streamline the process for expedient and appropriate claim payment with less friction. Patients will self-direct while playing the game when the insurer sends them for care that just doesn't work. The big clinic approach many insurers use is often ineffective and many patients will either begin to demand that the insurer authorize the chiropractor anyway, or get an attorney or they tell the comp doctor they helped when it was the chiropractor. This sounds crazy but it is the reality in NJ. Allowing employees to self-direct the first 12 visits of care for chiropractic. Maybe it is time to offer patients a better path to return to work and solve their problems too. Over my 37 years in practice, I have treated hundreds of cases that were chronic after having endured needless surgeries, and pain management that was non-curative and their problems improved markedly with chiropractic holistic methods to care. Health insurers were now paying the bill when these problems could have been resolved at a lower cost and without the years of suffering endured by patients who were misdiagnosed and treated noncuratively at a high level of cost. Evidence over many years proved it and continues to do so. Injured at work and want a second opinion? Book online here