Effective date: November 1, 2021
Application: Applies to all injury claims requiring chiropractic services.
Policy subject: Health care services – providers
To provide administrative guidelines for approving and evaluating chiropractic services.
- Upon Workers’ Compensation Board (WCB) approval, a worker entitled to benefits under The Workers’ Compensation Act, 2013 is also entitled to (Section 103):
- Any medical aid that may be necessary because of the work-related injury.
- Any other treatment by a health care provider.
- Any orthotic appliance that may be necessary as a result of the injury, an
- Any travel and sustenance costs associated with receiving medical treatment as a result of the injury.
- The WCB is authorized to determine health care service fees (Section 104).
- Chiropractors who are members in good standing of the Chiropractors’ Association of Saskatchewan (CAS) and accredited by the WCB to provide services to injured workers can access the following at www.wcbsask.com:
- Practice standards for chiropractic service providers.
- Accreditation requirements.
- Primary Chiropractic and Physical Therapy Soft Tissue Treatment Guidelines.
- Complex case criteria.
- Reporting forms, and
- Primary Authorization to Treat forms.
The CAS and WCB will negotiate changes to these documents as needed.
- The WCB Chiropractic Consultant will review files that have two or more progress reports (CHP) if the worker is not discharged or sent for an assessment team review. However, Operations staff can request the assistance of the WCB Chiropractic Consultant at any time during the review of claims. Files are automatically referred to the Chiropractic Consultant if treatment costs exceed $1,500.
- Medical and Health Care Services (MHCS) will contact chiropractors (by phone and in writing) that continually send initial reports (CHI) or progress/discharge reports (CHP) late to the WCB. MHCS will issue a final warning if the late reporting continues. Thereafter, the WCB will not pay for services that chiropractors provide after reports are due.
- The WCB will only reimburse functional conditioning treatment for workers after they have been unable to return to regular or modified work duties for at least four consecutive weeks. If the worker needs functional conditioning before then, the chiropractor will contact the WCB. The WCB Chiropractic Consultant will review the worker’s progress before making a decision.
- For all soft tissue injuries, Operations staff will review the worker’s file at seven weeks post-injury to:
- Evaluate the risk of prolonged recovery.
- Determine if the worker needs an assessment team review.
- Ensure vocational (return-to-work) interventions are occurring, and
- Ensure that the chiropractor is using the WCB’s standards of care and treatment protocols.
- If the WCB denies a chiropractic claim for coverage (following the initial assessment or request for further treatments), the WCB will pay for services up to the date of notification.
- Chiropractors must contact the WCB Chiropractic Consultant before providing services in excess of that noted in the soft tissue guidelines. If no contact is made, the WCB may not pay the excess fees.
- There may be instances where a worker, who has completed treatment, fails to sustain improvement and progressively deteriorates when treatment is withdrawn. The WCB may provide funding for supportive care to enable the worker to remain functional at work. This is in accordance with POL 08/2014, Continuum of Care.
- Workers who may be considered for supportive care include those who have functional restrictions as determined by a Functional Capacity Evaluation (FCE) and/or assigned a Permanent Functional Impairment (PFI).
- The following are the two types of supportive care:
- Short-term supportive care will be provided to a worker who experiences a flare-up of the injury following secondary or tertiary treatment. A short course of primary treatment will be provided to restore the injured worker to pre-flare-up stage. Treatment frequency will depend on the individual case with the goal to return the worker functionally to pre flare up stage.
- Long-term supportive care will be provided to a worker who has significant functional restrictions and/or PFI and requires long-term supportive primary treatment to remain functional in the workplace and/or to stop or reduce further deterioration in their functional status. The frequency of treatment will be determined after review by a WCB Chiropractic Consultant.
- A care provider may request permanent ongoing treatment due to the severity of the work injury, ongoing symptoms and functional loss, which will be evaluated by a WCB Chiropractic Consultant.
- The treating chiropractor must be able to demonstrate the following in the progress report (CHP) when establishing the need for supportive care:
- Worker’s deterioration demonstrated through self-report outcome measures, such as the Roland Morris or DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure.
- Objective physical examination findings showing deterioration of clinical findings compared to their discharge report.
- Reduced function relative to discharge, if functional testing was undertaken.
- Increased use of medication compared to level of use at discharge.
- Further deterioration of the physical condition demonstrated through diagnostic testing and imaging.
- Evidence of a treatment hiatus and failure to sustain functional status.
- The WCB Chiropractic Consultant will review reports and determine if the worker requires short- or long-term supportive care and provide their recommendations to Operations staff to arrange for the appropriate treatment.
(1) PRO 54/2016, Chiropractors (effective June 1, 2016 to October 31, 2021).
(2) PRO 56/2013, Medical Fees – Chiropractors (effective January 1, 2014 to May 31, 2016).
(3) PRO 50/2011, Medical Fees – Chiropractors (effective February 1, 2011 to December 31, 2013).
(4) PRO 52/2008, Medical Fees – Chiropractors (effective April 1, 2007 to January 31, 2011).
(5) PRO 53/2007, Medical Fees – Chiropractors (effective April 1, 2006 to March 31, 2007).
(6) PRO 50/2005, Licensed Chiropractors in Saskatchewan (effective April 1, 2005 to March 31, 2006).
(7) PRO 51/2003, Fees for Services Provided by Chiropractors who are Licensed to Practice in Saskatchewan (effective June 27, 2003 to March 31, 2005).
(8) PRO 104/2002, Fees for Services Provided by Chiropractors who are Licensed to Practice in Saskatchewan (effective November 25, 2002 to June 26, 2003)
(9) PRO 102/2001, Amended Fees for Services Provided by Chiropractors who are Licensed to Practice in Saskatchewan (effective April 1, 2001 to November 24, 2002).
(10) PRO 100/2001, Fees for Services Provided by Chiropractors who are Licensed to Practice in Saskatchewan (effective January 1, 2001 to March 31, 2001).
(11) PRO 57/1999, Fees for Services Provided by Chiropractors who are Licensed to Practice in Saskatchewan (effective April 1, 1999 to December 31, 2000).
(12) PRO 06/98, Fees for Services Provided by Chiropractors who are Licensed to Practice in Saskatchewan (effective April 1, 1998 to March 31, 1999).
(13) PRO 06/97, Fees for Services Provided by Chiropractors who are Licensed to Practice in Saskatchewan (effective July 1, 1997 to March 31, 1998).
(14) ADM 35/95, Chiropractor Rates (effective January 1, 1996 to June 30, 1997).
(15) Board Order 03/93, Medical Aid – Fees for Chiropractic Services (effective February 17, 1993 to December 31, 1995).
(16) POL 20/92, Chiropractic Service Fees (effective September 2, 1992 to February 16, 1993)