The treatment parameters set forth five “departures” that allow for chiropractic treatment or physical therapy to continue beyond the 12 weeks plus 12 treatments that are presumed to be reasonable. These departures are found at Minn. Rule 5221.6050, subpart 8.
Subpart 8A allows treatment to continue where a “documented medical complication” is present that complicates and prolongs the employee's recovery from their injury and justifies more treatment than is normally expected. Examples include: advanced degenerative disc disease; Scheuermann’s disease; diabetes; obesity; a long history of smoking; anything unique to the injured employee that medically complicates and prolongs their recovery.
Subpart 8B allows treatment where previous treatment did not meet the accepted standard of practice for the provider who ordered the treatment. This might arise where the first treating doctor did not treat the injury aggressively, telling the employee they should heal on their own in a few weeks, and the employee’s condition instead worsened and became chronic.
Subpart 8C allows treatment when necessary to assist the employee in their initial return to work where the work exacerbates the employee’s injury.
Subpart 8D allows treatment to continue so long as there continues to be “progressive improvement” in two of the three following criteria: the employee’s subjective complaints of pain, the employee’s objective clinical findings, and the employee’s functional status. Conceptually, this departure section allows for continuing chiropractic treatment or physical therapy until MMI is reached.
Subpart 8E allows treatment to continue or to be reinitiated when the employee experiences an “incapacitating exacerbation” of their injury. The exacerbation need not disable the employee from working. However, the exacerbation does need to be significant enough to justify the reinitiation of regularly scheduled care. Exacerbations can justify the recycling of a new twelve week period of care.