Can An Injured Worker in PA Be Compensated For Unprescribed Ayurvedic Medical Treatment

Many injured workers find traditional medicine incredibly helpful.  Chiropractic care, acupuncture, and other traditional therapies are often covered under Workers’ Comp benefits if the treatments are deemed medically necessary.  However, a prescription is usually required, which can make it challenging to get traditional Chinese medicine, traditional Indian medicine/Ayurvedic care, and other holistic medicine covered under Workers’ Comp.

Generally speaking, treatment that is prescribed by a licensed practitioner after being deemed medically necessary for treating your work injury should be covered under Workers’ Compensation.  This can allow a lot of different holistic or traditional therapies like acupuncture to be covered – and many of these therapies are covered quite frequently.  The issue comes when there is no prescription or proof of medical necessity, making it hard to get some of these therapies covered.

Call our Certified Pennsylvania Workers’ Compensation Lawyers from Cardamone Law at (267) 651-7945 today.

Can You Get Ayurvedic Care Covered Under Workers’ Comp Without a Prescription?

In a 2014 opinion by the Commonwealth Court, Babu v. WCAB (Temple Continuing Care Center), it was established that you cannot get Ayurvedic care covered under Workers’ Comp if you get it without a prescription.  The Commonwealth Court is the appeals court that hears appeals from the Workers’ Compensation Appeals Board (WCAB), making them the last stop on denials and legal questions about Workers’ Comp issues before potentially going to the Supreme Court.  In this holding, the court established that without a prescription or some proof of medical necessity – and treatment by a licensed practitioner – Workers’ Comp cannot cover Ayurvedic care.

In this case, the injured worker was a licensed nurse who, after a 2008 work injury, sought Ayurvedic treatment in India in 2008 and 2010.  She had a previous case in 2010 where they determined that massages that were prescribed by her doctors could not be covered when administered by an unlicensed masseuse.  Here, the question went further and considered whether care should be covered when the providers were not licensed in Pennsylvania and the care was not even prescribed.  However, the care was actually “recommended,” according to the record of the case, and as a nurse herself, the petitioner agreed she needed it.

All in all, the court found that since there was no prescription or official medical evidence that these treatments would be helpful – plus the providers were not licensed in Pennsylvania – the Ayurvedic care could not be covered.  They also dealt with a challenge to the constitutionality of a requirement that the providers be licensed in Pennsylvania, saying that the requirement was valid.

All in all, this means that you cannot get Ayurvedic care from an unlicensed provider without a prescription – but it notably does not block the possibility of Ayurvedic care and other holistic treatments entirely.

Can You Get Ayurvedic Care from Workers’ Comp in Pennsylvania?

The facts of this case were somewhat unusual, given that the petitioner tried to get care from someone without a license and without a referral or medical recommendation.  In a more typical case, your treating physician can provide medical evidence that a treatment should be administered, and you get that treatment from a licensed provider in Pennsylvania.  When that happens, coverage should be available, even for Ayurveda, holistic care, and other alternative treatments.  However, coverage is not guaranteed.

Prescription

For your coverage to be approved, you first need it to be recommended/prescribed by a doctor or other treating provider.  Whether you are seeking care from a doctor on your employer’s list of approved providers in the first 90 days of treating your condition or you are seeking treatment from your own chosen providers after that, you need your provider to recommend the care you are seeking.  Basically, this means you need a prescription for the care, and unprescribed treatments usually will not be covered.

Utilization Review (UR)

Second, they may need to provide additional medical evidence to challenge a carrier’s denial.  There are procedures whereby an employer can request a “utilization review” (UR), asking a neutral doctor to determine whether or not the requested treatment is “medically necessary” and, therefore, whether it should be covered or not.  Our Allentown, PA Workers’ Comp lawyers can represent you in hearings surrounding this UR and get additional medical evidence from your treating provider or other medical professionals to try to argue that the care is medically necessary.

Licensed Providers

Third, the care usually needs to come from a licensed provider in Pennsylvania.  This can be challenging given the licensing available for Ayurveda or other traditional medicines.  There is no licensing structure in Pennsylvania specifically for Ayurveda, though we do have a license that providers can get for what the state calls “Oriental Medicine” if they meet certain requirements.  Providers of Ayurvedic care might also be licensed in other fields, incorporating Ayurvedic treatments, principles, techniques, and practices into their licensed medical practice.  For example, if you are interested in herbal medicines or certain massages popular in Ayurveda, you may be able to receive these treatments from a licensed masseuse or chiropractor who incorporates them into their treatment.

Can You Get Other Traditional Therapies Under Workers’ Compensation in Pennsylvania?

The same processes and requirements apply to both conventional medical treatments and traditional therapies/holistic medicine that you might seek under Workers’ Compensation, requiring it to be prescribed/recommended, proven medically necessary, and provided by a licensed practitioner.  If you are able to get the medical evidence, our attorneys can fight to get your traditional medicine or holistic care approved.

When you think about it, chiropractic care and acupuncture both have origins in traditional medicine and holistic practices, yet chiropractic care and acupuncture are covered all the time in work injury cases.  On this same line, you may be able to get traditional Chinese medicine or other traditional treatments approved, as well as Ayurvedic treatments.

If not, nothing stops you from paying for them out of pocket or trying to get them covered under other health insurance if Workers’ Comp refuses to cover them.

Call Our Pennsylvania Workers’ Compensation Lawyers Today

For help getting treatments approved, call our Bucks County Workers’ Comp lawyers at Cardamone Law at (267) 651-7945.