State Farm Mut. Auto. Ins. Co. v. Cavoto, 197 A.3d 1209, 2018 Pa. Super. LEXIS 1128, 2018 Pa. Super 285, 2018 WL 5023614

Chiropractor may not delegate “therapeutic exercise” to unlicensed support personnel.

A chiropractor and his facility provided medical treatment to an insured under an assignment of benefits for first-party no-fault benefits. The chiropractor then submitted bills to the insurance company seeking payment for treatment rendered. The insurance company denied payment to the provider for several reasons, one of which was the fact that the insurance company claimed they were not obligated to remit payments to the facility for treatment and procedures delegated to and performed by support personnel who do not have official licenses and certifications. The insurance company alleged the staff was performing adjunctive procedures and physical therapy as delegated by a licensed chiropractor, however, the support staff was not, in fact, certified. The court found that, while some therapies are permissibly delegated to support staff, therapeutic exercise may not and must be performed by a licensed chiropractor.

 

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