Chiropractic manipulation under anesthesia is within the scope of chiropractic services permitted and eligible for reimbursement under New York's no-fault statute.
A chiropractor was entitled to recover no fault benefits from an insurer for chiropractic services provided to an insured because the chiropractic manipulation under anesthesia (MUA) performed was not prohibited by the Education Law §6551(1). The law did not prohibit a chiropractor from performing spinal MUA, although the chiropractor was not allowed to administer the anesthesia. The insurer's witness cited no authority to support his contention that a second opinion was necessary before an MUA procedure was performed on a chiropractic patient. The plaintiff's assignee, Dana Schepanski, had been involved in a motor vehicle accident on October 28, 2008, which left her with headaches, neck pain radiating to the shoulders and lower back pain radiating to the left buttocks and hip region. The plaintiff, as co-surgeon, performed five manipulations of the assignee's spine and hip joints while she was under anesthesia. The defendant, State Farm, denied payment of all services rendered by the plaintiff. At trial, the parties stipulated that the sole issue to be determined by the court was the medical necessity of the chiropractic MUA performed by the plaintiff. The court concluded that MUA does not exceed the scope of lawful chiropractic service under the Education Law, which provides that: the practice of the profession of chiropractic is defined as detecting and correcting by manual or mechanical means structural imbalance, distortion or subluxations in the human body for the purpose of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column. The court found that the plaintiff, as a licensed chiropractor, was authorized to perform the disputed manipulations under anesthesia and that the defendant failed to rebut the presumption of medical necessity of these procedures by a fair preponderance of the credible evidence. Accordingly, the court found in favor of the plaintiff.
Case Law Alert, 1st Qtr 2012