There are least two circumstances under which payment for massage therapy treatments are required, according to the recent Commonwealth Court Decision in Schriver v. WCAB (Commonwealth of Pennsylvania, Dept. of Transportation), No. 289 C.D. 2017; Filed: December 28, 2017.
(1): Treatments by a massage therapist working under the supervision of a qualified healthcare provider as defined by the Workers' Compensation Act.
The Massage Therapy Law of 2008 established a licensing procedure for massage therapists. However, the 2008 law made it clear that licensing did not require the payment of massage therapy as a covered medical treatment under the Act. Compensability requires that the therapist be supervised by a licensed healthcare provider or be acting as an employee or agent of a licensed healthcare provider.
In Schriver the Workers' Compensation Judge (WCJ) ruled that the employer must reimburse the injured worker's out-of-pocket expenses for the massage therapy treatments concluding that the therapist worked under the direction and control of a chiropractor at Chambersburg Chiropractic on the following facts: The licensed massage therapist worked in the office of the employee's chiropractor and was profiled on the website of the practice. The availability of massage therapy was also listed as a service provided by the practice and receipts for payment were printed on forms that identified the practice. On the issue of supervision the employee was the only person to testify and obviously did not know the inner workings of the practice.
The WCJ reasoned that because both the massage therapist and the chiropractor worked in the same office and in the same practice it would be permissible to infer that they talked to each other about their patients and appropriate treatments. From this inference the WCJ concluded that sufficient supervision by a qualified healthcare provider existed.
The Commonwealth Court agreed with that the workers' compensation insurer was liable for the massage therapy expenses. The Court held that sufficient evidence existed to support the finding of fact that the massage therapist worked under the direction of the chiropractor, (a qualified healthcare provider as defined by the Workers' Compensation Act) in providing a comprehensive treatment plan for the employee's work injury.
(2): If a massage therapist is an officer, employee or agent of a healthcare provider performing duties related to healthcare services then the treatments are also covered by the Act.
The Pennsylvania Workers' Compensation Act in Section 109 provides that treatments are covered if performed by an "officer, employee or agent of such person (a qualified healthcare provider) acting in the course and scope of employment or agency related to healthcare services." In Schriver, the Commonwealth Court recognized this statutory requirement but instead found the therapy compensable because the therapist worked under the supervision of the chiropractor. The record in that decision does not appear to contain information on whether the therapist was also an officer, employee or agent of the chiropractor or the chiropractic practice performing duties related to healthcare services. Had that been the case, it would have been another reason to find the insurer liable for the massage therapy expenses.
Comment: When bills are received involving massage therapy some investigation needs to be conducted to determine whether factual circumstance exists that would make the therapist bills compensable. In order to determine whether the massage therapist is working under the supervision of a qualified healthcare provider or is the officer, employee or agent of a qualified provider performing duties related to healthcare services, one may directly question the providers regarding their relationship and also review the website information about the practice and services offered. Generally a massage therapist treating an employee in his or her own office without a referral would not be covered. If a referral existed, the therapy would not be covered unless the massage therapist was supervised by the referring healthcare provider.
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