Learning from chiropractic claims

Guild Insurance spends a significant amount of time analysing the chiropractic claims reported to us. This analysis helps us to understand what patients complain about, factors which might make some patients more likely to complain, and what actions from practitioners make it challenging to defend these complaints.

Following this analysis, Guild, in conjunction with the Australian Chiropractors Association, creates risk messages and learnings to share with and educate chiropractors, with the aim of reducing complaints.

The following details Guild’s key learnings for the chiropractic profession based on this claims analysis.

Record Keeping

All chiropractors are aware of their requirement to keep detailed clinical records. Yet, Guild’s claims experience shows that many are not keeping records to the required level of detail.

Clinical records serve not only as a regulatory requirement but also as essential evidence in defending against allegations of harm or wrongdoing. Missing details can significantly weaken a defence and increase the cost of managing and settling claims.

Additionally, thorough record keeping supports quality treatment. Without a documented history, assessment outcomes, and patient response, chiropractors may rely on memory—which is never perfect—leading to poor clinical decisions.

Chiropractors should refer to the record keeping resources on the Ahpra website: www.ahpra.gov.au/resources/managing-health-records.

Informed Consent

Informed consent, like record keeping, is often not done well enough to meet the required standard. The key word here is informed.

A patient must be properly informed through a conversation with their chiropractor about their condition, treatment options, expected outcomes, and risks. Only then can they give true informed consent.

Simply having a patient sign a form is not enough—the form is a support tool, not a substitute for the discussion.

Communication

Communication issues are a common factor in patient complaints. Even when not directly mentioned, investigations often reveal that poor communication played a role.

Chiropractors should use language their patients understand—avoiding jargon and acronyms—and consider using visual aids like diagrams or models.

Maintain professionalism in all communication. While building rapport is important, conversations should remain appropriate and not cross professional boundaries.

Professional Conduct

Guild has noted an increase in complaints focusing less on clinical outcomes and more on perceived professional behaviour.

Patients have high expectations of how health professionals conduct themselves. The Shared Code of Conduct released in 2022 outlines these expectations for chiropractors and other professions.

You can review the Code of Conduct at: www.ahpra.gov.au/resources/code-of-conduct/shared-code-of-conduct

Chiropractors must maintain boundaries in both behaviour and communication, avoiding excessive familiarity and never exploiting the professional-patient dynamic.

Clinical Decision Making

All treatment decisions must be in the best interest of the patient. Chiropractors are not a solution for every condition and must refer patients elsewhere when necessary.

If a patient requires care outside a chiropractor’s expertise, the practitioner should refer them to a more suitable provider and clearly explain why.

Chiropractors must stay within their scope of practice and ensure they are suitably trained for any treatments or advice they offer. Professional development should always align with this scope.

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