A chiropractor may manipulate areas other than the vertebral column?

The permissible scope of chiropractic practice in New York presents recurring questions at the intersection of licensure law, malpractice statutes of limitations, and no-fault insurance reimbursement. A significant First Department decision addressing statute of limitations issues contains dicta suggesting that chiropractors may legitimately treat areas beyond the vertebral column, potentially undermining the Willets Point doctrine that restricted chiropractic reimbursement to spinal manipulation. While the case primarily resolved timing questions for malpractice claims, its broader implications for chiropractic scope of practice and insurance coverage merit careful analysis.

The tension between statutory definitions of chiropractic practice and judicial interpretations of compensable treatment has generated substantial litigation. Education Law Section 6551 defines chiropractic as detecting and correcting structural imbalance or subluxation in the human body through adjustment and manipulation, primarily of the vertebral column. Insurance carriers historically relied on this definition to deny reimbursement for chiropractic manipulation of extremities, arguing such treatment exceeded licensure authority and constituted unlicensed medical practice. The Willets Point decision crystallized this restrictive view, establishing that extremity manipulation fell outside compensable chiropractic services under no-fault insurance. However, Perez v Fitzgerald’s dicta challenges this framework by acknowledging broader chiropractic authority.

Case Background

The Perez case involved a chiropractic malpractice claim where the central issue was which statute of limitations applied to the plaintiff’s allegations. Under CPLR 214-a, medical malpractice claims against physicians are subject to a 30-month statute of limitations, while CPLR 214(6) establishes a three-year limitations period for general personal injury claims. The outcome turned on whether chiropractic treatment constitutes “medical” practice triggering the shorter 30-month period, or represents a distinct form of healthcare subject to the longer three-year window. The First Department held that the three-year period applied to chiropractic malpractice claims, reasoning that chiropractic care, while addressing physical conditions through bodily manipulation, does not constitute “medical” practice within the meaning of CPLR 214-a. In reaching this conclusion, the court examined the nature of chiropractic practice and its relationship to traditional medicine.

Jason Tenenbaum’s Analysis

Perez v Fitzgerald, 2014 NY Slip Op 00744 (1st Dept. 2014)

This is a chiropractor malpractice case and the Appellate Division held that the 3 year and not the 30 month statute of limitation period applies to these types of actions. What is relevant is that in the MUA world, the whole body seems to be fair game to these enterprising chiropractors. Willets Point held that this was outside the licensure of the chiropractor, potentially illegal and not compensable.

The Appellate Division in dicta or however else you wish to phrase it has endorsed the viewpoint that a chiropractor can work beyond the vertebral column. Does this invalidate Willets Point? Better minds than me will make this call. But this is definitely something that should have the Willets Point theorist thinking. Anyway, see below:

“The fact that defendant provided treatment to the human body to address a physical condition or pain, which may be within the broad statutory definition of practicing medicine (Education Law § 6521), does not, by itself, render the treatment “medical” within the meaning of CPLR 214-a, since the use of such a broad definition would result in the inclusion of many “alternative and nontraditional approaches to diagnosing treating … human disease’” which are clearly nonmedical in nature (Karasek v LaJoie, 92 NY2d at 175; compare Foote 118 AD2d 156).”

Legal Significance

The Perez dicta creates significant tension with the Willets Point framework restricting chiropractic reimbursement. While the court’s statement appears in the context of statute of limitations analysis rather than insurance coverage, its recognition that chiropractors may legitimately “provide treatment to the human body to address a physical condition or pain” suggests a broader scope of practice than Willets Point acknowledged. The First Department’s citation to Karasek v LaJoie, which distinguished alternative healthcare modalities from traditional medical practice, implies that chiropractic extremity manipulation might fall within legitimate chiropractic practice even if it shares characteristics with medical treatment.

However, the significance of this language remains uncertain. Courts distinguish between holdings, which establish binding precedent, and dicta, which represents judicial commentary lacking precedential force. Because Perez’s statement about chiropractic scope of practice was unnecessary to resolve the statute of limitations question, it constitutes dicta that lower courts may decline to follow. Moreover, the distinction between licensure (what chiropractors may legally do) and compensability (what insurers must reimburse) allows courts to conclude that extremity manipulation falls within chiropractic licensure while remaining non-compensable under insurance contracts or fee schedules that limit coverage to spinal treatment.

The decision’s practical effect depends on how subsequent courts interpret its reasoning. Healthcare providers challenging Willets Point restrictions may cite Perez for the proposition that judicial recognition of chiropractic extremity treatment undermines the foundation for denying reimbursement. Conversely, insurance carriers can emphasize that Perez addressed only statute of limitations issues, that its scope-of-practice language constitutes non-binding dicta, and that even if extremity manipulation falls within chiropractic licensure, reimbursement depends on contract terms and regulatory provisions that may limit coverage to vertebral treatment. The interplay between these competing interpretations will unfold through future litigation testing whether Perez signals erosion of Willets Point restrictions or merely represents isolated dicta without broader implications.

Practical Implications for Providers and Insurers

For chiropractic providers performing extremity manipulation, Perez provides arguable support for defending against licensure challenges and insurance denials based on scope-of-practice restrictions. When carriers deny extremity manipulation as outside chiropractic licensure or cite Willets Point for the proposition that such treatment is not compensable, providers can invoke Perez’s recognition that chiropractors legitimately treat non-spinal body areas. However, providers should recognize the limitations of this argument: Perez is dicta from a statute of limitations case, not a definitive statement on reimbursement obligations, and courts may distinguish between what chiropractors can legally perform and what insurers must pay for.

Providers pursuing reimbursement for extremity manipulation should develop comprehensive litigation strategies beyond mere reliance on Perez. This includes: obtaining expert testimony from chiropractic educators regarding modern scope-of-practice standards; presenting evidence that state licensing authorities have not disciplined chiropractors for extremity manipulation; demonstrating that chiropractic education programs include extremity treatment techniques; and arguing that technological and professional developments since Willets Point was decided warrant reconsideration of restrictive reimbursement rules. Perez serves as one component of this broader argument, but it alone likely cannot overcome established insurance denial practices.

For insurance carriers defending against reimbursement claims for chiropractic extremity manipulation, Perez requires acknowledgment that simple assertions about chiropractors exceeding their licensure may face judicial skepticism. Carriers should refine their denial rationales to focus on contract interpretation, fee schedule limitations, and medical necessity considerations rather than relying exclusively on scope-of-practice arguments. When denying extremity manipulation, carriers should emphasize that even if such treatment falls within chiropractic licensure, insurance policies and regulatory fee schedules may limit reimbursement to specific procedures, and that manipulation of non-spinal areas may not be medically necessary for treating documented accident-related injuries. This approach provides multiple grounds for denials that do not depend solely on licensure restrictions that Perez may have weakened.

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Legal Update (February 2026): The scope of chiropractic practice and treatment coverage under New York’s no-fault insurance regulations may have evolved since 2014, particularly regarding permissible treatment areas beyond the vertebral column and related reimbursement standards. Practitioners should verify current provisions in the Insurance Law and applicable fee schedules, as regulatory amendments may have clarified or modified coverage parameters for chiropractic services.