Over twelve years, Norwegian chiropractors delivered roughly 24.3 million consultations, yet only 147 patient injury compensation claims related to their care were completed by the national compensation system, and just 17 of those claims were approved. That approval rate of 12 percent, and an average of 0.1 approved claims per 100,000 consultations, comes from a retrospective registry study published in the journal Chiropractic & Manual Therapies, which analyzed all completed decisions by the Norwegian System of Patient Injury Compensation between 1 January 2013 and 31 December 2024.
The study was a descriptive registry analysis, not a clinical trial, and its authors are careful about what the numbers can and cannot show. Compensation claims represent a selective subset of adverse events in healthcare: only a minority of patients who experience an adverse event ever initiate a claim, and some people file claims without having experienced a treatment-related injury. The researchers therefore state explicitly that these data cannot be used to estimate the incidence or prevalence of adverse events in chiropractic practice. What the registry does offer is a systematic national picture of which alleged injuries prompt patients to seek compensation, and which claims survive legal scrutiny.
To assemble the dataset, the researchers combined administrative records from the Norwegian System of Patient Injury Compensation with national chiropractic consultation data drawn from the country’s reimbursement registry, which captures consultations billed under first-assessment and follow-up codes. All completed claims associated with chiropractic care were included regardless of whether they were approved or rejected. Annual claim counts ranged from a low of 4 in 2017 to a high of 16 in both 2020 and 2022, and year-specific approvals peaked in 2019, when 4 of 10 claims that year were approved. No claims were approved in 2023 or 2024.
When exposure was restricted to first-assessment consultations, which include both new patients and new clinical problems for existing patients, the average rate of approved claims was 0.5 per 100,000. The authors note that first-assessment visits plausibly involve greater diagnostic uncertainty than follow-up visits, although they describe this as a matter of clinical reasoning rather than direct empirical validation. Norway’s chiropractors are licensed primary-contact practitioners who provide approximately two million consultations annually to about 8 percent of the Norwegian population, which gives the registry a large denominator against which to judge how rare these claims truly are.
The profile of the claims reflected the clinical scope of chiropractic practice. Presenting diagnostic codes were available for all 147 claims, and musculoskeletal diagnoses accounted for 131 of them, or 89 percent, with 15 of those approved. Most of the approved musculoskeletal claims were associated with back and neck pain presentations, alongside one approved claim involving thoracic pain, one multifocal pain presentation, and one case coded as cauda equina syndrome. Other diagnostic chapters appeared only infrequently: general symptoms such as headache and pelvic pain accounted for seven cases with one approval, nervous system disorders consisted primarily of headache diagnoses with no approvals, and injuries to specific body regions included three cases, one of which, a concussion-related claim, was approved.
The injury codes told a different story from the presenting diagnoses. Injury diagnoses were available for 111 of the 147 claims, and circulatory system injuries, though only 16 cases, were associated with the highest number of approvals at 6 of 16. Among the NPE’s internal injury categories, the highest approval proportions were observed for bleeding, thrombosis or hematoma, and for central nervous system disturbance, each at 60 percent, with 3 of 5 claims approved in each category. The most frequent claim categories overall were treatment not performed correctly, with 56 claims, and pain, with 37.
Why were so many claims rejected? The most common reasons, based on the compensation system’s internal decision codes, were lack of causation, cited in 98 of 147 claims, and absence of failure in treatment or assessment, cited in 32. Under Norwegian law, a claim is accepted only if three conditions are all fulfilled: a healthcare failure, meaning examination, treatment, diagnosis, follow-up or referral below an acceptable professional standard; causation, meaning the injury is more likely than not caused by that failure; and a financial loss exceeding a set threshold. All 15 claims recorded as involving a failure in treatment were approved, along with one claim classified as a technical failure, which concerned a fall from the treatment bench resulting in a clavicular fracture, and one claim falling under a statutory exception provision.
Among the approved cases, the most common contributing factors were failure to refer the patient to appropriate care and inadequate documentation. Two thirds of the approved claims involved neck- and head-related circulatory or central nervous system injuries. For all approved claims involving head and neck vascular events, reviewers of the free-text case notes found that the temporal relationship between the chiropractic consultation and symptom onset was referenced as part of the causation assessment, with documented intervals between consultation and symptom onset ranging from 1 to 10 days.
The authors are emphatic that this temporal proximity reflects the statutory decision-making framework of the compensation system rather than implying pathophysiological causation. They note that the possible causal relationship between chiropractic care and such injuries has been extensively explored and does not currently indicate increased risk of such events, and that the existing literature primarily demonstrates temporal associations rather than established causal pathways. They also point out that many claimants experienced symptom exacerbation or serious events temporally associated with care, but without evidence that the chiropractor’s actions were below the expected standard or that the alleged injury was more likely than not caused by the treatment, a situation the authors attribute to the clinical complexity of musculoskeletal pain and the natural, often fluctuating course of conditions such as multisite pain, disc herniations, degenerative disorders and headache syndromes.
Total compensation over the study period amounted to 21.7 million Norwegian kroner, roughly 2.2 million euros, with a mean payout of 1.3 million kroner and a median of 485,000 kroner, a gap the authors attribute to a right-skewed distribution driven by a small number of high-cost cases. The Norwegian figures are broadly consistent with earlier Scandinavian research, which reported claim rates of 0.5 to 2.5 per 100,000 total consultations and approval rates of 6 to 16 percent in chiropractic care. Norway’s rate remained stable over the period, while Denmark’s has gradually increased, a difference the authors suggest may reflect the fault-based Norwegian system versus the Danish no-fault system, in which compensation does not depend on demonstrating provider fault. For context, the low volume of chiropractic claims contrasts with Norwegian general practitioners, who generated 3,526 cases between 2011 and 2017 with a 24 percent approval rate, a claims rate of 4 per 100,000 consultations, though the authors caution that such comparisons are limited by differences in patient conditions, diagnostic complexity, consultation volume and reporting practices. The study’s strengths include comprehensive national registry coverage and detailed coding, but its limitations include progressively introduced ICD-10 diagnostic coding that was not systematically applied before 2015, a dataset assessed by a single author to preserve claimant privacy, and the absence of granular detail on specific treatment techniques, preventing procedure-level risk estimation. The authors present the findings as a baseline for future monitoring and quality-improvement efforts in Norwegian musculoskeletal healthcare.
Subject of Research: Compensation claims related to chiropractic consultations in Norway from 2013 to 2024
Article Title: Chiropractic patient compensation claims in Norway from 2013 to 2024
Article References: Børsheim, C., Feier, C. H., Gevers-Montoro, C., Thomas, M., Young, A., & Hartvigsen, J. (2026). Chiropractic patient compensation claims in Norway from 2013 to 2024. Chiropractic & Manual Therapies, 34(1), Article 58. https://doi.org/10.1186/s12998-026-00684-6
Image Credits: AI Generated
DOI: 10.1186/s12998-026-00684-6
Keywords: chiropractic, patient safety, compensation claims, Norway, registry study, adverse events, spinal manipulation, musculoskeletal, NPE, healthcare quality, patient injury, claim approval rates
News Source: Ophelia Keating. (October 28, 2026). Only 17 of 147 Chiropractic Injury Claims Approved in Norway Over 12 Years. Scienmag.
