Workers’ compensation benefits aim to provide financial support to those who gain an injury from work through wage replacement during recovery, emergency room costs, subsequent check-ups, and physical therapy visits. Physical therapy visits aim to restore mobility, reduce pain, and prevent long-term damage — all of which most workers’ compensation insurance packages will cover. However, there are some nuances involved. Use this guide to learn whether you can seek physical therapy after gaining a workplace injury.
How Physical Therapy Fits into a Workers’ Comp Claim
To have your physical therapy covered by workers’ compensation, you must first file a claim and receive an evaluation by a healthcare provider. If the provider includes physical therapy in their recommended treatment plan, documents their recommendations, and your workers’ compensation insurance carrier approves it, you can receive physical therapy without worrying about covering the cost yourself.
Medical providers often recommend physical therapy if you have a musculoskeletal injury or if you had surgery for your injury. Physical therapy will help restore the former function and strength to the affected area so you can have better, if not the same, mobility as before the workplace accident. Physical therapy can also help speed up the recovery process by addressing underlying issues, especially when an injury gets aggravated by prolonged exposure to repetitive movements.
Conditions for Approval of Physical Therapy Under Workers’ Comp
Although workers’ compensation can cover physical therapy visits, you must meet the eligibility requirements first:
- Your employer uses a workers’ compensation insurance provider;
- You are an employee at the workplace;
- The injury must be related to work or a workplace accident;
- You must file the claim within the statute of limitations specific to your state;
- You must fill out all the claim documentation.
Your employer’s workers’ compensation insurance provider will then review the claim and evaluate whether your injury is related to your work and whether physical therapy is medically necessary. Insurers may also consider factors such as the timing of the therapy and whether you’ve attempted less intensive treatments. In some cases, they might request an independent medical examination to validate the necessity of physical therapy.
Common Injuries That Require Physical Therapy
According to a study by the National Library of Medicine, physical therapy treatments for workplace injuries are primarily focused on the wrist, hand, and lower back. These injuries occur either when lifting heavy objects, dealing with faulty equipment, or falling.
If left untreated, these injuries can be problematic. They can worsen and leave an employee permanently disabled. Depending on your job, if you let a neck, back, or foot injury worsen, you may be unable to return to your original position and find a different vocation.
How Long Will Workers Comp Pay for Physical Therapy?
The duration of workers’ compensation coverage for physical therapy depends on various factors, including the nature of the injury, the progress of the worker’s recovery, and state laws concerning workers’ compensation.
Typically, coverage lasts as long as a healthcare professional deems the therapy medically necessary and continues to show benefits for the injured worker’s rehabilitation. More severe or complex injuries, such as fractures or post-surgical recovery, may require more visits, while milder injuries, like sprains, may only need fewer sessions. The treating physician regularly evaluates the worker’s improvement and adjusts the treatment plan.
Suppose you need additional therapy beyond the initially approved period. In that case, you may need to extend the coverage by updating your medical documentation and sending it to your workers’ compensation insurance provider. This may include detailed progress reports, treatment goals, and evidence that the therapy remains effective. Sometimes, the insurance company may request an independent medical evaluation to verify the need for extended treatment.
You may also have a limited number of physical therapists to choose from that the insurance carrier covers. If you want to see any physical therapist outside of this limited network, you must pay out-of-pocket, with your medical insurance, or with employer-paid medical insurance.
Does Physical Therapy Affect Workers’ Comp Settlement Amounts?
Undergoing physical therapy can influence the compensation a worker can receive in a settlement. Settlements are often based on the extent of the injury, the costs associated with treatment, and the impact on the worker’s ability to perform their job. When physical therapy is part of the recovery process, it can contribute to the overall valuation of the claim by demonstrating ongoing medical needs and the associated costs. The duration and effectiveness of the therapy, as well as the anticipated need for future treatment, can all factor into the final settlement amount.
Medical documentation and progress reports from physical therapists play a crucial role in shaping the settlement outcome. These records provide a detailed account of the worker’s condition, the progress made during therapy, and any remaining limitations or permanent impairments. Insurers and legal representatives use this information to assess whether the worker has reached maximum medical improvement (MMI) or if further treatment is still necessary. If physical therapy significantly improves the worker’s condition, it may lead to a quicker resolution and a more favorable settlement. Conversely, if progress has been slow or the worker requires ongoing therapy, the settlement may need to account for future medical expenses.
How To Ensure Physical Therapy With Workers’ Comp
Getting physical therapy covered under workers’ compensation involves taking the proper steps to secure approval and maintain coverage. Here are some tips to help ensure a smoother process:
- Seek an evaluation from a doctor and obtain written documentation: The first step is to obtain a clear and detailed written recommendation from your treating physician specifying the need for physical therapy. When talking to your doctor, be honest about your injury, the incident that caused it, and your medical history. If you lie or leave anything out, this will likely lead to a denial from your insurance carrier. Their written recommendation should outline how the therapy will aid your recovery, including the expected benefits and the estimated duration of treatment.
- Follow the prescribed treatment plan: Once physical therapy is approved, attend all scheduled sessions, follow any at-home exercises, and communicate openly with your physical therapist about your progress. This will help your recovery and provide a record of compliance and ongoing need for the treatment, which can be crucial if additional sessions are required.
- Communicate with workers’ comp representatives and insurance adjusters: Stay in regular contact with your workers’ comp representatives and insurance adjusters to keep them informed about your treatment progress. If you need more sessions, notify the adjuster promptly.
By taking these proactive steps, injured workers can better navigate the approval process, increase the chances of having physical therapy covered under workers’ compensation, and avoid potential interruptions in their treatment.
What to Do If Workers’ Comp Denies Coverage for Physical Therapy
Don’t lose hope if your employer or workers’ compensation insurance provider denies physical therapy treatment. Denials occur typically because the claim lacks medical evidence, your insurance carrier or employer has concerns over pre-existing conditions, they don’t think physical therapy is medically necessary, or you didn’t report the injury within the statute of limitations. For most of these causes of denial, you can appeal your claim, gather the appropriate documentation, and potentially seek an independent medical evaluation to strengthen your case.
To further strengthen your case, you can always seek help from a workers’ compensation attorney. When picking the right attorney, look for those with a history of obtaining successful appeals. They’ll know what to look for in your denial letter and direct you toward your next steps in appealing the denial.
Use Request Legal Help for Workers’ Comp Paid Physical Therapy
Using an experienced attorney to file a workers’ compensation claim for physical therapy is a great way to ensure you don’t experience any challenges. While we recommend researching before picking an attorney, you can rest easy if you pick any attorney at Request Legal Help. All of our attorneys will work tirelessly so you can seek the physical therapy treatments you need and get back on your feet.
FAQs About Seeking Physical Therapy Through Workers’ Comp
Does Workers’ Comp Always Cover Physical Therapy?
Workers’ comp generally covers physical therapy if it is deemed medically necessary by a medical provider and the injury is related to a workplace accident or your role.
How Long Will Workers’ Comp Pay for Physical Therapy?
The duration of coverage depends on factors such as the severity of the injury, the state’s workers’ comp regulations, and the progress made during therapy. Some cases may have a set number of sessions approved initially, with options for extending coverage if further treatment is needed.
Do I Need a Doctor’s Referral For Physical Therapy to Be Covered?
Yes, most workers’ comp plans require a doctor’s referral or recommendation for physical therapy coverage. The referral helps establish the medical necessity of the treatment.
Can I Choose My Own Physical Therapist Under Workers’ Comp?
This varies by state and insurance plan. Some states allow injured workers to choose their physical therapist, while others may require network providers or therapists approved by the workers’ comp insurer.
What Should I Do if My Employer or Workers’ Comp Insurer Denies a Physical Therapy Claim?
If your employer or workers comp insurer denies your claim for physical therapy, you can file an appeal. Start by reviewing the reason for the denial, gathering supporting medical documentation, and consulting a workers’ comp attorney to strengthen your case.
Can Physical Therapy Help Increase My Workers’ Comp Settlement?
Yes, physical therapy can impact a workers’ comp settlement by demonstrating ongoing medical needs or permanent impairment. Accurate medical records and progress reports from the physical therapist can help substantiate the extent of the injury.
What Happens if I Miss Physical Therapy Appointments?
Missing physical therapy appointments may affect your workers’ comp claim, as your provider will see the action as non-compliance with the prescribed treatment. Attending all scheduled sessions or providing valid reasons for rescheduling is important. Otherwise, your insurance carrier may deny coverage if you need more physical therapy appointments to recover fully.
Can Workers’ Comp Stop Covering Physical Therapy if I’m Not Progressing?
If the treating physician or workers’ comp insurer determines that physical therapy no longer provides medical benefits or improvement, you won’t receive any more coverage. Documenting any progress and discussing alternative treatment options with your healthcare provider is essential.
Are There Limits on The Types of Physical Therapy Covered by Workers’ Comp?
Workers’ comp typically covers standard physical therapy treatments to recover from work-related injuries. However, some specialized therapies, such as alternative or experimental treatments, may not be covered.
About the Author
Aaron is a professional legal writer with a B.S. in English Education from Southern Illinois University – Carbondale. He has written, published, and edited thousands of legal articles for RequestLegalHelp, which has connected over 5 million people to legal help in the United States.
With over five years of experience writing thousands of legal articles for law firms across the U.S. and Canada, Aaron specializes in covering federal, state, and city-level legal issues ranging from auto accidents to wrongful terminations.
