Does Workers’ Compensation Cover Physical Therapy Costs?August 31, 2020
Workplace injuries can happen whether someone works at a busy construction site or an office environment. Although a construction worker is more likely to suffer from musculoskeletal or head injuries from being struck by a heavy object, an office worker may be more prone to Carpal Tunnel Syndrome or muscle strains from ergonomically incorrect workstations. These injuries may vary significantly when it comes to the severity of the injury, how long the employee is out of work, and the amount of time it takes to recover.
Fortunately, Workers’ Compensation will cover the costs associated with a workplace injury. When physical therapy is recommended as part of the treatment and recovery process, Workers’ Compensation will usually cover those costs as well, assuming the employee meets the general requirements. An experienced Workers’ Compensation lawyer will walk the employee through the claims process and ensure that they receive the full benefits for which they are entitled, including physical therapy.
Physical therapy is often prescribed by a doctor as part of a treatment plan for a workplace injury. Some injuries can impact a worker’s ability to perform his or her job, particularly if the injury requires surgery or causes chronic pain, muscle weakness, a compromised range of motion, or an inability to stand or sit for a prolonged period of time without feeling pain or discomfort. In these instances, physical therapy can be extremely effective at building strength, reducing pain, and helping the employee return to work as soon as possible. If the treating physician recommends physical therapy as part of the injured worker’s recovering plan, Workers’ Compensation must pay for treatment.
What are the Benefits of Physical Therapy After a Workplace Injury?
When an employee is injured in a workplace accident, the best way to ensure that he or she can return to work is to develop an active treatment plan that involves physical therapy. In addition to preventing or reducing pain, physical therapy can help workers avoid expensive surgeries and the need for costly prescription pain medication. The following are other examples of how physical therapy can help injured workers:
- Restores function and movement
- Relieves pain
- Improves strength and conditioning
- Promotes long-term health
- Reduces the duration of the injury
- Prevents the risk of future injuries
- Corrects imbalances and improves work conditions
What Can an Injured Worker Expect from Physical Therapy?
A physical therapist will develop a personalized treatment plan that involves a range of exercises that may include the following:
- Specific exercises targeting the injured body part
- Hot and cold treatment
- Ultrasound tests
- Joint mobilization
- Manual therapy
A physical therapist will develop a set of goals and work closely with the patient to complete each exercise, making sure that he or she is using the correct form to avoid aggravating an injury. The therapist will make sure that the employee stays on track and continues to work hard, even if frustration sets in. Although the ultimate goal is to help the injured employee return to work, a set of smaller, attainable goals will be set up throughout the recovery process, and the therapist will act as a coach to ensure that each goal is met.
Common Workplace Injuries that Require Physical Therapy
There are a wide range of workplace injuries, some of which can cause chronic pain, diminished range of motion, and other physical conditions that can prevent a worker from performing his or her job. The following are common workplace injuries that can benefit from physical therapy:
- Pulled muscle or joint caused by overexertion.
- Slip and falls caused by wet or slippery surfaces, broken or missing handrails, and uneven flooring.
- Head injuries and other bodily injuries caused by a heavy object falling from an elevated surface, or from a worker being hit with a hard object.
- Machine accidents involving heavy machinery can cause repetitive motion injuries, such as bursitis, tendinitis, and Carpal Tunnel Syndrome.
- Workplace violence can cause serious injuries that require long-term physical therapy.
- Injuries caused by car accidents.
The type and duration of physical therapy that is recommended will depend on the type and severity of the injury. Coverage for physical therapy should continue until the treating physician believes that the injured worker has reached the best level for recovery and rehabilitation, also known as maximum medical improvement (MMI). Once the patient reaches MMI, coverage for physical therapy is generally withdrawn, and Workers’ Compensation will no longer cover the cost of treatment.
What are the Guidelines for Obtaining Payment for Physical Therapy?
For Workers’ Compensation to cover the costs of physical therapy, the treatment must be ordered by a treating physician, and the insurance company must approve the treatment. If physical therapy is not approved, the injured worker can take the following steps to obtain approval:
- Contact the doctor’s office and ask that they file a Form WC-205 to request approval.
- File the Form WC-PMT to have the physical therapy approved.
- Request a hearing in front of a judge.
- Consult with an experienced Workers’ Compensation lawyer.
Can an Insurance Company Deny Physical Therapy?
Understandably, physical therapists generally proceed with treatment only after the insurance company approves the treatment. That way, they know that they will be compensated for the treatment they provide. In some cases, the insurance company will deny the request for physical therapy. There are two ways that an insurance company can deny therapy, including the following:
- The insurance company can deny treatment by filing a Form WC-3 Notice to Controvert. They can also notify the physical therapist’s office and tell them that they are denying the request for treatment.
- The insurance company simply withholds approval for treatment.
If an injured worker’s request for physical therapy is denied or the insurance company does not give approval, it is unlikely that the physical therapist’s office will schedule treatment. In some cases, insurance companies may approve only part of the therapy that has been requested. For example, a treating physician orders physical therapy three times a week for four weeks for an injured worker, but the insurance company only approves two times a week. A partial approval is essentially a partial denial and should be treated like any other denial. A skilled Workers’ Compensation lawyer will closely review all medical records and negotiate with the insurance company to have the doctor’s recommendations approved.
Is Physical Therapy Worth the High Cost?
A recent study found that even though physical therapy in Workers’ Compensation costs more than it does in group health, the quality of care seems to be overriding the cost difference. The study looked at research from the National Council on Compensation Insurance (NCCI) and data from MedRisk to compare the cost of physical therapy in Workers’ Compensation with group health. They found the following results:
- The cost of physical therapy in Workers’ Compensation was three times higher than it was in group health.
- Although part of the difference can be attributed to utilization, there was also a price differential. The utilization of physical medicine in Workers’ Compensation is 268 percent that of group health. In addition, there is a price differential of 105 percent.
- Workers’ Compensation patients are 45 percent more likely to undergo physical therapy compared to group health patients.
- Workers’ Compensation patients have 50 percent more visits per patient compared to group health.
According to the chief clinical and product officer at MedRisk, physical therapy is a valuable Workers’ Compensation benefit because it helps patients recover strength and range of motion. In addition, patients can return to work safely and are less likely to need prescription opioids. The executive cited the need to manage the quality and cost of care and focus on clinical management, communication, and technology that improves workflow. Improvements to the Workers’ Compensation process can help ensure that workers receive care faster, which can reduce the costs for payers.
Baltimore Workers’ Compensation Lawyers at LeViness, Tolzman & Hamilton Secure Physical Therapy Benefits for Injured Workers
If you or someone you know was injured at work, and the treatment plan includes physical therapy, do not hesitate to contact the Baltimore Workers’ Compensation lawyers at LeViness, Tolzman & Hamilton. Insurance companies may try to deny coverage of physical therapy or approve only partial coverage to save money. We will work tirelessly to ensure that you receive the full financial benefits you deserve so that you can fully recover from your injury and return to work as soon as possible. Our dedicated legal team will walk you through every step of the claims process and address all your questions and concerns. To schedule a free consultation, call us today at 844-556-4LAW (4529) or contact us online. Located in Baltimore, we serve clients throughout Maryland.