Does Workers’ Compensation Pay for Physical Therapy and Occupational Therapy

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If you’ve been injured at work, recovering your health and returning to your job is likely your top priority. One of the most common forms of post-injury care is therapy—whether physical therapy to restore movement or occupational therapy to help you regain job-related functionality.

However, many injured workers face confusion around one critical issue: Does workers’ compensation cover therapy, and if so, how much and for how long? This article will help you understand your rights under the workers’ compensation system, what kinds of therapy are typically covered, and what to do if your claim is denied.

 

Understanding Workers’ Compensation Therapy Coverage

Workers’ compensation is a type of insurance that employers are required to carry in most states. It provides medical care and wage replacement for employees who are injured on the job. One key benefit under this system is rehabilitation therapy, which includes both physical and occupational therapy.

However, coverage is not automatic or unlimited. Therapy must be:

• Medically necessary, as defined by your treating physician and the insurer.
• Related directly to the workplace injury or condition.
• Authorized in advance, especially in states requiring pre-approval.
• Provided by an approved provider, usually from a network chosen by the employer or insurer.

If you’re beginning therapy or planning to, it’s important to understand these conditions to avoid surprise denials.

 

Types of Therapy Commonly Covered by Workers’ Compensation

There are several kinds of therapy that may be prescribed after a workplace injury. These services aim to help you return to your previous level of function and, ultimately, get you back to work.

Physical Therapy

Physical therapy (PT) is often used for:

• Healing injuries like sprains, strains, and fractures.
• Rebuilding strength and mobility after surgery.
• Treating musculoskeletal injuries such as back or joint pain.

A physical therapist will work with you through exercises, stretches, and manual therapies designed to reduce pain and restore function.

Occupational Therapy

Occupational therapy (OT) focuses on helping individuals recover the skills needed for daily life and job-related tasks. It’s especially helpful if:

• Your injury limits your ability to perform essential duties.
• You’ve suffered a repetitive strain injury (e.g., carpal tunnel).
• You need adaptive strategies or tools to return to work.

OT might include hand therapy, ergonomics, or job simulation activities.

Return-to-Work Rehab Programs

In some cases, you may be enrolled in a structured rehabilitation program that combines physical and occupational therapy. These programs:

• Assess your readiness to return to work.
• Gradually build stamina and capability.
• May involve job-specific tasks to simulate your work environment.

 

The Therapy Approval Process in Workers’ Compensation

Before starting therapy, it’s essential to follow your state’s approval process, as workers’ compensation typically requires pre-authorization.

Pre-Authorization

Most states mandate that you get prior approval from your employer’s insurance carrier before receiving therapy. Here’s what that usually looks like:

• Your treating physician writes a referral or prescription for therapy.
• That recommendation is sent to the insurer for review.
• A utilization review board evaluates whether the therapy is medically necessary.
• If approved, a specific number of sessions will be authorized.

Failure to follow this process can result in non-payment, even if the therapy helps you recover.

Choosing the Right Provider

In many states, you’re required to use therapists from a pre-approved provider network. These are healthcare professionals contracted with the insurance carrier.

Before scheduling therapy, always verify:

• The therapist’s name is on the approved provider list.
• The insurer has received and approved the referral.
• You understand how many sessions are authorized.

 

How Many Therapy Sessions Are Typically Covered?

The number of therapy sessions you’re allowed under workers’ compensation varies depending on the state and specific injury.

Session Limits and State Guidelines

Some states place hard limits on the number of therapy visits allowed. Others are more flexible but require justification for continued care. For example:

• You might receive an initial authorization for 6 to 12 sessions.
• Additional sessions typically require progress reports showing that the therapy is effective.
• Some states allow up to 24 or 30 sessions, but only under strict conditions.

Always check your state’s rules and communicate with your provider about documentation to support ongoing treatment.

What Happens When You Reach Your Limit?

If you reach your session cap:

• Your therapist will need to provide detailed progress notes.
• Your doctor may submit a new treatment plan or re-evaluation.
• The insurance company may approve additional sessions or deny further coverage if they don’t see improvement.

Being proactive about documentation is key to maintaining therapy access.

 

Why Therapy Claims Are Sometimes Denied

Even when a doctor recommends therapy, it’s not guaranteed that the insurance company will approve it. Understanding the most common reasons for denial can help you avoid them.

Common Reasons for Denial

1. Lack of Medical Necessity

If the insurer believes the therapy isn’t essential to your recovery or doesn’t directly relate to your injury, they may deny it.

2. Administrative Errors

Delays in paperwork, missing documentation, or miscommunications between the therapist and the insurer can lead to automatic denials.

3. Insufficient Progress

If progress reports suggest you’re not improving, the insurer might decide further sessions aren’t justified.

4. Unapproved Provider

Receiving therapy from a provider not on the insurer’s approved list can also result in non-payment.

 

What to Do if Therapy Is Denied

A denial can be discouraging, but you have the right to challenge the decision. Here are several steps you can take:

1. Appeal the Decision

Request a written explanation of the denial and initiate an appeal through your state’s workers’ compensation process. Submit any missing documentation or medical reports to strengthen your case.

2. Get a Second Medical Opinion

If your primary provider is unsuccessful, another physician—especially a specialist—may be able to recommend therapy more convincingly.

3. Hire a Workers’ Compensation Lawyer

If your attempts to resolve the issue fail, a workers’ compensation attorney can step in. Legal representation can:

• Navigate complex state-specific appeals processes.
• Advocate for additional treatment.
• Help recover benefits that were unfairly denied.

 

Finding a Workers’ Compensation-Approved Therapist Near You

Your employer or insurer likely maintains a network of approved therapy providers. To find one:

• Ask your HR representative for a list.
• Call the insurance company’s customer service line.
• Check online provider directories from the insurer.

It’s important to verify this information before attending your first appointment to avoid treatment delays or out-of-pocket costs.

 

Frequently Asked Questions

Does workers’ compensation cover therapy after surgery?

Yes, therapy after surgery is often covered if it’s part of your prescribed recovery plan. Post-surgical rehabilitation is considered medically necessary in most cases, especially after orthopedic procedures. However, you still need pre-approval and must work with an in-network provider to avoid delays or denials.

Can I choose my own therapist under workers’ compensation?

In many states, you are required to use a therapist from an approved list provided by the insurance carrier. Some states allow one change of provider without requiring further approval, while others are more restrictive. If you prefer a different provider, check your state’s workers’ compensation laws or speak with your attorney about requesting a change.

What is a utilization review in workers’ compensation?

A utilization review is a process where the insurance company examines your treatment plan to decide if it’s necessary and appropriate. This review is usually handled by medical professionals hired by the insurer. It helps determine whether to authorize the treatment and how many sessions to allow. If therapy is denied through this process, you have the right to appeal.

Why would therapy be denied even if my doctor recommends it?

Insurance companies can deny therapy even with a doctor’s referral if they believe the treatment is unnecessary, excessive, or not yielding results. Denials can also happen due to documentation errors, missed deadlines, or non-compliance with insurer rules. Always keep track of paperwork and communicate regularly with both your doctor and the insurer.

What should I do if my therapy benefits are suddenly stopped?

If your therapy is cut off unexpectedly, first check if your authorized number of sessions has been used. Then contact your doctor and insurer to understand the reason. In many cases, additional sessions can be approved with updated documentation. If the insurer refuses to reinstate benefits, consider filing a formal appeal or consulting with a workers’ compensation attorney.

 

Conclusion: Take Action to Protect Your Recovery

Navigating the workers’ compensation system can feel overwhelming, especially when you’re focused on healing. But understanding your therapy rights—and knowing how to respond if coverage is denied—is essential to your recovery.

If your therapy has been delayed, denied, or unexpectedly stopped, don’t wait to take action.

 

Contact The Epstein Law Firm, P.A., Today

You deserve full access to recovery care. If you’re struggling to get the therapy you need, reach out to a workers’ compensation lawyer today to protect your health and your future.