What You Should Do If Worker’s Comp Denies Your Physical Therapy

Worker’s compensation is funded exclusively by your employer, and according to the Social Security Administration, the total benefit payments under workers’ compensation programs reached $63.6 billion in 2013.

In the event of a workplace injury, you usually have the opportunity to receive benefits through worker’s compensation. Often, injuries at work necessitate physical therapy. However, there are instances where your claim for physical therapy may face denial.

Reasons for Physical Therapy Denial:

  1. Failure to Promptly Notify Your Employer:
    • It’s crucial to report your injury to your employer immediately, as under worker’s comp insurance, your claim initiation depends on this report. Typically, you have a 30-day time limit to file a claim. If exceeded, services like physical therapy recommended by your doctor may be denied.
  2. Failure to File Your Claim Within the Statutory Period:
    • Reporting an injury and filing a claim are distinct processes. Missing the Statute of Limitations period for filing a formal claim could result in denial, leading to the rejection of physical therapy. State-specific filing periods vary, so understanding your state’s laws is essential.
  3. Injury Occurs Outside Work:
    • To file a claim, the injury must happen while working on your employer’s premises or during an off-site job. Volunteering after hours may not be covered, as you technically aren’t working for your employer at that time.
  4. Administrative Failure:
    • Doctor-prescribed physical therapy sessions need to be communicated to the worker’s comp insurance adjuster. Failure to do so might result in the denial of physical therapy.

Addressing Denials:

  • If physical therapy is denied, consider filing an appeal promptly. This process, usually within 30 to 90 days, benefits from consulting an attorney specializing in worker’s comp to navigate the complexities.
  • Reopening a previous claim is an option if your injury worsens, and physical therapy becomes essential for job performance. Seeking legal advice is advisable due to the intricacies involved in worker’s compensation laws.

Ensuring you receive maximum benefits and the necessary physical therapy requires careful navigation of the worker’s comp system. Consulting with an experienced attorney increases your chances of success and helps you regain control of your life.

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