Can Workers Compensation Deny Physical Therapy?
What is physical therapy?
Physical therapy is a common treatment after an injury at work. Doctors often order physical therapy for back, neck, arm, and leg injuries.
Physical therapy is often ordered shortly after an injury as an initial form of conservative treatment. Doctors also frequently order it after surgery to aid with recovery.
This article will focus on how physical therapy works in a Georgia workers compensation case. To get a more general background of physical therapy in general, you might also look at this article from Web MD.
Your treating doctor should write an order for the physical therapy. The order will generally include instructions about how often and what type of physical therapy should be done. This order can generally be taken to any physical therapy provider, although your doctor may have a recommended physical therapist.
The physical therapist who treats you is required to be licensed by the State of Georgia. You can make sure that your physical therapist has the proper licensing by visiting the Georgia State Board of Physical Therapy.
Physical therapy often includes active and passive modalities:
- Passive modalities where the activity is done to you. These include treatments such as heat packs or ultrasound.
- Active modalities in which you take an active role in the therapy. Some common active modalities include stretching and exercises to build muscle strength.
Physical therapists also perform other treatment and testing. One common test performed by many physical therapists is a functional capacity evaluation.
A functional capacity evaluation is a test that attempts to determine appropriate work restrictions for your injury. It can be very important in your workers compensation case. If a functional capacity evaluation has been ordered in your case, be sure and read this article.
What happens when I finish the physical therapy the doctor has ordered?
Most doctors will order a few weeks of physical therapy at a time. When this physical therapy ends, it does not necessarily mean that you do not need more.
The physical therapist remains in communication with your doctor throughout the treatment. The therapist generally writes a progress report for the doctor to review. This report helps the doctor decide whether further physical therapy would benefit you.
Will my physical therapy be scheduled immediately after the doctor orders it?
Not necessarily. Most doctor’s offices and physical therapists want to know that they are going to be paid for the treatment they provide. So, they often want the insurance company to tell them that the treatment is approved.
They may not be willing to schedule the treatment until the insurance company provides that approval. This can be a serious problem because you need to get the physical therapy to move forward with your recovery.
Can the insurance company deny my physical therapy?
Unfortunately, many insurance companies will delay or deny approval of physical therapy. This can take several different forms:
- The insurance company may delay approval while they get utilization review done
- The insurance adjuster does not call the physical therapy back to give an answer about approval
- The physical therapy receives approval from the insurance company, but the insurance company approves less visits than the doctor recommended
- The insurance company completely denies the physical therapy
When insurance companies delay or deny physical therapy, they often do it based on the insurance company’s own guidelines or the guidelines of some other company.
The insurance company is not the doctor. You should not wait around for the insurance company to decide it is going to approve treatment that the doctor says you need.
How can I speed up physical therapy approval?
There are things that can be done to make the insurance company pay for treatment you need. Going to court is always an option, but that can take a while.
You can file State Board forms to try to get medical treatment approved. One is called a Form WC-205. Another is known as a Form WC-PMT.
There are several other options as well. The article I wrote on overcoming delay and denial of medical treatment discusses many of these options in more detail.
How do I determine which option I should use to get medical treatment approved.
Since there are many different options for getting your physical therapy approved, it may be difficult to decide which option you should pursue. The best option to use will depend on your specific situation.
If you have questions about how to go about getting your physical therapy approved, I would encourage you to consult with a workers compensation attorney. The attorney can review your specific situation and make recommendations about the best way to get your treatment approved.
I provide free consultations in workers compensation claims so injured workers can get their questions answered without worrying about cost. To find out more about how a free consultation with me works, just read this short article that explains our free consultation process.
If you are ready to schedule a free consultation, it is easy to do. Just call our office at (770) 214-8885 or complete and submit our free consultation request form.
Jason Perkins is an attorney who specializes in representing injured workers. He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families.
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