Does Workers’ Compensation Pay for Physical Therapy and Occupational Therapy?
Workers’ Compensation is a no-fault insurance program that provides medical treatment, wage replacement, and permanent disability compensation to employees who have experienced job-related injuries or illnesses.
After a physician evaluates the injured worker, the doctor could prescribe rehabilitative services, including physical or occupational therapy. Therapy services will be covered under the Workman’s Compensation insurance carrier if deemed medically necessary. Continue reading below for more information about how your employee benefits cover your rehabilitative services.
Workers’ Compensation Medical Benefits
All employers must provide Workers’ Compensation medical benefits to their employees. This means that the employer is responsible for paying for necessary medical treatment associated with an injury or illness sustained due to the employee’s job.
Following a workplace injury, the employee will have a medical evaluation by a physician chosen by the employer or insurance carrier. This physician will oversee all medical treatment and recommend therapy, specialists, medical devices, or specific treatments to support the employee’s safe return to work.
Does Workers’ Compensation pay for Physical Therapy?
After an employee sustains a work-related injury, it should be reported to their supervisor. The employer’s human resource department is responsible for filing an incident report and submitting the claim to their insurance company.
Once the claim is reported and open, the injured individual will be referred to a doctor for a medical evaluation. The doctor may determine that the employee would benefit from physical therapy to regain strength, range of motion, and decrease pain in order to return to their work responsibilities. Once they determine that, the doctor would prescribe physical therapy, which will give the physical therapist insight into what type of treatment the individual will need and how often and how long treatment should last
Physical therapy sessions will include treatments and specific exercises that incorporate the worker’s essential job demands. The physical therapist should monitor progress toward their goals and communicate to all stakeholders. The workers’ compensation insurance will cover services if the worker continues to make improvements.
When the worker achieves their goals or reaches their maximum benefit from physical therapy, the employee should be discharged from physical therapy. The employer will no longer pay for services once the employee is discharged.
What about Occupational Therapy?
Occupational therapy requires a prescription by the overseeing doctor to determine if it is medically necessary for the worker’s specific injury. Typically, the worker will be given a prescription from their medical physician, which indicates the type of therapy, the diagnosis or problem area to be treated, and a general outline of treatment frequency and duration.
Once the therapy service is approved and authorized by the insurance company, the worker will be able to receive occupational therapy treatment. If the worker demonstrates that they benefit from occupational therapy and makes progress toward the treatment goals and ability to return to work, they will be able to continue receiving services.
Once the worker has achieved their goals or the maximum level of function, the employee will be discharged from therapy services and coverage will no longer paid for by the employer.
Claim Process for PT and OT
The claim process for physical and occupational therapy services relies on the documentation completed by the treating therapist demonstrating medical necessity. Each treatment session requires a detailed treatment note documented in the electronic medical record (EMR).
It’s important to perform routine functional progress notes to assess the injured worker’s capabilities to meet specific work-related demands. During a re-evaluation of progress, the therapist will assess factors such as the injured worker’s progress towards the treatment goals involving:
- Musculoskeletal components
- Posture and body mechanics
- Functional tasks
- Range of motion
- Special tests to form their clinical assessment
- Provide recommendations for the most appropriate treatments to assist with a return to work plan
All the information in the EMR is sent via secure fax to the primary treating physician and to the insurance claims adjustor or nurse case manager who works for the insurance company. The insurance company initially approves a set number of visits.
Then, if necessary, the treating occupational or physical therapist will document why continued treatment is for review by the doctor. If continued treatment is warranted, the Workers’ Compensation insurance company will review the claim and approve or deny the authorization request.
We’re Here For You
Ivy Rehab Network’s Workers’ Compensation Program can help improve an employee’s functional performance for return to work-related tasks such as lifting, climbing, walking, and carrying.
Upon initial evaluation, the therapist will review the job description to develop a structured return to work plan of care. Treatment will include:
- Addressing impairments an employee might have
- Decreasing pain levels
- Increasing range of motion
- Increasing strength
- Improving walking techniques to allow them to perform work tasks more easily
A key part of the injured individual’s recovery is to ensure their functional performance is evaluated regularly to ensure they are on the right path or to identify any changes to their care that should be made to suit the employee’s needs better.
Physical therapy sessions may include:
- Hands-on manual therapy
- Joint mobilization techniques for improving range of motion
- Stretching and strengthening exercises
- Practicing the exact tasks an employee would need to complete at work but is having difficulty with
- An individualized exercise program to be completed at home to empower employees to manage their symptoms independently
With the help of physical therapy, employees will be able to decrease pain levels and improve function to help them get back to work. For location information or to request an appointment online, visit our website. To learn more about our workers’ compensation and work-related injury programs provided by occupational therapists, please call 1-877-5-Ivy-Comp (1-877-548-9266).
Article By: Katie A. Richter, MS, OTR/L, CEAS I, II and Eduardo Arocha, PT, DPT, MS
Katie A. Richter, MS, OTR/L, CEAS I, II
Katie began her Occupational Therapy career three years ago. After graduating from Mercy College with a Master of Science in Occupational Therapy in 2019, she received a Bachelor of Arts in Psychology from Stockton University in 2015. Katie enjoys working with the adult orthopedic population. She is a recent graduate of Ivy Rehab’s Hand Specialization Program in 2021 and is working towards achieving her Certification in Hand Therapy (CHT). Katie is also a Certified Ergonomic Assessment Specialist and enjoys incorporating proper workplace ergonomics in her hand therapy treatment sessions to minimize the risk of repetitive strain injuries. If you are interested in scheduling an appointment with Katie, she is currently accepting new patients at Ivy Rehab Physical Therapy in Cranford, New Jersey.
Eduardo Arocha, PT, DPT, MS
Eduardo Arocha began their physical therapy career after graduating from the University of Delaware in 2018 with a Bachelor of Science in Exercise Science. He received his Master of Clinical Anatomy and Science and Physician of Physical Therapy from the University of Delaware in 2021. Eduardo enjoys working with the orthopedic, neurological, and vestibular populations. He believes in providing individualized care to help his employees achieve their goals and live healthy lifestyles. He is a member of the inaugural Vestibular Specialization Program at Ivy Rehab. To request an appointment with Eduardo, visit the Ivy Rehab Physical Therapy in Cranford, New Jersey webpage.
The medical information contained herein is provided as an information resource only, and does not substitute professional medical advice or consultation with healthcare professionals. This information is not intended to be patient education, does not create any patient-provider relationship, and should not be used as a substitute for professional diagnosis, treatment or medical advice. Please consult with your healthcare provider before making any healthcare decisions or for guidance about a specific medical condition. If you think you have a medical emergency, call your doctor or 911 immediately. IvyRehab Network, Inc. disclaims any and all responsibility, and shall have no liability, for any damages, loss, injury or liability whatsoever suffered as a result of your reliance on the information contained herein.