Reasons Workers’ Compensation Claims are Denied for Physical Therapy and Actions to Take

Reasons Workers’ Compensation Claims are Denied for Physical Therapy and Actions to Take

Unfortunately, injuries on the job are a reality in life. Often, these injuries require medical care, including physical therapy, to help the employee restore their functional abilities to return to work. If a worker is injured on the job, medical care is initiated by filing a Workers’ compensation claim. Workers’ compensation is financed exclusively by the employer and is commonly directed by a team including the physician, insurance adjuster, case manager, and other parties. However, there are times when a workers’ compensation claim may be denied. 

Reason #1: Failure to notify employer 

 Many times, an employee may sustain an injury and initially feel the injury is not significant. A few days or a couple of weeks later, the employee comes to the realization the injury is more painful or limits their abilities. The failure to report the injury at the time of occurrence can result in a denial of the claim. 

Reason #2: Failure to file a claim in a timely manner

There is a difference between reporting the injury to the employer and filing a claim for coverage of necessary medical expenses. Each state has its own statute of limitation for filing a claim, and failure to file within the statute will result in denial of the claim.  

Reason #3: Injury occurs outside of work or work hours

Workers’ compensation claims are only covered for injuries sustained at work or during work hours. One should be aware, if performing volunteer activities or participating in work-related activities outside their normal work hours, coverage for injuries may be denied.  

Reason #4: Administrative error 

Workers’ compensation claims involve several parties, including physicians, physical therapists, case managers, insurance adjusters, and in some instances, attorneys. There are times when miscommunications occur, which leads to the denial of a claim.  

Actions to Take  

  • File an appeal  – If you find yourself facing a denial, you can always file an appeal. Remember, each state has a statute of limitations for filing a claim and an appeal, in most states, it’s between 30 and 90 days.  
  • Communication – There are multiple parties involved when a claim is filed. It is important to maintain open communication with all parties involved, and most importantly, with your employer.  
  • Protect yourself  – When in doubt, you should consider hiring an attorney who specializes in workers’ compensation claims.  

Ivy Rehab Physical Therapy can help 

At Ivy Rehab Physical Therapy, we specialize in the treatment of workers’ compensation cases using evidence-based practice. Our teammates receive specialized training and continued education to optimize the care of our patients. From intake to discharge, we work closely with our patients and focus on the continuity and progression of care through communication with all parties involved. Click here to find a location near you!

Article By: Paul Heim, PT, Functional Capacity Evaluator, Industrial Ergonomic assessor 

Paul began his physical therapy career 40 years ago. Paul enjoys working with the worker population and believes in the importance of providing comprehensive and effective care. He currently specializes in industrial rehabilitation and testing. Paul enjoys working with all parties involved to reach their highest level of potential. He currently treats patients at Ivy Rehab Physical Therapy in southern New Jersey.

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.

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