Health Care

When Is Physical Therapy Covered by Workers’ Compensation?

When Is Physical Therapy Covered by Workers’ Compensation?

Cardinal Law Partners November 4, 2020

Workers’ compensation cases can be in-depth, complicated, and sometimes challenging. In North Carolina, workers’ compensation is designed as a mandatory insurance program to provide compensation for employees who are injured on the job. There are regulations in place to cover things like long-term disability, lost wages, and medical care resulting from work related injuries.  

If an employee is injured at work, however, and it is determined that they will need physical therapy, some may wonder if physical therapy is part of medical care for workers’ compensation and covered under workers’ compensation. While in many cases, the answer is a simple, “Yes, physical therapy is covered under workers’ comp,” there are exceptions.   

Physical Therapy and Workers’ Compensation 

Most often, workers’ comp pays for physical therapy because it is deemed reasonably necessary as a treatment method and is recommended by a treating physician. The instances where workers’ compensation typically pays for physical therapy often include:  

  • Short-term rehabilitation services needed – these services will hopefully allow the employee to regain the necessary function to return to work. 
  • Immediately after injury treatment to aid in rehabilitation and/or recovery. 

Post-surgical procedure rehabilitative therapy is often covered after a workplace injury. Ongoing physical therapy past that point is sometimes also covered under workers’ comp. This type of treatment, however, would be in the case of long-term disability and could last for a specified or unspecified period of time. Ongoing physical therapy is geared toward providing the injured employee with the chance for recovery and functional improvement in the best possible manner. 

What Does This Mean for You? 

Here’s the scenario: You were injured on the job. As a necessary component of your medical treatment, physical therapy (PT) is deemed medically necessary and authorized by your treating physician in order for workers’ compensation to cover the treatment. 

Generally, as long as your recovery is being aided by the therapy (this can be determined by your doctor), and you are making progress, PT will continue to be covered by workers’ comp. 

However, coverage for physical therapy will likely be withdrawn if the following occurs: 

  • Your physician feels that you have reached MMI (maximum medical improvement), or… 
  • Your physician feels that you have reached your highest level of rehabilitation and recovery. 

In either of these scenarios, physical therapy services in your case will likely be challenged by the workers’ compensation carrier.  This is not to say that you couldn’t continue physical therapy sessions if you felt so compelled; if you feel that it is necessary, you should absolutely continue. Unfortunately, authorization for the therapy may cease, meaning you’ll have to pay for the expensive services out-of-pocket until the Industrial Commission ordered the carrier to provide the therapy. 

Cardinal Law Partners –Workers Compensation Attorneys 

 At Cardinal Law Partners, we have been successfully handling workers’ compensation cases for years are we are all board certified in North Carolina.  Our experienced attorneys are highly knowledgeable, compassionate, and dedicated. If you need to file a workers’ compensation case, we are the people you want on your side. Whether your case has been denied, you’ve run into some snags with your claim, or you’re just now considering filing a claim, our team can help. For a free consultation, contact us today.