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Is My Therapy Covered Under Workers’ Compensation?

When you are injured at work, your doctor may recommend you for therapy. Depending on your injuries and your condition, this therapy may be physical therapy, where you work to heal from your injuries, or it can be mental health therapy to help you cope with a condition caused by your injuries.

Some treatment for your injuries, such as surgery and doctor appointments, can be pretty cut-and-dried on whether it’s included with your workers’ compensation claim. But when it comes to therapies, the line can be a little more blurred.

Let’s take a look at whether therapy – physical and mental health – is included with your workers’ compensation claim:

Physical Therapy

Physical therapy to help you recover from your injury, or to help you rehabilitate from surgery related to your work injury, is often recommended by doctors in workers’ compensation cases.

As long as your physical therapy is directly related to the condition named in your workers’ compensation claim, and not any old conditions, it should be covered by your workers’ compensation claim. 

However, there are a few things to remember when it comes to your physical therapy case.

First, the physical therapy must be ordered by an authorized treating physician. That means you can’t just call up a physical therapy office and make an appointment for yourself and still have it covered by workers’ comp; your doctor must make a referral before you can be seen by a physical therapist.

Second, your treatment in physical therapy can only be for your work-related injury. If you hurt your knee at work, you cannot receive physical therapy treatment for a sore back unless your doctor can directly link that injury to your injured knee. Receiving treatment for an unrelated condition can mean you risk workers’ compensation denying your entire course of physical therapy treatment, leaving you holding the bill.

Finally, some states authorize only a certain amount of physical therapy as covered under workers’ comp. Anything beyond these limits must be approved by the insurance company, and your doctor must provide a solid reason that you still need the therapy.

Once you reach what is considered maximum medical improvement (MMI) – even if your injury is not completely healed – your physical therapy can end. This means that, if you’re in physical therapy and aren’t making any progress, the workers’ comp insurance company can cut off any future visits.

Mental Health Therapy

Unlike physical therapy, receiving mental health therapy as part of workers’ compensation can be a more difficult need to prove.

To qualify, your mental condition must be caused as a direct result of the employer’s negligence that led to your injury or illness. If there is evidence that you were suffering from or treated for the same mental health condition prior to your workers’ comp claim, you risk your therapy being denied.

Qualifying mental conditions under workers’ compensation can include:

  • Post-Traumatic Stress Disorder (PTSD) caused by job conditions or expectations
  • Mental conditions that developed as the result of physical injuries suffered at work, such as a fall or accident
  • Stress that results in permanent damage and harm
  • Stress due to being overworked to the point of exhaustion

Because the need for mental health therapy can be much more difficult to prove to the workers’ comp insurance company, it often is best to have the input and assistance of an approved doctor in making a referral and proving your need for therapy.

Just like with physical therapy, most insurances only cover mental health therapy to the point where you reach MMI, which can be the rest of your life depending on the severity and nature of your condition.

Workers’ Compensation Attorney in Washington, D.C.

If you’ve been injured at work, you need the help of an experienced attorney to make sure your claim is processed appropriately. At Lopez Law Firm, we work hard to make sure you get the compensation you deserve for your injuries. Schedule your consultation today!

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