Worker’s compensation is financed exclusively+- by your employer. According to the Social Security Administration, benefit payments under worker’s compensation programs totaled $63.6 billion in 2013.
If you’ve been injured at work, chances are you will be able to get benefits through worker’s compensation. Work-related injuries often lead to the need for physical therapy. However, there are some circumstances that arise where you may find that your claim for physical therapy has been denied.
Circumstances That Lead To Loss Of Physical Therapy:
Failure to Timely Notify Your Employer
It is essential that you report your injury to your employer right away. Under worker’s comp insurance, your claim doesn’t begin until you report the injury to your employer. Generally, the time limit to file a claim is 30 days. If you go beyond that time, treatment and any services ordered by your doctor, such as physical therapy, will be denied.
Failure To File Your Claim Within The Statutory Period
Keep in mind that reporting your injury and filing a claim are very different. The Statute of Limitations period is the time period in which you must file a formal claim. Your claim could be denied if you miss that filing period, meaning your physical therapy will be denied. Each state has its own filing period so it is important to know your state’s laws when filing a claim.
Your Injury Occurs Outside Work
In order to file a claim, your injury must occur while you are working either on your employer’s premises or at an off-site job. You must be working for your employer at the time of the injury. If you decide to stay late and volunteer your time to complete a task and the injury occurs during this time, you may not be able to file a claim since you technically were not working for your employer.
Your doctor will order a certain number of physical therapy sessions. However, those orders must be sent to the insurance adjuster for worker’s comp. You could be denied physical therapy if the orders were not sent.
Injuries that are work-related usually require physical therapy because you are dealing with a specific injury to your extremities. This could range from carpal tunnel because you use a computer to physical therapy for an injury to your arms or legs. Your doctor might order 12 sessions of physical therapy and worker’s comp will only cover six. What do you do then?
Moving Past Denial
File An Appeal
If you’ve been denied physical therapy through worker’s comp, the first step you should take is to file an appeal. You should start this process as soon as you get the denial letter. Depending on your state’s laws you have between 30 and 90 days to file an appeal. When you file the appeal, it is wise to consult with an attorney who specializes in worker’s comp.
An experienced attorney can help you file the appeal and ultimately help you win your case. He or she can also guide you through the process and ensure you won’t miss any important deadlines that could result in the denial of your appeal.
Reopen A Previous Claim
You may find that your injury has worsened and physical therapy is needed in order for you to be able to perform your job duties. This is a good reason to reopen a claim. Because there are confusing laws concerning worker’s compensation and how the process works when reopening a claim, it is often necessary to seek the advice of an attorney.
You want to receive the maximum benefits from worker’s comp and get the required physical therapy. Therefore, you don’t want to take a chance of losing by taking on the case yourself. Consult an experienced worker’s comp attorney so you have an increased chance of winning your case and getting your life back on track.
Tom Moverman established the Lipsig Bronx Firm with Harry Lipsig and his partners in 1989; The firm’s focus is in personal injury, construction accidents, car accidents, products liability, and medical malpractice.