Physical Therapy and Workers’ Compensation?

Posted on Wednesday, June 30th, 2021 at 9:38 am    

Many workers who have physical injuries such as broken bones, back pain, an amputation, disc damage, or muscle pain spend a number of sessions with a physical therapist. Workplace victims often treat with a specialist such as an orthopedist or other surgeon before treating with a physical therapist. The victims may have surgery though many people in North Carolina and Virginia who treat with a physical therapist have not had surgery.

What Is a Physical Therapist?

A physical therapist must be licensed and must have met specific education requirements in order to qualify for their job. Physical therapists are also known as PTs or physiotherapists.

According to the American Physical Therapy Association (APTA), a physical therapist must earn a “doctor of physical therapy degree from a Commission on Accreditation in Physical Therapy Education-accredited physical therapist education program and pass a state licensure exam.” It normally takes about three years to earn a Doctor of Physical Therapy (DPT) degree. Courses generally include: “biology/anatomy, cellular histology, physiology, exercise physiology, biomechanics, kinesiology, neuroscience, pharmacology, pathology, behavioral sciences, communication, ethics/values, management sciences, finance, sociology, clinical reasoning, evidence-based practice, cardiovascular and pulmonary, endocrine and metabolic, and musculoskeletal” studies.

Most of the work is in the classroom. About 20% of the educational program is achieved through clinical education.

After a physical therapist is licensed, they can decide to pursue a residency or fellowship program. A physical therapist can also work to become a board-certified clinical specialist – through the American Board of Physical Therapy Specialties

What does a physical therapist do?

A physical therapist helps develop a plan of hands-on treatments and exercises to help your body adjust to any injuries that you have. The treatments and exercises often aim to improve your muscles, joints, and other parts of your anatomy near the injured area – so these healthy parts of your body can support the injured parts.

An experienced North Carolina and Virginia workers’ compensation lawyer can explain if you can see your physical therapist directly or if you need a referral from your treating physician. As with all healthcare providers, workers must choose from a list of health care providers that the employer provides. Normally, it’s advisable to coordinate your PT care with your doctor. PTs often have assistants who help with some of the physical treatments.

Physical therapy aims to:

  • Relive your pain
  • Improve your mobility
  • Help you recover from an injury
  • Help you recover from a surgery
  • Improve your balance
  • Manage a chronic injury
  • Adjust to a prosthesis
  • Learn to use canes, wheelchairs, walkers, and other assistive devices
  • Control your bladder and bowels

Normally, a PT will start by discussing your pain and additional symptoms. He/she will ask about your ability to perform everyday tasks including sleeping. The PT will conduct a series of tests to determine what you can and can’t do. These tests include:

  • Examining how well you can reach, grasp, bend, and move
  • Seeing if you can climb stairs without difficulty
  • Monitoring your heartbeat or pulse while you’re active
  • Determining how good your balance and posture are

Treatments may include:

  • Specific exercises and stretches targeted to help support the injured part of your body  
  • Cold and heat therapy, warm water therapy, ultrasound, and massage. These therapies are designed to help with muscle pain
  • Rehabilitation if you need to use an artificial limb
  • Using a cane or a walker

The physical therapist will also recommend exercises for you to do at home in between sessions with the PT. The physical therapist should monitor your progress during your treatments.

Where do injured workers get physical therapy?

Physical therapy is often available at outpatient clinics. PT may also be available at your physician’s office, a hospital, a sports center, rehab centers, schools, and even at work sites. Some doctors have their own, “in-house” facility, while others will refer you out to stand-alone PT facilities. 

What problems may arise regarding physical therapy and my workers’ compensation claim?

Workers who are injured at work are entitled to have all their reasonable medical bills paid. Physical therapy is generally covered if the therapy is recommended by a physician or the PT you choose is approved by your employer.

In most work injury cases, one of the issues that sometimes comes up regarding physical therapy is that the insurance company for the employer may seek to terminate your PT treatments after you’ve treated with your physical therapist for a while. The insurance company’s argument will be that after a certain period of time, the PT treatments aren’t improving your health. The insurance company will often get one of their company doctors to state that for the type of injuries you have, PT after a certain point in time is unnecessary.

Workers have the right to contest the termination if the continued physical therapy is helping, because ultimately, it is up to your authorized treating physician, NOT your nurse case manager or the insurance company as to whether additional PT will help you. Your lawyer will either work with your treating doctor to verify the necessity of the physical therapy treatments and possibly engage in an appropriate motion if the insurance company is not being responsive. 

We have found that in most cases, the main problem is that over time, the injured worker may be perceived as not fully participating in physical therapy, either by missing too many appointments or not performing the exercises they are required to perform either in PT or at home. In some cases, this can result in a Motion from the defense to terminate benefits based on your failure to follow the treatment plan. In Virginia, even without a hearing, this would result in an immediate loss of ongoing benefits. Therefore, it is imperative that you should take your physical therapy very seriously and treat each appointment as seriously as you would any doctor’s appointment. When performing exercises, give it your maximum effort, short of causing any injury to yourself. 

Functional Capacity Examinations (FCE) 

We’ve discussed these elsewhere, but many physical therapists and physical therapy facilities are set up to perform an FCE. A Functional Capacity Examination is typically ordered by your doctor once he or she has determined that you have reached maximum medical improvement. The main purpose of the FCE is to determine your physical capabilities that remain after you have recovered to the fullest extent you are able from your work injuries. The test can last for up to 6 hours, sometimes longer. After the doctor signs off on the FCE results, these become your permanent restrictions. Your attorney will obtain a copy of your FCE and review it thoroughly. This can be quite critical if and when the insurance company decides to engage in vocational rehabilitation

Often, there is also a second part to the FCE, designed to determine whether there is any permanent partial impairment in a specific, injured body part such as your lower extremity (leg) or upper extremity (arm). The results of that examination typically produce a percentage impairment rating, which, after being adopted by your physician, may result in additional money for you. 

Our skilled North Carolina and Virginia worker’s compensation lawyers have been fighting for injured employees for more than 30 years. We have a strong track record of success obtaining just recoveries for our clients. We help you obtain the physical therapy you need. We work with physicians who understand when employers are trying to cut off your physical therapy treatments because the employer’s insurance company wants to save money – even when you need the physical therapy treatments to fully recover. 

If you were injured in any workplace accident, there’s no need to prove fault to file a workers’ compensation claim. To assert your right to medical and wage loss benefits, call lawyer Joe Miller, Esq., at 888-667-8295. or fill out my online contact form. To schedule an appointment.

Injured or ill workers in North Carolina and Virginia can also use our New Electronic Case Review. The link is an easy way to get an answer on the facts of your case, without ever having to pick up the phone.