Reasons Why Workers’ Compensation
Denies an Injured Worker’s Physical Therapy Claim

workers compensation provider network

Workers’ compensation has always been helpful especially to workers who got sick or injured in the course of their employment. As an employer duly registered by the Department of Labor, you play an important part in providing the finances needed for this institution. According to a report from the National Academy of Social Insurance, (NASI), the total benefits workers’ compensation has paid in 2018 was $63.6 billion.     

Work-related injuries are almost always associated with physical therapy. If one of your employees is injured at work, that individual will most likely be able to get workers’ compensation benefits most probably through a workers compensation provider network

However, being injured on the job does not automatically qualify an employee to physical therapy workers’ comp benefits, as there are circumstances when a claim for physical therapy is denied.

Here are the four most common reasons why it happens:

1. Your Worker Failed to Report the Injury within the Prescribed Period

Reporting a work-related injury within the prescribed period is an essential requirement for the approval of a claim for workers’ compensation medical treatment and possible rehabilitation. Under workers’ comp insurance, workers who are injured on the job are required to report the injury to their employer within 30 days from the time of the injury. Failure to make such a report is a solid basis for the denial of their workers’ comp claim for treatment and related services like physical therapy.

2. Your Worker’s Injury was not Work-Related

In order for a workers’ comp claim to be valid, an injury must take place while your employee was on official duty regardless of whether it happened in your company’s premises or off-site. 

3. Administrative Failure   

This lapse or oversight is usually committed by one of your administrative personnel who’s in charge of coordinating with your workers’ comp insurance adjuster. Typically, when an employee is injured while on duty, the treating physician will recommend a specific number of physical therapy sessions if necessary, to restore mobility of the injured part. This doctor’s order must be relayed to the insurer as a prerequisite for proper documentation and approval. If this order is not sent for whatever reason, your employee’s claim for physical therapy could be denied.

What Employees Could Do to Reverse a Denial

As an employer, you’re paying workers’ compensation insurance for your employees to make sure that they have access to medical treatment when they sustain work-related injuries. With that said, a denial of an employee’s claim can be bad for you because it implies that the workers’ insurance you’re paying for isn’t serving its purpose. 

Additionally, a denial of claim could mean a delay of that employee’s return to work, which could impair your operations especially if that worker’s technical and decision making skills is highly needed in your workplace. In short, you could be at the losing end of the rope if your injured employee’s physical therapy workers comp claim is denied. 

To be able to move past denial, you should have someone assist your injured worker perform these steps:

File An Appeal

This is the first step your injured worker should do to reverse a denial and it should start right after they receive the denial letter. The period for filing an appeal ranges between 30 and 90 days depending on your state’s laws. Tell your worker to consult a workers’ comp attorney to help them win the appeal.

Reopen an Earlier Claim

This approach is applicable if your employee’s injury doesn’t heal or gets even worse because physical therapy is necessary. 

Workers’ Compensation is an employee benefit mandated by law. You are spending money on it to make sure that your workers are compensated and given access to medical treatment when they get injured on the job.

If you look at it from a different angle, workers’ compensation can be beneficial to you as an employer. It’s because the insurance assumes a big part of the medical treatment costs and speed up your injured worker’s recovery which could get them back to productive status as early as possible. 

Workers’ compensation is part of your investment. Make it work for you. The help of an effective workers compensation provider network can make it even more favorable for your business.

Work with Direct Pay Provider Network for a positive workers’ comp experience.

Call us at (866) 214-5920.