Workers’ Comp for Long-Term Physical Therapy

Physical therapy often plays a vital role in helping injured workers recover and regain function after a workplace injury. In some cases, treatment may extend for weeks or even months. When that happens, workers may require long-term physical therapy, which can create added challenges in getting continued care approved under workers’ compensation.

At Stern & Cohen, we help injured workers throughout Pennsylvania secure the medical treatment and benefits they deserve, including long-term physical therapy.

What Is Long-Term Physical Therapy in Workers’ Compensation?

Long-term physical therapy refers to rehabilitation that continues for an extended period—often beyond the typical recovery timeline. This type of treatment is especially common for musculoskeletal injuries, such as back, neck, and shoulder injuries sustained on the job.

Workers’ compensation in Pennsylvania covers medical treatment related to workplace injuries, including physical therapy. However, when therapy extends beyond the initial plan or typical duration, additional requirements and reviews may apply.

Medical Necessity: The Key to Approval

One of the most important factors in receiving workers’ compensation for physical therapy—especially long-term care—is proving that the treatment is medically necessary.

To qualify for ongoing physical therapy coverage, the treatment must be:

• Reasonable and necessary for the injury
• Focused on helping the injured worker recover
• Connected to the goal of returning the worker to their job

If the insurance carrier questions the necessity of the treatment, they may request updated documentation or medical justification. Without sufficient proof, the insurer may deny or discontinue coverage.

Utilization Review and Long-Term Therapy

In Pennsylvania, insurance carriers often rely on Utilization Review (UR) to evaluate the reasonableness of ongoing treatment, including long-term physical therapy.

How the Utilization Review Process Works:

1. A UR request may be filed by the employer, insurance company, or the injured worker.
2. A medical professional reviews the treatment records and determines if the therapy is appropriate for the injury.
3. The reviewer may issue one of three decisions:
   • Approved – Therapy is medically necessary
   • Denied – Therapy is not necessary
   • Modified – Therapy is partially approved or requires changes

Types of Review:

• Prospective – Conducted before treatment begins
• Concurrent – Performed while treatment is ongoing
• Retrospective – Completed after treatment to determine if payment should be issued

The outcome of a UR can impact whether or how long therapy continues.

Disputes and Denials

If your long-term physical therapy is denied, modified, or cut short, you have the right to challenge the decision. A workers’ compensation attorney can help you file a formal dispute, gather medical evidence, and argue your case.

Common reasons for denial include:

• The insurer no longer finds therapy medically necessary
• The worker has reached maximum medical improvement (MMI)
• The therapy is considered excessive in duration or frequency

Don’t accept a denial without reviewing your options—especially if you’re still recovering.

Physical Therapy and Return-to-Work Plans

One of the core goals of long-term physical therapy is to help the injured worker return to work. In some cases, the worker may:

• Return to their original job
• Resume work in a modified or light-duty role
• Remain out of work while continuing treatment with the goal of eventually resuming full duties

The ability to work during or after physical therapy depends on the injury, the worker’s progress, and medical recommendations.

Documentation and Communication Are Crucial

Thorough Documentation

Doctors and physical therapists must provide regular, detailed updates to justify ongoing treatment. This includes progress notes, functional goals, and estimated recovery timelines.

Clear Communication

All parties—worker, healthcare provider, employer, and insurer—should remain in close contact. This ensures the treatment is not interrupted and that approval for long-term physical therapy stays on track.

Next Steps for Injured Workers

Understanding the rules for obtaining workers’ compensation for physical therapy is essential—especially when long-term treatment is required. If you’re facing denials, delays, or confusion about your physical therapy coverage, legal guidance can make all the difference.

At Stern & Cohen, we advocate for injured workers across Pennsylvania. If your recovery requires long-term physical therapy, we’ll help you fight for the treatment and benefits you deserve.

Call us today for a free consultation.