Does Workers’ Comp Cover Rehabilitation Costs?

Written by AskTheLawyers.com™ on behalf of Rachael K. Jones with Tilton & Tilton LLP.

Does Workers’ Comp Cover Rehabilitation Costs?
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Workers’ compensation, commonly referred to as “workers’ comp”, is an insurance program employers pay for to offer financial compensation to injured workers to cover lost wages and medical bills as a result of workplace accidents.

Workers’ comp is designed to serve two purposes; it protects employers from liability in most scenarios, and it ensures that injured workers begin receiving the help they need as soon as possible. However, every case is unique, and some injuries may require additional care to reach maximum medical improvement. In some situations, rehabilitative expenses such as physical and vocational therapy may be covered under workers’ comp. To learn whether your rehabilitation needs are covered under your state’s workers’ comp laws, reach out to a workers’ comp attorney as soon as possible.

Two primary kinds of rehabilitation may be covered by workers’ comp, including the following:

  • Physical rehabilitation: This type of rehabilitation generally refers to short-term therapeutic services intended to help the injured party reach maximum medical improvement (MMI). This type of physical therapy is often focused on helping the injured person regain their mobility in areas affected by the injury. However, physical rehabilitation may also refer to post-surgical physical therapy if the worker’s injuries required corrective surgery.
  • Vocational rehabilitation: Vocational rehabilitation may be covered under workers’ comp when a worker’s injuries are expected or have proven to prevent the worker from returning to their job. A recovering worker may be entitled to rehabilitative vocational services such as updated on-the-job training, assessment for and training in transferable skills, and even help with job resume and application services if the injured person cannot return to their chosen profession.

To be covered by workers’ comp, the rehabilitation must be regarded as reasonably necessary by an in-network physician.

The primary caveat to a workers’ eligibility determination regarding workers’ comp covered rehabilitation is whether or not that rehabilitation is considered medically necessary by the worker's physician. Workers who seek medical care under workers’ comp are required to see a doctor for treatment who falls into the employer’s workers’ comp insurance network; only in-network medical professionals are considered authorized to prescribe rehabilitative therapy.

If the treating physician does prescribe rehabilitative therapy as a medically necessary component of the patient’s treatment, that therapy will only be covered as long as the physician feels the patient is benefiting from therapy. As soon as the patient has reached maximum medical improvement, workers’ comp coverage for that therapy will end. This means any additional rehabilitative services the worker wants to pursue will not be covered under workers’ comp benefits.

Talk to a workers’ comp attorney.

Navigating workers’ comp claims can be tricky, especially if rehabilitative therapy is necessary. Additionally, workers’ comp laws can vary widely from one state to another, so it’s important to talk to an attorney in your area. The good news is that workers’ comp attorneys generally offer free consultations, and may be able to identify other avenues for financial recovery.

For example, if the injury occurred due to negligence on the part of the employer or another worker, you may be eligible to file a personal injury claim in addition to receiving workers’ comp benefits. Similarly, if a third-party may have been responsible for or contributed to the injury, you may be eligible to file a third-party claim, seeking compensation for rehabilitation costs in addition to other damages. To learn more about workers’ comp or to see if your rehabilitation may be covered, reach out to a workers’ comp attorney.

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