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Does Physical Therapy Increase Workers’ Comp Settlement?

Physical therapy can increase the amount you receive in a workers’ compensation settlement.

Workers’ compensation claims cover medical expenses and lost wages for employees injured on the job. Many injured workers undergo physical therapy as part of their recovery process. A common question is whether physical therapy increases the overall settlement amount. This guide explores how physical therapy impacts workers’ comp settlements, the factors involved, and how it can affect a claim’s medical and financial aspects. More about our workers’ comp lawyer here.

Does Physical Therapy Increase Workers’ Compensation Settlement?

Physical therapy can increase the amount you receive in a workers’ compensation settlement.

It provides proof of how serious your injury is and shows that ongoing treatment is necessary. Keeping up with your therapy sessions also demonstrates that you are actively working on recovery, which can help during settlement negotiations.

However, the impact of physical therapy on your settlement depends on your condition. If therapy helps you fully recover before settlement talks begin, you may not receive extra compensation. On the other hand, if therapy shows that your injury has lasting effects or requires ongoing care, you could receive a higher settlement to cover future medical expenses and possible disability.

How Physical Therapy Affects Workers’ Comp Settlements?

Engaging in physical therapy (PT) after a workplace injury can positively influence your workers’ compensation settlement. Here’s how:

Medical Documentation

Regular physical therapy sessions generate detailed medical records that document your injury’s severity and treatment progress. These records substantiate your claim and can influence the settlement amount.

Prolonged Treatment

Extensive physical therapy can highlight the seriousness of your injury and the necessity for ongoing medical care. This prolonged treatment can justify higher compensation to cover the associated medical expenses.

Functional Limitations

Physical therapists assess and document any functional limitations resulting from your injury, such as restricted mobility or reduced capacity to perform work-related tasks. This documentation provides evidence of how the injury impacts your ability to work, which is a critical factor in determining compensation.

Independent Medical Examinations (IMEs)

Insurance companies may request an Independent Medical Examination to verify the necessity and effectiveness of your ongoing treatment. The findings from an IME can either support or challenge your claim, potentially affecting the outcome of your settlement.

Factors That Influence the Impact of Physical Therapy on Settlements

Physical therapy (PT) can significantly influence workers’ compensation settlements. Key factors include:

Extent of Injury

Severe injuries often necessitate extensive PT, leading to higher medical expenses and prolonged recovery. This increased treatment correlates with larger settlements to cover the costs.

Employer/Insurer Response

Some insurers may dispute the necessity or duration of PT, especially if they perceive the treatment as excessive. Such disputes can affect the settlement amount, potentially reducing compensation.

State Laws

Workers’ compensation regulations vary by state, influencing medical coverage and PT provisions. Understanding your state’s specific laws is crucial, as they directly impact the extent of benefits and settlements.

Doctor’s Recommendations

When an authorized physician prescribes PT, it adds credibility to the treatment plan. Insurers are more likely to approve and cover prescribed therapies, which positively affect settlement calculations.

When Physical Therapy Might Not Increase Settlement?

Physical therapy does not always lead to a higher workers’ compensation settlement, especially when insurers question its necessity or when recovery is complete before negotiations.

Full Recovery Before Settlement
Compensation may remain unchanged if physical therapy restores full function before settlement negotiations. Insurers assess claims based on ongoing medical needs. A complete recovery means no additional medical costs, reducing the likelihood of a higher payout.
Disputes Over Necessity
Insurers may challenge the necessity of prolonged therapy, especially if progress is slow. If a doctor determines that further treatment will not improve the condition, the insurer may deny additional coverage. Independent medical exams (IMEs) often serve as a basis for insurers to dispute claims.
Pre-Existing Conditions
If therapy treats an existing injury rather than a workplace accident, insurers may argue against covering the costs. Claimants must prove that the therapy directly relates to the work injury. Without this link, compensation for treatment is unlikely.
Insurance Cost Containment Measures
Insurers often set limits on therapy sessions to control costs. They may require a second opinion before approving extended treatment. If a second doctor deems additional therapy unnecessary, the insurer may refuse further coverage, preventing an increase in settlement.

Understanding the Role of Physical Therapy in Workers’ Comp

Physical therapy is critical to recovery and can impact a workers’ comp settlement. The extent of its influence depends on injury severity, treatment duration, and insurer evaluations. While therapy often increases settlements by proving medical necessity, it is not guaranteed. Workers should document their progress, follow medical advice, and consult legal professionals to ensure fair compensation.

FAQs

1. How long should I continue physical therapy for my workers’ comp claim?

You should follow your doctor’s prescribed treatment plan. Stopping therapy too soon may weaken your claim, while unnecessary extended treatment can lead to insurer disputes.

2. Can I choose my own physical therapist under workers’ comp?

This depends on state laws. Some states allow you to select your own therapist, while others require treatment from a provider approved by your employer’s workers’ comp insurer.

3. What happens if I skip or miss physical therapy sessions?

Missed sessions can hurt your claim by signaling to insurers that treatment is unnecessary. Always attend scheduled therapy or reschedule promptly to maintain strong medical documentation.

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Defending Nonsubscribers

Texas Department of Insurance, Department of Workers Compensation
Texas employers have been opting out of Worker’s Compensation insurance in growing numbers in the past two decades to avoid the program’s high costs.

There are a lot of factors that go into the decision to be a nonsubscriber. How big is the company? What is their loss record? What are their comp premiums? Is it going to be a cost-saving measure from year to year? That just scratches the surface. There are so many questions, and there isn’t a cookie-cutter answer. More Information here
The big issue is how comfortable the employer is with allowing a jury to determine negligence.

Typically in a civil lawsuit, comparative liability deems that a Defendant can be held proportionately liable for a Plaintiff’s damages. If a jury finds a Plaintiff is thirty percent at fault, Defendant pays seventy percent of the damages. In Texas, if a Plaintiff is found to be fifty-one percent at fault, then Defendant pays no damages.

However, in nonsubscriber cases, if a jury finds a Defendant to be even one percent at fault, that Defendant is one hundred percent liable. Add to that the fact that the employer cannot show evidence that the employee was negligent or that the employee knew the risks and voluntarily proceeded. Nonsubscribers face a difficult challenge in the courtroom.

What’s key to being a nonsubscriber is having an attorney who is experienced in dealing with these limitations. Our Law Firm has found that many attorneys, unaccustomed to the critical differences, fail to grasp nonsubscribers’ intricacies.

Rather than try to spread liability, the defense must look to what the employer did by training, supervision, providing safety equipment, and providing a safe environment so that the one-percent threshold can be defused by showing how reasonably the employer acted. If the employer can show that it took reasonable steps and nothing it did or failed to do caused the accident. The fact that an employee was injured is not an indication of negligence. To that end, your approach to the case must be a little different.

The differences in handling nonsubscriber lawsuits may be subtle, such as refocusing questions in discovery or depositions, but an employer’s attorney must understand those differences. Our Law Firm has the necessary experience.

Our Law Firm has handled nonsubscriber cases for fifteen years and has worked with various employers. We are familiar with the nuances of nonsubscriber cases, how to evaluate them, and prepare them for trial.

Worker comp

Does Physical Therapy Increase a Workers’ Comp Settlement?