Off The Record – Workers’ Comp – Medical Treatment

Video Transcript

Hi everyone, Craig Rosasco, Law Firm Turley, Redmond & Rosasco, Workers’ Compensation attorneys serving clients throughout New York State, including Long Island and New York City.

Today we’re going to talk about medical treatment under a Workers’ Compensation claim.

Not a day goes by that I don’t get a phone call from someone saying, “They’re denying my treatment,” or “I’m not getting enough physical therapy.”

Here’s what you need to know.

There are medical treatment guidelines that determine what types of treatment you’re entitled to receive and for how long. Your doctors and medical providers are expected to follow those guidelines.

Let’s look at a common example.

Someone suffers a back injury at work. They begin physical therapy after the injury. Let’s say they were injured in November 2022 and have been attending physical therapy for several months, but they still aren’t feeling better. They want to continue therapy because they believe it will eventually help.

The treatment guidelines automatically approve approximately six to eight weeks of physical therapy.

After that, your doctor must show what’s called objective functional improvement before additional therapy will be approved.

For example, your doctor may document that your spinal range of motion improved from 40 degrees of flexion to 60 degrees. They may also note improvements in your activities of daily living (ADLs), such as being able to sit longer, stand longer, walk farther, or perform everyday tasks more easily.

If objective improvement is documented, additional physical therapy can often be approved.

However, if you started therapy with 40 degrees of spinal flexion and, after eight weeks, you’re still limited to 40 degrees with no measurable improvement, additional physical therapy is unlikely to be authorized.

The next step for many back injuries is pain management.

This may include treatments such as:

• Epidural steroid injections
• Facet joint injections
• Radiofrequency ablation
• Trigger point injections

These are all recognized treatment options under the Workers’ Compensation medical guidelines.

Many of these procedures can be pre-authorized. For example, one epidural steroid injection is often pre-approved. If it provides more than 50% pain relief, your doctor may be able to obtain authorization for additional injections based on your documented improvement.

If conservative treatment and pain management are unsuccessful, the next option may be surgery.

By the third year after your injury, insurance companies generally are not looking to continue authorizing ongoing physical therapy if there has been no measurable progress.

I frequently have clients tell me they’ve attended physical therapy for nine months and believe they need more treatment. When I review the medical records, I often find there has been no documented improvement. The patient continues to report the same pain, remains totally disabled, and there has been no reduction in overall impairment.

It’s also important to understand that if you’re showing measurable improvement, the insurance company may argue that your disability is decreasing, which could potentially affect your disability benefits.

One final point.

If you injure your back outside of work and use your private health insurance—whether it’s Aetna, Blue Cross Blue Shield, Empire Plan, or another insurer—you’ll often receive only 10 to 20 physical therapy visits per year.

Yet many Workers’ Compensation claimants receive treatment three times per week for months. Someone attending therapy three days a week for nine months could easily receive over 100 visits.

If you’ve already received that much treatment and there still hasn’t been measurable improvement, we need to discuss what the law allows and what additional treatment may realistically be available.

I understand New York’s Workers’ Compensation medical treatment guidelines. It’s my job to explain how they work and help you obtain every benefit and every treatment you’re entitled to receive.

If you’re dealing with treatment denials or have questions about your Workers’ Compensation medical care, give me a call.

516-745-5666

You won’t be disappointed.