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The World of Workers’ Compensation

computer-stressThe workers’ compensation physical therapy world is different than the basic physical therapy world. If you get injured at work, it is imperative to report the injury to your employer/supervisor right away. If your injury occurs over time, then you should report it to your supervisor as soon as you feel that it may have been caused by your job. This is the beginning of a workers’ compensation (WC) case.

After you are injured on the job, several people will work with you to decide when you will return to work and what work you will do. These people include your treating MD, managers who represent your employer, and a claims administrator (usually known as a claims adjuster) handling your claim for your employer. All WC patients have a claims adjuster that works for the WC insurance company, and they help manage and authorize treatment for the case.

Realize that just because your MD requested something (MRI, therapy treatment, or surgery) doesn’t automatically mean the request will be authorized. In California, most WC insurance companies will not authorize over 24 visits of physical therapy (depending on the injury), and they will review the request usually after 6-12 visits. This type of review is called utilization review. Utilization review (UR) is the process used by employers or claims administrators to review treatment, to determine if it is medically necessary. All employers, or their workers’ compensation claims administrators, are required by law to have a UR program. The UR program is used to decide whether or not to approve the medical treatment recommended by a physician. The medical recommendations must be based on the medical treatment guidelines.

WC physical therapy is different than private insurance physical therapy because the treatment and therapy goals should be focused on returning the patient back to their job or type of job. It is important for the MD, claims administrator, and physical therapist to understand what activities the patient did for work before being injured, and what activities are limited with returning to work. Therapy will still include manual interventions (active/passive range of motion, manual stretching, and soft tissue and joint mobilizations), stretching, and injury specific strengthening and stabilization, but WC PT should also include job specific strengthening and training.

ProActive Physical Therapy and Sports Medicine’s therapists are experienced working with WC patients and have a collaborative goal of getting them back to work, play, and life safely.

About the Author - Laura

Laura was born and raised in Poway, CA, and is a southern California girl through and through. She went to college at Loyola Marymount University where she played basketball and rowed crew. She received her Physical Therapist Assistant degree from San Diego Mesa College, and she has been working as an outpatient, orthopedic PTA since 1996. She started her career in Los Angeles, CA, working for HealthSouth and Select Medical at the Kerlan Jobe Orthopaedic Clinic for 10 years. Laura came back home to San Diego in 2007, and has been working with ProActive Physical Therapy and Sports Medicine ever since. She works out of the Rancho Bernardo clinic as well as covering at all of the ProActive clinics. She ran the Aquatic Therapy Program at Kerlan Jobe for 9 years, and now has been in charge of the ProActive’s Aquatic Therapy in Rancho Bernardo. Her other career passion is working with Industrial Rehab and Worker Compensation patients. She has been performing Functional Capacity Evaluations (FCE) and POETS (Post Offer Employment Tests) for her entire career, and has worked with companies like Chevron, Union Pacific Railroad, American and Hawaiian Airlines, and Chrysler. She loves working with and helping people get back to what they want to do. . . walking their dog to playing pickle ball/tennis to going on a trip with their grandchildren. She enjoys walking/hiking with her dogs on her spare time.