Can A Worker Use Their Workers' Compensation Claim For Rehabilitation Purposes?

Workers’ compensation benefits are designed to cover a wide range of expenses related to workplace injuries, including medical treatment and rehabilitation. Rehabilitation is often a critical part of an injured worker’s recovery process, and in many cases, workers can use their workers' compensation claims to cover rehabilitation costs such as physical therapy, vocational training, and mental health services.

Steps to Take for Rehabilitation Under Workers’ Compensation

Notify the Employer and Insurance Company

Once the worker has filed a workers' compensation claim, they should inform the employer and insurance company about the need for rehabilitation services. This can include physical therapy, counseling, or vocational retraining if the injury impacts the ability to work.

Obtain Medical Recommendations

A doctor or healthcare provider will typically need to recommend rehabilitation services. This could include therapy for physical injuries, counseling for mental health, or even retraining for a new role if the worker cannot return to their previous job due to the injury.

Submit a Request for Rehabilitation Benefits

The worker may need to submit a formal request for rehabilitation services through their insurance provider or workers’ compensation board. In many jurisdictions, rehabilitation services are covered as part of the worker’s medical treatment, but they must be approved first.

Keep Detailed Records

Maintain a record of all rehabilitation treatments, including appointments, therapy sessions, and any communications with the insurance provider. This ensures that the worker can track their recovery progress and document expenses for reimbursement.

Follow Rehabilitation Plans

Engage in the recommended rehabilitation activities, as failure to actively participate in the rehabilitation process could affect the worker’s compensation benefits or eligibility for continued coverage.

Legal Actions and Protections

Medical and Vocational Rehabilitation

Most workers’ compensation programs include benefits for both medical and vocational rehabilitation. This can include treatments such as physical therapy, psychological counseling, and job retraining programs.

Employer’s Obligation to Pay for Rehabilitation

In many cases, the employer or the insurance company is legally obligated to cover the costs of necessary rehabilitation services, as long as the services are directly related to the injury and recommended by a healthcare professional.

Vocational Rehabilitation

If the worker is unable to return to their previous role, they may be entitled to vocational rehabilitation, which includes training or education for a new type of work that accommodates their injury.

Contesting Denials

If the insurance company denies coverage for rehabilitation services, workers can appeal the decision through the workers’ compensation board or through legal channels, such as a hearing or a civil lawsuit, depending on the jurisdiction.

Example

Imagine a construction worker who suffers a back injury due to lifting heavy materials on the job. The injury requires ongoing physical therapy and possibly retraining for a desk job due to the long-term impact on the worker’s ability to perform physical labor.

• The worker informs the employer and submits a claim for workers' compensation benefits.
• After seeing a doctor, the worker is referred for physical therapy and vocational training.
• The insurance company approves the rehabilitation plan, covering the costs of physical therapy and retraining for a new office-based role.
• The worker participates in the rehabilitation programs and receives the necessary treatment for recovery.

If the worker feels the rehabilitation benefits are insufficient or the insurance company denies any part of the claim, they can appeal the decision with the workers' compensation board.