An injured worker with a physician’ s prescription for massage therapy was denied coverage for the prescribed treatment, while another injured worker without any prescription was awarded a wheelchair-accessible van. What made for the different results?
No Massage Therapy
The worker who received massage therapy had been injured on the job when he strained his lower back. Treated without success by numerous treatment providers including chiropractors and neurosurgeons, he turned to his primarycare physician for help. The primary-care physician referred the worker to a therapeutic massage program, writing a series of prescriptions for treatment with a particular massage therapist.
The injured worker testified that his pain was relieved and that his functioning was improved as a direct result of the massage therapy. However, his entitlement to workers’ compensation benefits coverage for the therapy was denied on the ground that the particular therapist was not licensed and was not working under the direct supervision of a licensed healthcare provider.
On appeal, the Pennsylvania appellate court found that a referral or prescription from a licensed physician is not enough to qualify services for workers’ compensation insurance coverage. Instead, all compensable services must be provided by a licensed health-care provider. If you are an injured worker, be sure that all of your health-care providers are licensed or are working under the direct supervision of a licensed health-care provider if you expect to have workers’ compensation insurance coverage pay for the costs of the services.
Injured Worker Entitled to Van
In the case involving the wheelchair-accessible van, the injured worker had sustained serious injury, rendering him quadriplegic, when he was struck by a bale of hay that fell from overhead when he was working at a commercial farm. Discharged to his home after a four-month hospital stay, the worker had numerous medical follow-up appointments. His wife rented a series of handicapped-accessible vans and then purchased one for $28,500.
The workers’ compensation insurance carrier initially denied coverage for the van, offering to pay only for the “conversion costs”—the costs of approximately $10,000 associated with equipping the van with a wheelchair ramp. The worker argued that he was entitled to coverage for the full purchase price of the van itself and the conversion package.
The Pennsylvania Supreme Court held that the entire van was an “orthopedic appliance,” for which the workers’ compensation insurance company was completely liable. The court observed that, depending on an individual’ s circumstances, a van could be “a necessity, a luxury or something in between.” In the case of the quadriplegic worker, the court found that his need for the van was not a “lifestyle choice,” but a direct solution to his complete lack of mobility caused by his work-related injury. Finding that both the van and its conversion package were essential to enable the injured worker to get to medical appointments and to “restore some small measure of the independence and quality of life” that he enjoyed prior to his injury, the court held that the insurance company was liable for paying for the total cost of the van and the conversion package.