Workers’ compensation covers physical therapy in every state, including New York, when a job-related injury requires rehabilitation and an authorized treating provider prescribes it. The insurance carrier pays for approved care directly, and the injured employee is not billed. What differs from state to state is the approval process, the provider rules, and how long treatment can continue before further review.
Every year, tens of thousands of workers’ comp insurance claims are filed due to workplace injuries. Despite this prevalence, the New York process is often confusing and poorly understood by those who need it most. This guide covers the steps to get rehab care approved and paid for, from the first injury report through discharge.
Keith Chan, MPT, CKTP, a New York State licensed physical therapist, provided the clinical context throughout this guide.
What Workers’ Compensation Covers
New York’s well-established system requires almost all businesses to cover all employees, including those who work part-time. Anyone employed in New York City is likely eligible for this insurance through their employer, regardless of company size.
This insurance is not the same as regular health coverage. It specifically covers injuries or illnesses sustained while working, and it pays for related rehabilitation without deductibles or copays. Conditions that commonly qualify include:
- Sprains and strains
- Occupational arthritis
- Fractures
- Torn ligaments and tendons
- Back injuries such as herniated discs
- Dislocations
- Shoulder injuries from repetitive lifting or overhead work
Many of these injuries, particularly fractures and torn ligaments, may also require post-surgical recovery exercises once the initial repair has healed. Employees with questions about eligibility should contact their employer or the state Board directly. Knowing the situation before an injury occurs, or immediately afterward, helps ensure access to every available benefit.
How The New York Claims Process Works
New York workers’ compensation physical therapy guidelines follow a fixed sequence, and missing a deadline at any stage can jeopardize coverage. The five steps below cover the path from injury to approved treatment.
Report The Injury Promptly
The first step is notifying the employer as soon as possible. The claims process moves quickly in New York, and injured employees have no more than 30 days to inform their workplace of an illness or injury.
Timely reporting connects the condition to the workplace where it happened. Delayed notice can make an employee ineligible for treatment under the claim entirely.
Once notified, the employer has 10 days to inform the insurance carrier. Employers must report any incident involving medical care beyond first aid, or any injury that leads to at least one lost day of work after the day of the incident. From there, the carrier communicates directly with the employee.
Submit An Employee Claim Form
In addition to notifying the employer, the injured employee must submit an Employee Claim Form to the New York State Workers’ Compensation Board. Anyone who previously injured the same body part may need to submit an additional form.
The reporting deadline to the employer is 30 days, but you can file the claim form up to two years after the incident. Filing early speeds everything downstream, so submitting it around the same time as the employer notification is the practical approach.
Choose A Board-Authorized Provider
Claims are only approved when the medical providers involved are authorized by the New York State Workers’ Compensation Board. This applies to both the provider conducting the initial evaluation and every clinician delivering treatment afterward.
Since January 1, 2020, all provider types eligible for authorization must be authorized to treat injured workers. That means a workers’ comp-approved physical therapist is required; an unauthorized clinician cannot bill the carrier. Employees can search the Board’s provider directory or review a clinic’s workers’ comp services before scheduling.
That means any Board-authorized clinician is available, so employees seeking workers’ comp physical therapy NYC-wide can select a provider based on location, specialty, and availability rather than a restricted list.
Get Authorization For Treatment
Before rehab can begin, the employee needs a referral from the medical provider overseeing the case, and understanding when a referral is required helps prevent delays at this stage. That referral can come from a Board-authorized physician, physician assistant, nurse practitioner, or podiatrist, and it is required, not a formality.
The treating therapist must hold both a current New York State license and active Board authorization. If you’re unsure how referrals work more generally, you can review what to know before seeing a PT, though the authorization process adds an extra layer.
Attend Scheduled Sessions
Once care is authorized, the therapist builds a treatment plan around the specific injury. That plan typically includes an initial evaluation, an estimated number of sessions, and the interventions most likely to restore function for the employee’s actual job demands.
Attendance matters more here than in standard care. Under the Board’s Medical Treatment Guidelines, carriers review progress on an ongoing basis, and gaps in attendance can be read as evidence that treatment is no longer needed.
Visit Limits And Session Frequency
New York does not set a single statewide cap on sessions. Instead, care follows the New York Medical Treatment Guidelines, 16 protocols covering the most common work-related injuries. Each one defines expected duration and frequency for that body part or condition.
Treatment that falls within those parameters generally proceeds without additional approval. Anything outside them requires a prior authorization request submitted through OnBoard, the Board’s online system. Requests are categorized by cost, with separate paths for treatment above and below $1,000.
Physical therapy visit frequency under workers’ comp usually starts at two to three sessions per week early in recovery, then tapers as function improves. Severity, job demands, and the treating provider’s plan all shift that number, and how long treatment typically lasts depends on those same factors, so the initial authorization sets a starting point rather than a fixed schedule.
Documentation Requirements During Treatment
Continued coverage depends heavily on paperwork. Every session requires a detailed treatment note, and periodic re-evaluations must document measurable change in range of motion, strength, endurance, and the ability to perform specific work tasks.
Providers bill using the CMS-1500 universal billing form with an accompanying medical narrative, submitted electronically through a Board-approved partner. Reimbursement follows the state fee schedule, which sets what the carrier pays the provider directly.
One limit is worth knowing. Under New York rules, physical therapists may comment only on work status, meaning whether the patient is currently able to work. They cannot render opinions on causality or degree of impairment, and cannot perform Independent Medical Examinations.
When Coverage Ends, Or A Request Is Denied
Coverage continues while the injured worker demonstrates measurable improvement. Once treatment goals are met, or the employee reaches maximum medical improvement (MMI), the therapist discharges the case, and the carrier stops paying for further sessions. The Board defines maximum medical improvement and other claim terms in its glossary.
If a carrier denies an authorization request, the treating provider can submit supporting documentation for review. Insurers can dispute a claim for several reasons, including disagreement over whether the injury occurred or whether the employer’s coverage was active at the time. The Board resolves these disputes through administrative decisions, conciliation, or a formal hearing before a Workers’ Compensation Law judge when the parties cannot agree. Employees are not required to accept a denial as final.
Anyone who chooses to continue care outside an active claim pays self-pay rates, which run $120 per session for standard physical therapy visits. That figure reflects current clinic pricing; reviewing the average cost of physical therapy nationally can help set expectations if treatment continues beyond an approved claim.
Additional Considerations
A few practical points help protect coverage throughout the process:
- Medical bills related to an approved claim should never be paid personally; they belong to the carrier
- Using only Board-authorized providers prevents personal liability for treatment costs
- Clear communication with the therapist, employer, and carrier keeps all parties aligned on progress and work status
- Legal representation can help avoid procedural mistakes that cost benefits
- Accurate claim forms matter, since errors delay or block access to treatment
In Touch NYC Physical Therapy works with workers’ compensation claims and provides treatment tailored to each patient’s job demands. Contact the clinic to discuss options for a current claim.
