Will workers compensation pay for a gym membership for physical therapy?!


Question:

Will workers compensation pay for a gym membership for physical therapy?

I have "hardware" holding my spine together as a result from a fall off of a ladder. I have lifetime medical for my back and went to my w/c dr. for a Rx for gym membership to resume PT. I want to be able to swim laps as well as go to the yoga classes. He says they won't cover it.


Answers:

It is highly doubtful that they will cover it. Release to gym should only come after physical therapy has been complete as is no longer deemed "skilled." In other words, once you have completed PT, or perhaps during your PT, there may be a recommended home program from your therapist. These should be exercises that do not require the skill of a physical therapist to be present while you complete them (ie, you can perform them as directed by the therapist). However, if your therapist recommends that you complete a certain set of exercises that would require a gym membership, then, it is POSSIBLE that a gym membership would be medically necessary. It would take a lot of arguing, but I would say it is possible if done with the consent of the PT and physician. Yet, usually at this point, most people are released to return to work, or if no further benefit is possible, then usually a settlement is made...no longer placing them under the coverage of workman's compensation...I suppose it's a catch 22.

I would speak to your therapist about it as a letter of medical necessity would need input from the PT.




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