A very nice caller to my office hurt her shoulder while working in the northern suburbs of Chicago and was upset over what an insurance adjuster had told her.

Long story short, her doctor said she might need surgery, but wanted to try six weeks of physical therapy first.  This woman does not want to have surgery if possible to avoid it and was encouraged that after four weeks of therapy her arm was improving.  The orthopedic doctor thought this was great and said they’d do an additional four weeks, so eight weeks total, not six.

All of the sudden the insurance adjuster calls and says that they are only authorizing four weeks of physical therapy total and tell her that this is all you are allowed under Illinois workers’ compensation law.  So she wanted to know if this is true?

Short answer is hell no!!!

There is no law capping the amount of medical visits you may have for your injury.  The law in Illinois is that if you are hurt at work you are entitled to all reasonable and necessary medical care.  So who decides what is reasonable and necessary?

I can tell you who doesn’t decide.  It’s not some insurance adjuster making an arbitrary decision at their desk.  It’s decided by a doctor and in this case, the injured worker has a very credible orthopedic doctor who is monitoring her care and making recommendations.

What I think happened here is that there are some doctors who also own/operate the physical therapy clinics they recommend so some insurance adjusters won’t approve a long period of therapy because some shady doctors use their clinics as a way to make money when treatment isn’t needed.  In this case though the doctor does not have an affiliation with the physical therapy location and the therapy is actually working.

So the insurance company is breaking the law and has no leg to stand on for their terrible actions.  It’s a solvable problem, but it’s sad that these type of actions even take place at all.  Here is a legitimately injured worker who is trying to avoid an expensive surgery that would keep her out of work for a while and the therapy she’s tried seems to be working.  There is no legit reason at all for the insurance company to play these games.