Two schemes with their own rules
Workers' Compensation and No-Fault
If you were hurt at work or in a car, your treatment runs on a scheme with its own paperwork, its own deadlines and its own limits. Direct access does not reach either of them.
Comp and No-Fault need a referral from the first visit. Workers' Compensation and No-Fault run on their own rules and direct access does not reach either. Both need a referral from an authorised provider before the first visit. Comp treatment follows the New York Medical Treatment Guidelines, which broadly authorise twelve visits after an injury; going beyond that needs a Prior Authorization Request with documented functional improvement behind it. We file that paperwork, we tell you when it has been filed, and we tell you when it has been refused.
These two schemes account for a good deal of the work in any physical therapy clinic in Queens, and they are where patients most often lose a benefit they were entitled to. Not because the treatment went wrong — because a form was late, or a referral was missing, or nobody explained that the rules were different until it was too late to act on the explanation.
So here is what actually governs each of them, and what we do about it.
Workers' Compensation
You need a referral before a physical therapist may treat you: from a Board-authorised physician, physician assistant, nurse practitioner or podiatrist. Direct access does not apply, and starting without the referral is the commonest way a comp course of treatment goes unpaid.
Treatment then follows the New York Medical Treatment Guidelines rather than our clinical judgement alone. Broadly, twelve visits are authorised after an injury. Continuing beyond that requires a Prior Authorization Request supported by documentation — objective functional improvement, specific outstanding goals, and a reason to believe more treatment will achieve them.
The visit range is not uniform. The Guidelines contemplate as few as two or three visits for mild deficits and twelve to fifteen for more severe ones, with more than that indicated where there is documented progress towards specific functional goals. The number that gets quoted as “twelve” is the middle of a range, not a wall.
We file the PAR, we tell you the day we filed it, and we tell you if it is refused. What we will not do is quietly stop treating you and leave you to work out why.
No-Fault, after a motor vehicle accident
New York No-Fault pays for medically necessary treatment after a motor vehicle accident regardless of who caused it, out of the policy on the vehicle you were in. It is genuinely good cover and it has one very unforgiving feature: the application has a strict filing window that starts on the date of the accident, not on the date you decided to seek treatment.
That is the trap. Somebody is shaken up, decides to see how the neck feels in a fortnight, and the fortnight becomes six weeks. By the time they arrive here the window has closed on a benefit they were fully entitled to.
So: if you have been in a car accident, deal with the application first and the appointment second. Bring the claim number to the first visit. If you are not sure where you stand, telephone and ask before you book — we would rather spend ten minutes on that than treat you and have you find out afterwards.
No-Fault also requires a referral. Direct access does not apply here either.
What both schemes have in common
Documentation is the currency. Both are systems where continued treatment depends on demonstrating functional improvement, which means the measurements taken at your first visit matter far more than they do for a self-paying patient. We measure properly at the start partly for that reason.
Both also create a pressure worth naming. A scheme that pays per visit up to an authorised number gives a clinic a reason to use the authorised number, and gives a patient in a dispute a reason to keep attending. We treat the authorisation as a ceiling rather than a target, and if you are better at visit seven of twelve we will discharge you at visit seven.
What we will not do
We will not tell you what to say to an adjuster or an independent medical examiner. What we write down is what we measured and what you told us, and that is what goes in the file.
We will not extend a course of treatment because a case is open. If treatment is no longer producing functional change, our records will say so, and that will be true whichever way it cuts.
We will not take a comp or No-Fault patient without the referral the scheme requires, however keen everybody is to get started. Beginning without it is how a course of treatment ends up unpaid, and the person who carries that is usually you.
In order
How this works in practice
Tell us the scheme when you book
Comp and No-Fault change what we need before you arrive, and it is much easier to sort out then.
Get the referral first
From a Board-authorised provider for comp; No-Fault needs one too. Direct access does not reach either.
File the No-Fault application immediately
The window runs from the date of the accident. This is the deadline people miss.
Bring the claim number to the first visit
Along with the referral and your identification.
We measure properly at visit one
Because in both schemes continued treatment depends on demonstrating functional change.
We file the PAR and tell you
The day it goes, and the day it comes back, whichever way it comes back.
Questions we are actually asked
Workers' Compensation and No-Fault — frequently asked
Do I need a referral for physical therapy on Workers' Compensation?
Yes, from the first visit — from a Board-authorised physician, physician assistant, nurse practitioner or podiatrist. New York's direct access law does not apply to Workers' Compensation, and starting without the referral is the commonest reason a course of treatment goes unpaid.
How many physical therapy visits does Workers' Comp cover?
Broadly twelve are authorised after an injury under the New York Medical Treatment Guidelines, though the Guidelines contemplate a range — as few as two or three for mild deficits, twelve to fifteen for more severe ones, and more where there is documented functional progress. Beyond the authorisation a Prior Authorization Request is needed, which we file and tell you about.
What is the deadline for a No-Fault claim in New York?
The written application has a strict filing window running from the date of the accident, not from when you first sought treatment. It is the single most common way people lose a benefit they were entitled to. If you have been in an accident, file first and book second — and telephone us if you are unsure where you stand.
Can I use direct access for a car accident injury?
No. No-Fault requires a referral, as does Workers' Compensation and Medicare. Direct access covers the ordinary case where you are using a commercial plan or paying yourself.
Will you keep treating me while my case is open?
Only for as long as treatment is producing functional change. We will not extend a course because a case is open, and our records will say what we measured either way. If you are better at visit seven of an authorised twelve, we will discharge you at visit seven.
Sixty minutes, one to one, with the therapist you chose
Book an appointment
The booking page shows each therapist's own diary rather than a generic grid, so a slot you can see is a slot that is genuinely free. Most people do not need a doctor's referral to start — New York's direct access law runs to ten visits or thirty days — though Workers' Compensation, No-Fault and Medicare each need one from the first visit. If you are not sure which of those you are, telephone and we will work it out before you book.