Skip to main content

Can my insurance adjuster cancel my Physical Therapy treatments?

Long Beach, CA |

I was in a car accident in November 2012. I have already received about 10 weeks of physical therapy. Upon returning to my doctor for an examination, she determined that I was at about 80% range of motion, and wrote me a prescription for more physical therapy, to return me to 100%. My insurance adjuster called my Physical Therapy office and told them she wasn't going to pay for the second round of treatment, and now the office won't even let me make an appointment. The longer I go without Physical Therapy, the more the pain slowly starts returning. Is this legal? Don't they have to pay for all of my treatments that are prescribed by a doctor?

Attorney Answers 6


  1. You should contact a personal injury attorney asap. Your attorney will find a doctor who would be willing to continue your treatment on a lien basis. If you have injuries and pain you should receive proper medical attention. You may contact us for a free consultation. We don't charge a fee unless And until there is recovery.

    Jasmine Gevorkyan
    818-497-8565 direct

    The response given is not intended to create, nor does it create an ongoing duty to respond to questions. The response does not form an attorney-client relationship, nor is it intended to be anything other than the educated opinion of the author. It should not be relied upon as legal advice. The response given is based upon the limited facts provided by the person asking the question. To the extent additional or different facts exist, the response might possibly change. Attorney is licensed to practice law only in the State of California. Responses are based solely on California law unless stated otherwise.


  2. Unfortunately, most insurance companies only cover so many pt visits per year. For example, blue cross only covers about 20 visits for my injured clients per year. Have your lawyer send the pt place a letter of protection.


  3. I agree with my colleagues. You should be consulting with a personal injury attorney in your area as soon as you can. There are limitations specific to your state as to the number of physical therapy visits you would be entitled to. If there is a potential lawsuit monetary award expected, your providers may agree to treatment with the expectation that there will be a lien against any award. You will need to be careful because anything that you receive will be reduced by all of the liens that you have including your healthcare (Medicaid/Medicare/insurance/Workers' Compensation). The end result could mean that you do not have any sizable amount of money moving to you at the conclusion of your case. Your attorney should be able to give you a good faith estimate as to the value of your case.

    The valuation of a case is not an easy thing for any attorney, and is not an exact science. While the attorney cannot give you any guarantees as to the outcome of the case, if you win the case, there would be an expected value range. At the low end of this range is exceeded by the expected liens, your potential compensation could be nil.


  4. In general (there are exceptions but these are quite technical and uncommon) Insurance companies do not direct medical care but instead decide which services they will pay for... that means they deny payment not deny care. This is an issue with liability insurers as well as health insurers... and one that has caused a battle for decades now. Fortunately, the patient being denied coverage should be able to easily find a local lawyer who can look for available sources of coverage and use the laws to obtain what his or her client is entitled to receive.

    Fortunately, most of us personal injury types offer free consultations and take such cases on contingency, so there is nothing to fear in calling us.

    - Paul

    Paul J. Molinaro, M.D., J.D.
    Attorney at Law, Physician, Broker
    Fransen & Molinaro, LLP
    980 Montecito Drive, Suite 206
    Corona, CA 92879
    (951)520-9684
    www.fransenandmolinaro.com / www.888MDJDLAW.com

    "When you need a lawyer, call the Doctor... Call Paul J. Molinaro, M.D., J.D... Call (888)MDJDLAW."

    * This post and all others I make on Internet are for informational purposes only. None of the information or materials I post are legal advice. Nothing I post as comments, answers, or other communications should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing of this information does not constitute, an attorney-client relationship. While I try to be accurate, I do not guarantee accuracy.
    ** Fransen & Molinaro, LLP practices in the areas of personal injury, medical malpractice, and real estate law.

    Paul J. Molinaro, M.D., J.D. ... Attorney at Law, Physician, Broker... Fransen & Molinaro, LLP... 980 Montecito Drive, Suite 206... Corona, CA 92879... (951)520-9684... www.fransenandmolinaro.com / www.888MDJDLAW.com... "When you need a lawyer, call the Doctor... Call Paul J. Molinaro, M.D., J.D... Call (888)MDJDLAW." ... * This post and all others I make on Internet are for informational purposes only. None of the information or materials I post are legal advice. Nothing I post as comments, answers, or other communications should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing of this information does not constitute, an attorney-client relationship. While I try to be accurate, I do not guarantee accuracy... ** Fransen & Molinaro, LLP practices in the areas of personal injury, medical malpractice, and real estate law.


  5. You need to hire an attorney. Auto insurance claims are handled on a reimbursement basis. With the help of an attorney you can get your necessary medical treatment. Our office in Long Beach is available for a free in person consultation. 562-981-1010


  6. If you are in a car accident and the insurance company is paying for treatment directly, the insurance company can only address the issue of coverage. The adjuster is not licensed to practice medicine and cannot cancel physician order and interfer with treatment. Report the adjuster to the Department of Insurance as this is an improper claims practice.

    24 Hour Attorney Call Center (314) 361-4242 or visit us on the Web at http://www.hoffmannpersonalinjury.com.

Personal injury topics

Top tips from attorneys

What others are asking

Can't find what you're looking for?

Post a free question on our public forum.

Ask a Question

- or -

Search for lawyers by reviews and ratings.

Find a Lawyer

Browse all legal topics