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Industry Insights

Moore: Physical Therapists as Primary Treatment Providers

  • State: North Dakota

Workers' comp physical therapists have received a huge amount of good press over the last two months. I had always thought that physical therapists could treat certain injuries from the onset.

James Moore

James Moore

I have always been a proponent of physical therapy. Check out these two prior articles that I wrote years ago on the subject: Is Physical Therapy Really Worth It? and Physical Therapists — Seen Most Often by Injured Workers.

North Dakota becomes test case

North Dakota decided to step up and become the state test case for physical therapy.  Workforce Safety & Insurance, a monopolistic carrier, changed its law in August to allow physical therapists to treat injured workers as the primary provider. WSI even provided a pamphlet on how this would work in comp.

WSI website changed for PT

WSI considers the following types of practitioners eligible to be primary treating providers: MD, DO, APRN, PA, DC, DPM, OD, DDS, DMD and PT. An injured employee may have only one primary treating provider who will manage treatment, assess functional capabilities and determine when the injured employee achieves maximum medical improvement. 

WSI requires a referral for therapy treatment if the PTP is not a physical therapist. Initial therapy treatment on a claim does not require prior authorization for the first 10 visits or 60 days of care, whichever comes first. WSI refers to this as an initial window period. 

WCRI study: Comp physical therapists cut costs

I was not going to write an article on one state approving physical medicine providers as the primary treatment providers. Then the Workers Compensation Research Institute published a study that shows physical therapy as a major cost-cutter if the treatment starts very early in the claim.

Among workers with low-back pain who received manual therapy, early manual therapy (within two weeks of PT care) was associated with lower costs and shorter temporary disability duration as compared with late manual therapy (after two weeks of PT care). Early manual therapy was also associated with a lower likelihood of receiving magnetic resonance imaging, pain management injections and opioids as compared with late manual therapy.

Will other states adopt the WSI program?

We will likely see more discussion in the future on workers' comp physical therapists expanding their roles in treating injured workers as primary medical providers.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at

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