Will My Insurance Cover Physical Therapy After a Car Accident in Los Angeles?

What Is Physical Therapy?

Physical therapy is non-emergency medical care that aims to relieve pain and help you move better. In some cases, physical therapy is crucial to a full recovery. California licenses physical therapists.

Who Pays for Physical Therapy After a Car Accident?

California is a “fault” auto insurance state. That means the at-fault driver (or their insurance company) generally pays for their own injuries and those of whoever was hurt in the accident. If the accident was your fault, California MedPay will probably pay for your physical therapy as long as the amount is within policy limits. The problem you may run into is that MedPay is optional.

Third-Party Claims

If someone else was responsible for your accident, you can seek compensation from their auto liability insurance. Unfortunately, many California drivers are uninsured. That is why you should purchase uninsured motorist insurance before you have an accident. As a last resort, you might seek reimbursement from the driver’s personal resources.

Does My Insurance Cover Physical Therapy?

If you purchased optional California MedPay, it will cover your physical therapy expenses as long as they are reasonable, necessary, and within policy limits. Keep in mind that since physical therapy is expensive, it doesn’t take long to exhaust insurance resources.

Limitations on Compensation

Following is a list of some of the most common practical limitations on the amount of your compensation.

The “Reasonable and Necessary” Restriction

Any applicable insurance policy will only cover your physical therapy expenses to the extent that they are a “reasonable and necessary” consequence of your injury. 

What this phrase really means is that the insurance company reserves the right to contest your claim for expenses. To establish that physical therapy is a “reasonable and necessary” expense, be sure to obtain a written referral from the emergency department that treated you or from your primary care physician.

Insurance Limits

California requires its automobile drivers to purchase bodily injury liability insurance for $15,000 per person and $30,000 per accident. This coverage limit applies to a claim you might make against an at-fault driver. Much higher coverage limits apply to commercial truck drivers, for example, and to Uber/Lyft drivers.  

MedPay limits vary according to how much coverage you choose to carry. Typical MedPay coverage limits range from $2,000 to $25,000 per accident. Your health insurance policy might also cover some of your expenses. Check the terms of your particular policy to find out the coverage limits.

Never forget that no insurance company will pay you a dime beyond their policy limits, no matter how serious your injuries might be.

Comparative Fault

In California, the principle of pure comparative negligence applies when more than one party is at fault for the accident. Each party is assigned a percentage of fault for the accident. If you were assigned 15% of the blame, your damages award can be reduced by 15%.

Negotiating Skill

The great majority of personal injury claims resolve at the negotiating table, not in court. Like it or not, negotiating skill matters in a personal injury claim. Choose a good lawyer who knows how to negotiate. 

Remember, however, that a large part of securing a generous settlement boils down to a strong record of winning at trial. If your lawyer has proven they can win at trial, nobody will want to take them to court. And that leaves only one alternative: settlement.