Insurance & LiensQuestion 570 of 1632

Under California workers' compensation, medically necessary treatment by chiropractors, physical therapists, and occupational therapists for a single industrial injury is generally capped at:

a.Ten visits for each one of the three provider types
b.An unlimited number of visits, as treatment needs
c.Twelve visits shared across all three provider types
d.Twenty-four visits for each of the three provider types

Explanation

§4604.5(c)(1) is the cap, and it runs per discipline rather than pooled: for injuries occurring on or after January 1, 2004, an employee is entitled to no more than 24 chiropractic, 24 occupational therapy and 24 physical therapy visits per industrial injury. That is what makes (c) the tempting wrong answer — it merges the three into a single allowance the statute never creates — and (a) simply cuts the figure by more than half. (b) ignores the cap altogether. There are two genuine exits, and both matter in practice: under §4604.5(c)(2)(A) the employer may authorise additional physical medicine visits in writing, and paying for or authorising treatment beyond the limit is not a waiver of the limit for future requests; and under §4604.5(c)(3) the cap does not apply to post-surgical physical medicine and rehabilitation provided under the post-surgical treatment utilization schedule the administrative director adopts pursuant to §5307.27. The underlying duty to provide medical treatment is §4600.

Law Reference: Labor Code §4604.5(c)(1)-(3); §4600; §5307.27

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