What can a personal injury law firm do when a client needs recommended physical therapy but does not yet have a valid medical referral?

Why a Chiropractic Recommendation May Not Be Enough

A chiropractor’s recommendation to stop or change treatment can be important medical documentation. It may show that the client’s condition has not improved as expected and that a different type of care should be considered.

However, a recommendation in chiropractic records is not necessarily the same as the referral required by a physical therapy clinic. The clinic may have its own intake policy, or the client’s health plan may require a particular type of order before it will consider paying for treatment. The exact requirements can depend on the provider, the plan language, and the client’s circumstances.

North Carolina law defines physical therapy to include evaluating patients, establishing treatment programs, and implementing referrals from licensed medical doctors or dentists. It also makes clear that physical therapy does not include making a medical diagnosis of disease. N.C. Gen. Stat. § 90-270.90 describes this scope of practice. This does not mean every North Carolina patient always needs a physician referral, but a particular clinic or payer may still require one.

What the Law Firm Can Do Without Directing Medical Care

The law firm’s role is to help remove administrative barriers while leaving medical decisions to licensed providers. Depending on the situation and the client’s authorization, the firm may take the following steps:

1. Confirm the physical therapy clinic’s requirements. The firm can ask what type of referral the clinic accepts, who may issue it, whether it must name the clinic, and what records are needed before scheduling.
2. Help the client contact a primary care provider. If the clinic requires a referral from a primary care provider, the client may need to arrange an evaluation. The provider—not the lawyer—decides whether physical therapy is appropriate and what the referral should include.
3. Collect the chiropractor’s records. With a signed medical authorization, the firm can request treatment notes, imaging reports, billing records, and the written recommendation for physical therapy.
4. Transmit relevant records with permission. The firm may send the primary care provider or physical therapy clinic records that explain the injury, prior care, symptoms documented by providers, and the reason for the requested evaluation.
5. Supply claim information after the referral is accepted. This may include the date of injury, claim number, insurer contact information, a letter confirming representation, and other documentation requested by the clinic.
6. Track the referral and scheduling process. The firm can follow up about missing documents, record when the referral was requested, and preserve communications explaining any delay in beginning therapy.

A law firm should not draft a clinical order for a provider to sign without review, tell the client what treatment to receive, or represent that an insurer will pay the bill. Medical necessity, treatment frequency, and clinical goals must come from the treating providers.

Information the Primary Care Provider May Need

A primary care provider may want to examine the client and review the prior course of care before deciding whether to issue a referral. The client should be prepared to provide accurate information rather than asking for a referral as a paperwork formality.

Helpful materials may include:

• The chiropractor’s written recommendation and recent treatment notes.
• Records from urgent care, emergency, hospital, or other post-incident visits.
• Available imaging reports and test results.
• A current list of symptoms and functional difficulties documented accurately.
• Dates of treatment and any interruptions in care.
• Health insurance information and relevant claim correspondence.
• The physical therapy clinic’s referral form or written intake requirements.

If the primary care provider issues a referral, the record should clearly identify the recommendation and any clinical instructions the provider considers appropriate. Keeping the referral, visit summary, and related communications can help establish why the treatment plan changed and when the change occurred.

Why Documentation Matters to the Injury Claim

Insurance adjusters commonly review whether treatment was connected to the incident, recommended by a provider, and reasonably consistent with the medical records. A documented transition from chiropractic care to physical therapy may be easier to explain than an unexplained change or a long gap in care.

The records should show the actual sequence of events: the chiropractor concluded that continued chiropractic treatment was not adequately helping, physical therapy was recommended, the receiving clinic required another referral, and the client took reasonable steps to obtain it. The law firm can preserve emails, portal messages, appointment records, and referral requests that explain any resulting delay.

Medical bills also matter. The firm may request itemized bills and complete treatment records under a valid authorization. Those documents can later help evaluate accident-related medical expenses, identify billing issues, and determine whether a provider or health plan may assert a reimbursement or lien claim. Providing claim information to a clinic does not guarantee payment, and the client should understand the clinic’s financial paperwork before treatment begins.

How This Applies When a Chiropractor Recommends Physical Therapy

Under the stated facts, the next step is not for the law firm to create or replace the missing referral. The firm can obtain the chiropractor’s recommendation, confirm exactly what the physical therapy provider requires, and help the client send the relevant records to a primary care provider for an independent evaluation.

If that provider issues an acceptable referral, the firm may then supply the physical therapy clinic with authorized claim documentation. If the provider declines to issue a referral, requests an examination, or recommends a different course, the law firm should document that response rather than attempting to influence the clinical decision.

The client should also keep copies of the referral request, appointment confirmations, the final referral, and any written explanation for delays. These records may help distinguish an administrative delay from a decision by the client to stop treatment without explanation.

Common Problems to Avoid

• Assuming that a chiropractor’s recommendation automatically satisfies the physical therapy clinic’s intake rules.
• Waiting without documenting efforts to schedule a primary care evaluation.
• Sending medical records without the client’s authorization.
• Assuming that a liability claim number guarantees payment for treatment.
• Allowing the records to suggest that the lawyer selected or prescribed the treatment.
• Failing to save the referral, itemized bills, visit summaries, and provider communications.