Direct access has given physical therapists more autonomy than ever, and more liability exposure than most of them realize. I help PT practices build coverage programs that match what they actually do, not what a standard policy assumes they do.
Jeremy A. Jones
Healthcare Insurance Specialist
Helping PT practices find the coverage gaps before a claim does.
In states with direct access, a patient can walk into a physical therapy clinic without a physician referral. That's a meaningful shift in autonomy for the profession, and a meaningful shift in liability exposure. When the PT is the first clinician evaluating a condition, they're not just treating. They're screening. And if they miss a red flag, a symptom that warrants referral back to a physician or emergency evaluation, and treatment continues instead, that's a professional liability claim with a very different profile than a routine treatment injury.
Dry needling introduces a similar mismatch. It's a procedure that's become increasingly common in PT practice, but it carries a risk profile — infection, nerve injury, pneumothorax that looks nothing like therapeutic exercise. The question isn't just whether the PT is trained and licensed to perform it. The question is whether their policy actually contemplates it. Many don't.
Then there's the staffing question. Who is actually an insured under your policy? How does it respond when a PTA, a student, a temp clinician, or an independent contractor covering a shift is involved in a claim? These are the same gaps that catch other healthcare practices off guard, and they're just as real in PT.
Direct access means the PT may be the first and only clinician to evaluate a condition before treatment begins.
Building coverage (if you own), business personal property, treatment tables, therapeutic equipment, and leasehold improvements — the physical infrastructure your practice depends on.
Malpractice coverage for treatment errors, patient injury claims, and scope-of-practice disputes arising from your PT services.
Coverage for claims arising from treating patients without a physician referral — a growing exposure as direct access expands across states.
Many standard PT policies exclude dry needling entirely. This coverage addresses claims arising from dry needling procedures specifically.
Patient falls during gait training, balance work, or exercise are among the most common PT liability claims. Coverage must be explicit.
Coverage for relief PTs, PRN staff, and independent contractors working in your practice — often excluded under standard policy definitions.
Legal defense costs if your PT license is investigated or threatened — separate from malpractice and often excluded from standard policies.
Making sure your policy actually covers the services you provide — including any specialty modalities or expanded scope procedures.
Hospitals, physician groups, private equity platforms, and referral partners all impose insurance requirements. I review those requirements and make sure your program satisfies them.
Common Questions
Insights & Resources
November 2, 2026
Moving your physical therapy practice out of a gym and into your own clinic is a big step. Here is what changes with your insurance and what to have in place before you sign the lease.
Read ArticleOctober 28, 2026
If you run a pediatric therapy center or pediatric dental practice, your policy may exclude abuse and molestation claims. Check your coverage before you move or grow.
Read ArticleSeptember 13, 2026
If your PT practice sells, supplies, or sends patients home with products, product liability is an exposure worth specifically reviewing, separate from professional liability.
Read ArticleAugust 18, 2026
Direct access has expanded what physical therapists can do without a physician referral. It has also expanded what they can be held liable for. Here is what your policy needs to reflect.
Read ArticleAugust 13, 2026
Direct access, dry needling, and relief clinicians create coverage gaps most PT policies miss. Here is what independent physical therapists need to know.
Read ArticleIf you offer direct access, dry needling, or employ contract clinicians, and most PT practices do at least one of those, your standard policy may have gaps you don't know about.
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