A medical referral is not required for access to occupational therapy services. Some occupational therapists see clients without requiring them to submit a medical referral. The problem is that insurance companies ask their customers for a medical referral before they reimburse them for the services received. If people want to be reimbursed for their expenses by their insurance company, then they must provide a medical reference. We then get caught in a vicious circle where a referral from a physician is required to obtain a refund from the insurance company. That aside, the referral is not necessary.
On March 10th, 2015. See this statement in context.