Mental Health Services

Treatment Must Focus on Return to Work

Under workers’ compensation insurance, mental health treatment must focus on helping occupationally injured and ill workers heal and return to work.

For detailed information, see Authorization and Reporting Requirements for Mental Health Specialists.

When treatment is covered

  • Mental health conditions are caused or aggravated by a work-related injury or illness.
  • A pre-existing or unrelated condition is delaying recovery from work-related injury or illness.
  • When authorized — required for initial evaluation and ongoing treatment (up to 90 days at a time).
  • When documentation shows clinically meaningful improvement.

Treatment that is NOT covered

  • Palliative care (when treatment is not curative and rehabilitative).
  • Treatment has reached maximum medical improvement.
  • Temporary treatment does not improve physical function of the industrial injury or occupational disease.

Use of DSM-5 criteria is required (effective October 23, 2015)

  • L&I or the self-insured employer uses your information to determine the relationship between industrial injuries and mental health conditions. 
  • During evaluation and ongoing reports, you must clearly indicate your opinion about the possible relationship between a mental health condition and an industrial injury — and the basis for your opinion using the criteria of the American Psychiatric Association’s Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Services that mental health specialists can provide to injured workers

  Psychiatrist (MD/DO) Psychiatric ARNP Psychologist (PsyD or PhD)
Submitting Report of Accident Yes Yes No
Acting as Attending Provider (and certifying time loss) Yes Yes No
Counseling Yes Yes Yes
Prescribing medication* Yes Yes No
Conducting an IME Yes No No
Rating impairment Yes No No

* A psychiatrist or psychiatric ARNP may prescribe medication either as the attending provider or when providing concurrent care. (See WAC 296-20-071 “Concurrent Treatment” and WAC 296-21-270 “Mental Health Services.”)

 

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