Workers’ Comp: Teletherapy for Mental Health Claims

Let’s paint a picture of a real-life scenario: Meet James, a 36-year-old firefighter, who began missing shifts after responding to a traumatic car accident, his supervisor noticed a shift—his usual enthusiasm was replaced by silence and withdrawal. Eventually, James filed a workers’ compensation claim, citing anxiety and insomnia. His case manager, new to handling mental health claims, was faced with navigating teletherapy.

Mental health has long been underdiagnosed and undertreated, but that’s changing. According to the National Alliance on Mental Illness (NAMI), 22.8% of adults in the U.S.—or roughly 57.8 million people—experience a mental health disorder in a given year (National Alliance on Mental Illness, 2023). For many, it’s triggered in the workplace.

The American Psychological Association (APA) reveals that over 60% of employees experience work-related stress, with depression and anxiety topping the list of consequences (American Psychiatric Association, 2023).

This isn’t just a personal issue anymore; employees are being affected by absenteeism, presenteeism, and decreased productivity—costing employers billions annually.

Absenteeism is when an employee is not at work because of illness, injury, or other reasons. They’re missing days entirely.

Presenteeism is when an employee shows up to work but isn’t fully productive—maybe because they’re sick, stressed, or dealing with a health issue that affects how well they can do their job.

As a result, more claims with mental health components are being filed—and case managers must be prepared.

Teletherapy and Its Role in Workers’ Compensation

Teletherapy is the delivery of therapy sessions via video or phone calls, much like teams or Zoom calls, which grew rapidly during the pandemic. What began as a temporary workaround has become a permanent fixture in behavioral health care.

Patients benefit from easy access, reduced stigma, and the convenience of speaking to professionals from home.

The National Conference of State Legislatures notes that first responders develop behavioral health conditions like PTSD at a rate more than 50% higher than the national average (Cunningham, 2022). One of the challenges of these professions is taking time off to go to a doctor’s office but now these workers can access the benefits of therapy during their lunch break.

For workers’ compensation, teletherapy offers new pathways for timely treatment. Injured workers—especially those in rural areas or high-stress professions—can connect with therapists quickly, removing travel time or scheduling conflicts. This allows for earlier intervention and an approach as effective as it is in person. As we’ve seen in telehealth (click here), the shift to virtual care presents new challenges for claims management.

Challenges

Mental health claims are inherently more complex than physical injury claims. There’s rarely a straightforward diagnostic test or x-ray to confirm symptoms. Instead, case managers must rely on clinical observations, patient self-reporting, and therapist notes.

With teletherapy, the case manager may not have the same visibility into progress as they would in a traditional care setting. It’s harder to verify whether the injured worker is actively participating or merely checking a box. There’s also the risk of over-treatment, especially with newer or less regulated telehealth providers who may not align with evidence-based guidelines.

Additionally, it’s important to understand burnout. The World Health Organization defines burnout as “chronic workplace stress that has not been successfully managed,” which can manifest in emotional exhaustion, detachment from work, and declining performance.

They estimate that 23% of workers globally suffer from burnout (World Health Organization, 2019).

These cases usually do not involve a single traumatic event but rather a slow, change in mental well-being. But the hardest part – is managers must differentiate between legitimate mental health deterioration and exaggerated or unrelated claims.

Case Managers and Teletherapy

To successfully manage claims involving teletherapy, case managers should:

1. Verify provider credentials: Ensure that the teletherapy provider is licensed in the claimant’s state and that sessions are being conducted with qualified professionals such as psychologists, psychiatrists, or licensed clinical social workers.
2. Request structured treatment plans: Teletherapy shouldn’t be open-ended. Providers should supply treatment goals, progress updates, and expected timelines for improvement—just like with physical rehab.
3. Monitor engagement: Use consistent check-ins to verify that the claimant is attending sessions, engaging with the therapist, and applying coping techniques outside of therapy.
4. Use guidelines: Both the American Psychological Association (APA) and the American Psychiatric Association (APA) publish peer-reviewed, nationally recognized guidelines that outline recommended treatment durations, therapeutic modalities, and diagnostic criteria for a range of mental health conditions. These resources can help if you are unsure that treatment plans align with what’s considered clinically appropriate and effective.

For example:

• The APA’s Clinical Practice Guidelines provide detailed recommendations for treating conditions like major depressive disorder, PTSD, and generalized anxiety disorder, including the typical number of therapy sessions, medication strategies, and when to consider adjusting the treatment plan.
• The American Psychiatric Association’s DSM-5-TR offers criteria that help validate the legitimacy and severity of a diagnosis, which is particularly useful when a claim presents vague or subjective symptoms.
• These organizations also outline when certain interventions—like CBT (Cognitive Behavioral Therapy), EMDR (Eye Movement Desensitization and Reprocessing), or medication management—are indicated, and how long they should reasonably take to show progress.

You don’t have to use these yourself, but you can request that the injured worker’s therapist explain how their treatment plan aligns with APA-recommended practices.

Mental Health Claims in a Virtual World

One of the most difficult aspects of managing mental health claims is measuring recovery. Unlike physical injuries, there’s no cast to remove or range of motion test to confirm improvement. Instead, case managers must focus on functionality and goal recommendations from the behavioral therapist.

Questions to ask yourself during a mental health case:

• Has the injured worker returned to social activities or work tasks?
• Are they following the prescribed treatment plan?
• Have any return-to-work accommodations been requested or accepted?

Teletherapy also introduces new variables neither you nor your patient might be experienced with, like poor connectivity, distractions during sessions, or lack of privacy. All of these uncontrollables can interfere with progress. Case managers should maintain regular communication with both the provider and the claimant to ensure treatment is going smoothly.

For example, repeated no-shows or excuses for non-engagement may indicate either a lack of motivation or a non-work-related issue driving the claim. In such instances, a second opinion from a mental health Independent Medical Evaluation (IME) can’t hurt. Curious when is the right time to use an IME for a Workers’ Comp case? Here’s a quick breakdown.

Case management ensures this foreign style of independent care, stays responsible, fair, and contained. James, our firefighter, eventually returned to work after six months of weekly virtual therapy, supported by a dedicated case manager who ensured he received timely, evidence-based care. His story reflects a new chapter in workers’ comp—one where mental health is taken seriously, and teletherapy, when managed well, is part of the solution.

Check out our sources:

American Psychiatric Association. Stress in America: 2023 Report. APA, 2023, www.apa.org/news/press/releases/stress.
Cunningham, Amy. “Post-Traumatic Stress Disorder in First Responders.” National Conference of State Legislatures, 2022, www.ncsl.org.
National Alliance on Mental Illness. Mental Health by the Numbers. NAMI, 2023, www.nami.org/mhstats.
World Health Organization. Burn-Out an Occupational Phenomenon: International Classification of Diseases. WHO, 2019, www.who.int/news/item/28-05-2019.