A Workers' Compensation behavioral-health case is not a private therapeutic relationship between a clinician and a patient. It is a clinical relationship embedded in a claims process, and several parties have a stake in the record. The injured worker — referred to as the member — is the patient. The employer carries the obligation that the workers' compensation system exists to discharge. The claims administrator, or adjuster, manages the claim on the employer's or insurer's behalf and decides what gets paid. Utilization review (UR) is the gate that decides whether requested treatment is authorized.
On the clinical side, two treating clinicians typically share the case: a psychologist, who evaluates, diagnoses, and renders the causation opinion, and an LPCC, who carries the ongoing therapy and progress reporting. Outside the treating relationship sit the medical-legal evaluators — a QME (Qualified Medical Evaluator) or AME (Agreed Medical Evaluator) — who provide independent opinions when the parties dispute the claim. If the worker is represented, an applicant attorney advocates for them; if not, the I&A officer (Information & Assistance) provides state-supplied guidance.
CareHub Therapy is the HIPAA-compliant platform the treating clinicians work in. It operates as a HIPAA Business Associatean entity that handles protected health information on behalf of a covered entity, under a written agreement, with direct compliance obligations to the covered entities it serves — which means the platform carries direct HIPAA obligations, not merely contractual courtesy.
Three things separate it from ordinary therapy: a higher causation bar set by statute (covered next), special confidentiality rules that limit what the employer ever sees, and a structured reporting and utilization-review regime that general practice has no equivalent for. A clinician fluent in therapy but not in this frame can still get the case wrong.
The practical consequence is that almost everything a clinician writes serves two audiences at once: the patient's care, and a claims record that adjusters, reviewers, and possibly evaluators and attorneys will read. The rest of this course is about writing for both well.
Which party decides whether a requested course of treatment is authorized?