When to Refer
Guidance for identifying when behavioral health support may be appropriate in workers’ compensation claims.
Identifying Behavioral Health Needs
Behavioral health factors can affect recovery, treatment engagement, and return to work across a range of workers’ compensation claims.
Referral may be appropriate when these factors are influencing progress or creating uncertainty.
Match the Situation to the Right Solution
Delayed Recovery Prevention (DRP)
For physical injury claims where recovery is not progressing as expected and behavioral or psychosocial factors may be interfering with function.
Refer when:
- Recovery is slower than expected
- Progress has plateaued
- The injured worker is struggling to stay engaged in care
- Pain, sleep, or health behaviors are affecting recovery
- Fear of reinjury or difficulty returning to function is present
Mental Health Solutions (MHS)
For claims involving psychological conditions or when behavioral health treatment may be appropriate.
Refer when:
- A psychological injury or condition is present
- Symptoms such as anxiety, depression, or stress are affecting function
- Behavioral health treatment is needed to support recovery
- Psychiatric evaluation or medication management may be appropriate
Advanced Psychological Evaluations (APE)
For situations requiring diagnostic clarification, causality determination, or additional clinical insight.
Refer when:
- Diagnostic clarity is needed
- Questions exist around causality (AOE/COE)
- Recovery is not progressing and the reason is unclear
- Specialized evaluation is needed (e.g., cognitive concerns, surgical clearance, PTSD)
- Additional data is needed to guide next steps
Referral
Screening/ Assessment
Appropriate Intervention
Collaborative Case Conference
Measured Outcomes
Case Closure
Once a referral is made, the process is managed from initial screening through intervention and outcome tracking.
This structured approach ensures:
- Appropriate level of care based on clinical need
- Consistent communication throughout the claim
- Clear documentation supporting next steps and decisions