Do I need counselor liability malpractice insurance?
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If you are delivering psychotherapy, you need counselor liability insurance. Regardless of whether you are student or associate level LPC LCSW or LMFT, you need malpractice insurance. In many cases, organizations will require it. Why?
Who needs malpractice coverage?
Everyone who is doing some form of professional counseling or psychotherapy should carry professional liability insurance. As mentioned above, sometimes it is required anyway.
As it applies to the counseling profession this would include psychologists, social workers. marriage and family therapists and professional counselors OR anyone including graduate students in pursuit of a state license to provide emotional treatment and mental help.
Counselors get sued. Broadly speaking, we are sued for some form of perceived ethical misconduct that caused damage.
Clients view us as expert professionals. They put their care in our hands. Sometimes they believe they have been harmed. They could also file an ethics complaint to the licensing board. While not directly related to a civil suit, a licensing board can use evidence collected with the civil suit in making decisions about the alleged ethics violation.
It is important to understand this because your career can often survive a lawsuit, but a license suspension or revocation could prevent you from practicing.
We can be sued by other therapists. Even friends could file a civil suit against us for incorrectly believing our conversations with them were psychotherapy.
Some professional entities and state licensing boards require we carry malpractice insurance. Most if not all, third party payers (HMO’s, Medicaid and other federal government programs, numerous others) require we provide proof of malpractice insurance every few years.
For associate professional counselors, peers supervising us toward licensing often require proof of counselor liability insurance.
Part of that is that both of us carry malpractice insurance. Graduate school counseling programs require internship students to carry liability insurance.
Reasons Psychotherapists are Sued.
The reasons therapists must defend themselves in a civil suit are numerous. The most obvious are sexual boundary crossings with clients and other gross ethical misconduct. Here are some of the less obvious reasons you should know about:
Client Abandonment
A client feeling abandoned usually results from a therapist’s struggles with setting boundaries and improper termination of care.
It is the therapist’ responsibility to manage the counseling relationship. We must be sure this relationship does not stray from our sole responsibility of treating their emotional and mental struggles.
We may unwittingly move the counseling relationship into one of friendship. When the relationship begins to resemble a friendship, we can be vulnerable to allegations of abandonment.
Boundary crossings can develop gradually and in a subtle manner. A healthy counseling relationship will minimize the chances that a client will feel jilted or abandoned and file a civil suit against you.
Personal supervision and ethics and boundaries training will help you maintain healthy client relationships.
Breaches of Confidentiality
Breaches of psychotherapy confidentiality are a violation of the law. They are usually a misdemeanor. A breach is also an ethics violation under the Georgia Composite Board’s Code of Ethics. In fact, most states’ ethics and professional association codes of ethics address confidentiality breaches.
However, there are types of violations of patient confidentiality that are more likely to result in either a licensing board ethics complaint or lawsuit.
Sharing content of sessions with a third party one would reasonably expect the client would object.
Sharing client records or information that could cause direct emotional harm.
Sharing information that could be used against a client or otherwise weaken their position in a separate legal situation. For example, obtaining public benefits or financial settlement.
When spouses are engaged in divorce proceedings, sharing information about either’s mental health treatment without consent.
Counseling Beyond Your Scope of Practice
A central theme with my APCs in supervision toward license is to “stay in your lane.” This means practice in areas where you are trained and experienced. If you want to expand your practice to another specialty, get trained in it first. Attorneys use an expression regarding safe legal practice: “if you want to be sued, be a generalist”.
If you keep your practice simple, you will have fewer complications and less stress and worries. Be confident in what you know, but understand your limitations.
For example, treating eating disorders is highly specialized. There are factors known only to experienced eating disorder therapists such as dietary concerns and that symptoms can rapidly escalate. Suicide rates among eating disorders are among the highest of all mental disorders.
Eating disorders are observed disproportionately in females. They are frequently young females.
What if you are providing treatment to a female minor with an eating disorder, don’t specialize with this population, and they die by suicide? Be prepared for the possibility of needing to defend yourself in a civil suit or before your state licensing board for an ethics violation.
Keep your practice simple and stay in your lane.
Inadequate Informed Consent
In short, informed consent in psychotherapy means your client knows the treatment they are receiving and have agreed to it. For example, if you are treating a patient using EMDR (eye movement desensitization and reprocessing), you should inform them in writing they will likely experience distress after the session.
Especially important is clear informed informed consent for couples and minors. It should be made clear who is the client, the limits of confidentiality and parameters of conduct in the therapy.
Child Custody and Divorce
One of the most common types of lawsuits. Counselors involved in divorce proceedings while treating a minor child are often sued. A common scenario is when the court decree child custody court decree is not in favor of one of the spouses. That spouse upset about the outcome, sues the therapist because notes in the child’s treatment records suggest questionable fitness to parent.
There are many other family law scenarios that could result in a therapist being sued.
Incompetence
Incompetence is in every profession, but it is especially serious when one is issued a license to practice a healthcare profession. None of us can understand how to treat every condition. Don’t advertise you can treat every mental illness from A to Z and that you work with children, adolescents, adults, couples and families if you don’t have that education training and experience. It is guaranteed you will be incompetent in at least one of those specialties and are therefore inviting a civil suit
Improper Documentation of Treatment
Therapists can be sued when damage arises from poor documentation. For example, not documenting information that proves you acted in a clinically responsible manner. For example, not documenting referrals you made for other treatment services, improper assessment of suicidality and steps taken to protect the client.
The Ethics of Involuntary Psychiatric Hospitalization
Not all states permit masters level therapists to execute an order for involuntary hospitalization. If you practice in a state that permits it, understand that with this right comes a great responsibility and legal vulnerability.
You are arguably most vulnerable if you work in an independent practice setting and many of your clients have severe mental illness and addiction. Essentially, there is a gap in service in this setting. Stay in contact with your clients’ psychiatrist. If you are in a private independent practice office, consult with a peer experienced in mandated psychiatric evaluations.
If you have a physician or psychiatrist at your job, you can ask them to execute the order. These orders are routine work for a psychiatrist. You can also complete the form, have the physician review and sign it. In most states, masters level therapists can legally diagnose but not all courts are aware of this. Protect yourself by having a physician render the diagnosis whenever possible.
Always consider that if you are accused of malpractice, you should be confident that you acted within a standard of care and within your scope of practice. Understand there is general misconception and attitude that since masters level therapists are not doctors, their qualifications are limited despite the fact that Georgia LPC’s can legally diagnose mental disorders.
How Counseling Malpractice Insurance Protects You
Basic counselor malpractice liability insurance primarily covers incidents arising directly from the profession your policy covers e.g. professional counseling.
Essentially, malpractice insurance protects you against events arising between you and your clients that are related to your treatment of their mental condition.
Many carriers provide supplemental coverage for property damage and personal injury, but it must be as a direct result from professional practice. So this usually excludes civil action from business disputes, actions as a business owner or employer and actions taken by your managed care panels.
You can purchase the amount of coverage you need. Malpractice insurance carriers offer other types of coverage usually at an additional cost. Insurance coverage you should consider purchasing that is not related to practice includes office liability (“slip and fall”)and fire and casualty.
Telemental Health and Clinical Supervision Coverage
Confirm with your professional counselor malpractice insurance company that telemental health- including across state lines- is covered. If applicable, confirm that you have coverage for clinical supervision.
Which Counselor Insurance Is Best
The “best” is what is best for you. Therapists needs differ. Different work settings and arrangements. Different clinical work. Check with the carrier for professional association discounts. The following carriers are among the most commonly used. Some are actually brokers.
CPH and Assoc / Philadelphia Indemnity
CPH and associates offers coverage for part and full time self employed counselors, counselors working as agency employees, graduate interns and post masters in supervision towards full LPC license. Contact them for a policy quote at 800-875-1911.
HPSO Professional Liability Insurance
HPSO malpractice insurance for counselors provides complimentary coverage to students who are members of ACA (American Counseling Association). They also provide coverage for assault. They can be contacted at 800-982-9491
American Professional Agency, Inc (APA)
American Professional Agency provides coverage for school counselors, employed counselors, self employed counselors, certified hypnotists, and bachelors in mental health. They can be contacted for a rate quote at 800-421-6694.
