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I am working therapeutically is there anything I need to check with my insurer?

Not all insurers are the same. I did a secret shopper survey in 2014 and I found a huge variation with regards to working online and some insurers didn’t seem to understand some of the issues involved, especially around jurisdiction. If you are working online we would suggest you contact your insurer to insure that you are covered to work online and if you’re working outside the UK to check that the country where your client is (or where you are) is covered by your insurer.  Get confirmation of this in wiritng.

I have clients in The States, my supervisor has told me this is not OK. Is she right? Generally how does it work if your client is in a different country?

This subject is known as jurisdiction. As the question covers the USA specifically I will start with the USA where there are specific issues. There are two issues to think about when working in the States online. HIPAA and State Licenses. There is an American online therapist, Roy Huggins, who runs a really interesting company and website ….. you’ll find plenty of resources there and Roy is a great person to consult. In brief, HIPAA (Health Insurance Portability and Accountability Act of 1996) is a United States legislation that provides data privacy and security provisions for safeguarding medical information. If you are going to work in the States you’ll need to sign up for this and comply with it. The second constraint is that most States require you to have a State license. This is for face to face work and online work. So to comply with US State laws you’ll need to be licensed in each State that you work in. You’ll understand from this that it is for this reason that most insurers do not include working in the States within their Professional Indemnity Insurance cover.

To summarise it’s therefore HIGLY UNLIKELY that you’ll be able to work in the States unless you have the correct licenses and comply with HIPAA. If you want a second opinion on this Roy Higgins is your man!

I have used the USA as the example, but each country has its own laws, and you should not assume that because we are in (just) Europe that all EU countries Have the same rules and laws, they don’t. It can be very difficult to get the information you need, for example if you have a child protection issue with an online client in Italy, how might you proceed. You still need to think about safeguarding and compliance wherever the client is and it’s not always easy.