Rehabilitation counseling was a growing field throughout the 1900s, following societal milestones such as the Soldier’s Rehabilitation Act of 1918, the Smith-Fess Act of 1920, the 1954 Amendments to the Vocational Rehabilitation Act, and the Rehabilitation Act of 1973. These acts highlighted the value of rehabilitation counseling as a profession. While rehabilitation counseling emerged from adjacent fields including psychology, social work, mental health, physical, and occupational therapies (Bomberger & Choppa, 2025), it grew into its own profession, primarily focused on assisting those experiencing varying levels of disability. In 1974, the Certified Rehabilitation Counselor Certification was developed by the Commission on Rehabilitation Counselor Certification (CRCC). This was the first certification to emerge related to rehabilitation counseling. Since that time, the profession has expanded to include related certification programs and numerous specializations.

It has come to our attention that although there exists a large population of rehabilitation counselors, many are not aware of the expansive list of practice areas available to them. As of 2024, there are 91,900 rehabilitation counselors in the United States (Bureau of Labor Statistics, 2026). This figure does not include individuals from other disciplines (e.g., nurses, occupational therapists, physical therapists.) who also perform some rehabilitation counseling tasks such as case management and/or life care planning, both of which are discussed more in detail below. The largest employers of rehabilitation counselors are vocational rehabilitation services, state and local government, individual and family services, and nursing/residential care facilities. Vocational rehabilitation services are the largest of these at 32%, a category that includes counselors working within the workers’ compensation system (Bureau of Labor Statistics, 2026).

Although workers’ compensation programs vary by state, most, if not all states have at least some level of rehabilitation counseling involvement. For example, in the state of Washington, Vocational Rehabilitation Counselors play a key role in assisting injured workers in returning to work under the Department of Labor & Industries.

The purpose of this article is to educate rehabilitation counselors on ways they can expand their practice beyond workers’ compensation and other common settings in this profession. As rehabilitation counselors, we are trained in the medical and psychosocial aspects of disability and vocational counseling. Under this training, we perform labor market research, job analyses, testing, coordination of care, assessing home care needs, etc. Rehabilitation counseling now functions as an umbrella profession, encompassing not only vocational counseling under the workers’ compensation and similar settings, but also in social security disability hearings, life care planning, case management, civil litigation, marital dissolution, and medical bill review. The skills described above are transferable across each of these practice areas.

Expanding to these areas is a way to diversify the work of a rehabilitation counselor and diversify practice settings. These settings may include state and federal court civil litigation (including person injury, medical malpractice, and general liability), social security disability hearings, employment law, marital dissolutions, etc., which often require testifying in hearings, in depositions, at arbitrations, and/or at trial. As we discuss these practice settings, keep in mind that in litigation roles, the expert witness may be retained by either the plaintiff or the defense, and the methodology and standards of practice do not change. The expert witness remains an objective rehabilitation counselor and case manager addressing coordination of care and vocational issues.

The expert witness does not get to come back five, 10, or 20 years later and re-assess an evaluee’s life care plan, wage earning capacity, private case management, etc. Thus, it is critical that a valid and reliable assessment is conducted. In their analysis of records, interview(s), and consultation(s), the expert witness synthesizes clinical judgment and case management in their recommendations.

To follow is an overview of each practice setting.

Vocational Assessments of Earning Capacity in a Forensic Setting

Forensic vocational expert practice is a specialized area of rehabilitation counseling in which the vocational expert (VE) conducts a vocational assessment that integrates medical information, labor market analysis, and legal standards to determine an evaluee’s employability and earning capacity. As in workers’ compensation practice, the VE translates the medical limitations and impairments defined by the appropriate medical providers or experts into vocational implications, a process that requires a systematic methodology incorporating functional capacity information, occupational classification data, and local labor market conditions. What qualifies a rehabilitation professional in their day-to-day clinical work is what qualifies them as an expert and ultimately establishes their admissibility as an expert in the court (T. Field & Choppa, 2005). The main factors relied upon to establish subject matter expertise are knowledge, skills, experience, training, and education (Cary et al., 2023).

A forensic case will typically originate from a law office or from a private individual (heretofore referred to as referral sources). The referral source contacts the VE to discuss the nature of the assignment, with varying levels of information. Before accepting a case, the VE must complete a conflict-of-interest check to confirm whether another VE at their firm has been retained by opposing counsel and whether the firm or the VE has previously performed work involving the evaluee.

Once conflicts are cleared, the VE will request records. These records may include medical records related to the disability and/or injuries sustained, education records, employment records, earning records, the complaint, and any interrogatories or depositions available. Once the records have been reviewed, an interview of the evaluee will take place when possible. In some cases, such as when working at the request of the defense, the VE may not have access to the evaluee to complete an interview. Other situations in which there may be no access to the evaluee include the death of the evaluee or certain pediatric cases. If necessary, the VE may consult with a medical provider as well before proceeding with forming their expert opinion.

The VE must use a peer-reviewed, generally accepted methodology to conduct a thorough forensic evaluation that synthesizes clinical judgment and follows standards of practice (Johnson et al., 2025). Clinical judgment is defined as “the extension of the credentialing factors of the expert, [which] encompasses all relevant factors germane to the weight of the case while discarding those factors which are not relevant, and which are allowed by the court” (A. J. Choppa et al., 2004, p. 135). In simpler terms, clinical judgment is the expert drawing on their training, credentials (education), and experience to decide which facts matter, set aside those that do not, and present conclusions in a form the court will accept.

Furthermore, a peer-reviewed generally accepted methodology will assist the VE in avoiding exclusion or limitation as an expert witness. The RAPEL methodology is one peer-reviewed generally accepted methodology. RAPEL comprehensively analyzes the evaluee’s Rehabilitation Plan, Access to the Labor Market, Placeability, Earnings Capacity and Labor Force Participation (R. O. Weed, 2004). It is a framework that comprehensively includes the clinical judgement and best practices of the VE performing a forensic assessment. There are other peer-reviewed methodologies available for VEs; however, RAPEL is the one the authors have found to be the most functional and comprehensive for our purposes. There is also an adapted form of RAPEL, known as PEEDS-RAPEL, that enables the VE to evaluate pediatric cases (Neulicht & Berens, 2005). Sprong et al. (2023) found that, when examining vocational rehabilitation models, the RAPEL and PEEDS-RAPEL models were “reported as being most frequently used during the entirety of the participants’ career, regardless of forensic setting” (p.13).

RAPEL as one of the most comprehensive methods (models), as it considers resources and strategies from a variety of sources (T. F. Field, 2008). In conceptualizing RAPEL, Weed and Field (2001) described the model as a:

Comprehensive approach which includes all elements needed to determine loss of access, loss of earnings capacity, future medical care, work life expectancy, rehabilitation plan, placeability, and employability factors (p.246).

The Rehabilitation Plan portion of RAPEL considers the evaluee’s functional limitations, strengths, emotional functioning, and cognitive capabilities. From these, the VE develops a plan for establishing or increasing employment potential through training or accommodation or identifies future life care needs when developing a life care plan (R. O. Weed, 2004). This is the part of the methodology that addresses future medical/psychological treatment and rehabilitation needs, including whether vocational retraining or accommodations will be necessary to maintain or transition the evaluee’s career. The VE does not determine medical or psychological treatment needs; those recommendations are obtained from the appropriate medical professionals and incorporated into the plan.

Access to the Labor Market refers to the vocational choices and opportunities available to the evaluee before and after injury, assessed through evaluation of transferable skills, labor market data, and the application of clinical judgment regarding the effects functional limitations have on their access to the labor market (R. O. Weed, 2004). It is used to establish whether the evaluee lost job opportunities, or access to certain job opportunities, that they had prior to the injury or disability.

For example, consider a hypothetical carpenter who sustained a traumatic injury to their knee and shoulder and is now limited to work in the light physical demand category. As a result, they have lost access to all jobs in the construction field that fall into the medium, heavy, and very heavy physical demand categories. In this hypothetical situation, there is a significant loss of access to the construction jobs the carpenter was able to compete for prior to the injury.

The Placeability in the RAPEL methodology analyzes the probable likelihood of an evaluee’s successful placement into an actual job. It includes considerations of labor market demands, job availability, and factors such as cultural considerations, attitude, and the evaluee’s personality (R. O. Weed, 2004). This is where the VE assesses the evaluee’s ability to compete for available positions, and gives consideration to the quality of work, quantity of work, and interpersonal relationships. Deficits in any of these areas may reduce the evaluee’s competitiveness and the likelihood of successful placement.

Earnings capacity is assessed in RAPEL by evaluating the compensation paid for positions the evaluee can reasonably attain and hold, and by estimating earnings potential based on the individual’s unique worker traits (R. O. Weed, 2004). Vocational rehabilitation must recognize the individualized nature of disability and recovery. Each client represents an “N of 1,” meaning that standardized methods must be supplemented by clinical judgment to determine how injury affects a particular individual’s vocational capacity (A. Choppa & Johnson, 2008).

For example, consider an experienced attorney earning a high income at the time they were involved in an accident and sustained a traumatic brain injury. The injury is permanent, with sequelae that includes impaired cognitive capacity. After consulting with a neuropsychologist regarding permanent cognitive impairments, it is clear that they are no longer the same worker and are unable to perform at pre-injury levels. This evaluee has sustained a permanent loss of future earning capacity, as they are no longer capable of returning to work in their high-paying position as an attorney. In this situation, the VE may be asked to calculate lost wages between the time of injury and the present, and potentially to the projected end of the evaluee’s work life.

Labor Force Participation in RAPEL examines the extent to which functional impairment reduces the evaluee’s expected involvement in the workforce. This may include longer periods of unemployment between jobs, a reduction from full-time to part-time work, work time lost to medical treatment and follow-up, and a shortened work life resulting in earlier retirement (R. O. Weed, 2004). For example, a treating or evaluating provider may find that the evaluee’s injury or disability has reduced their work-life expectancy, or the evaluee may have lost time in the labor force during a lengthy period of treatment and recovery.

In order to form an opinion as to the evaluee’s post-injury ability to work and earn money, the VE considers all aspects of RAPEL in conjunction. Returning to the example of the attorney who sustained a TBI, we would ask questions such as: Are they limited to part-time work? Can they work at all? What are their residual functional capacities for work? What transferable skills do they possess? The answers lead the VE to form and provide an opinion as to the attorney’s ability to work and how their earning capacity has been impacted. Essentially, the VE is assisting the referral source in assessing and establishing damages that can be used as the matter moves forward in litigation.

A defensible vocational assessment must clearly describe the methodology used to reach its conclusions. This includes identifying data sources, explaining analytical steps, and demonstrating the logical relationship between the medical restrictions and the vocational outcomes. Labor market data, occupational classifications, and wage projections should be derived from reliable sources such as government occupational databases, regional labor statistics, and/or validated labor market surveys.

Perhaps the most significant difference in the day-to-day work a VE will notice when transferring into forensic practice is the higher frequency of being deposed and having their sworn testimony taken. VEs familiar with state vocational rehabilitation work may be called for testimony, but this occurs rarely. In forensic work, the VE may be called for depositions or trial testimony several times per month and may need to travel to provide testimony in person.

The VE needs to be comfortable defending their opinion as an expert witness. The VE may need to qualify their expertise by explaining how they coordinate care in the clinical rehabilitation setting. For example, is the VE reviewing case files as a regular job task? Is the VE doing day-to-day clinical work of labor market surveys, on-site job analyses, ongoing vocational rehabilitation counseling with an individual; consulting with physicians, employers, and evaluees regarding job accommodations?

If the reader has hesitation about this portion of forensic work, there is a webinar in the IARP library entitled “Expert vs. Expert Witness: What’s the Difference” that can further expose the reader to this topic in greater detail (Giles, 2016).

The authors feel that overall, there are more similarities than differences in the VE transitioning from state clinical workers’ compensation vocational rehabilitation into the forensic setting. Forensic vocational assessments have similarities with ability to work assessments performed under many workers’ compensation systems. Transferable skills are evaluated from work history and education, the need for further services is identified, the nature and extent of the evaluee’s functional impairments are coordinated with an appropriate medical professional, etc. In a forensic vocational assessment, there is a more critical analysis of past lost wages, and future wage-earning capacity.

Rehabilitation counselors who have done clinical rehabilitation for a significant number of years will have the foundational skills to make this transition outside of state workers’ compensation or other systems. However, further training, experience, and mentoring are needed to hone those foundational skills for forensic work.

Forensic Vocational Rehabilitation Rebuttal

A VE may also be retained to complete a forensic review or rebuttal of an opposing vocational expert’s or vocational counselor’s work product, which involves reviewing the report and opinions of another vocational counselor or VE retained in the same matter.

The defensibility of a vocational opinion therefore depends on the evaluator’s adherence to established methodology, professional standards, and evidence-based decision-making within the setting they are working in.

The accuracy and credibility of a vocational opinion are grounded in three foundational pillars:

  1. Methodological rigor

  2. Clinical and professional expertise

  3. Accurate application of researched labor market and medical data

A defensible vocational evaluation must clearly describe the methodology used to reach conclusions. This includes identifying data sources, explaining analytical steps, and demonstrating the logical relationship between medical restrictions and vocational outcomes.

Labor market data, occupational classifications, and wage projections should be derived from reliable sources such as government occupational databases, regional labor statistics, or validated labor market surveys.

Accurate documentation of the worker’s background is a foundational component of vocational evaluation. A comprehensive vocational profile should include detailed information regarding the Workers’ age, educational history, employment experience, and skill development.

Essential documentation may include:

  • Age, educational attainment, and vocational certifications

  • Prior employment history and occupational classifications

  • Earnings history (if applicable)

  • Demonstrated vocational aptitudes and skills

  • Transferable skills derived from prior work experience

The assessment should also consider the personal and contextual barriers that may influence the evaluee’s ability to return to employment, such as:

  • Literacy limitations

  • Limited English proficiency

  • Immigration or work authorization considerations

  • Cognitive impairments

  • Psychological conditions

  • Functional limitations, such as those related to chronic pain

Failure to assess factors may result in unrealistic employability assumptions. For this reason, the VE integrates medical information, psychosocial considerations, and labor market realities when evaluating return-to-work potential. This is where the ‘N of 1’ of the evaluee is an essential component (A. Choppa & Johnson, 2008).

A forensic review may culminate in a formal written report that identifies specific errors, omissions, or inconsistencies, and addresses whether the assessment adheres to established professional and, where applicable, regulatory standards. The report may also offer recommendations, such as obtaining medical clarification, conducting an updated labor market survey, or considering alternative retraining pathways. Forensic rebuttals may take place therein the VE reviews the opinions of the practicing vocational rehabilitation counselor and provides an opinion. These may also take place in forensic settings, when there is an opposing VE and you are asked to review their opinions.

Social Security Disability Hearings

An option for a rehabilitation counselor to diversify their practice may be working as a VE for Social Security disability hearings. As such, VE’s are asked to provide an impartial expert opinion about a claimant’s vocational abilities. This assists the administrative law judge (ALJ) in determining that claimant’s disability status.

Rather than a trial with a jury present, VE testimony is taken within an administrative hearing. Social Security disability cases are received in dockets after a qualified VE communicates their availability to a local hearing office. Prior to hearing, the VE will review the exhibits within the file, focusing on documents that include information about the claimant’s diagnoses, age, educational attainment, and past employment. The VE will then review the work history information to determine which jobs they may be asked to categorize within the Dictionary of Occupational Titles (DOT). The VE will be asked by the ALJ to classify the claimant’s past work using the DOT’s job title and code, specific vocational preparation (SVP) level, and physical demand level. The VE may also have to classify the physical demand level as the claimant actually performed it as well.

Present at a hearing is the claimant, often their representative, the ALJ, the VE and occasionally a medical expert (ME). During the hearing, the claimant can provide testimony about their disabling condition(s) (physical, cognitive, and/or mental) and how it impacts their function and ability to work. The ALJ will also solicit testimony about their medical conditions, treatment and past employment activities.

During the hearing, the ALJ will identify the past relevant work (PRW) the claimant performed in the past five years. For an ALJ to determine PRW, the claimant must have performed the job long enough and earned wages to the level considered Substantial Gainful Activity (SGA) - equaling or exceeding $2,700 per month for non-blind individuals or $1,620 per month for blind individuals (Social Security Administration, n.d.). If the claimant did not perform the job long enough to have earned SGA or only performed it at a part-time level, then it is not considered past relevant work.

The ALJ will then provide the VE with a series of hypothetical questions that are similar to the claimant’s residual functional capacity. This will include information about the hypothetical individual’s physical limitations, skill level, mental limitations, environmental factors, and can include considerations such as contact with other people (e.g., co-workers, supervisors, or the general public). The VE then responds to the ALJ’s hypothetical questions by addressing whether the hypothetical individual can still perform the past work, whether that individual has any transferable skills (a question typically raised when the individual is of advanced age), and whether there are other jobs in the national economy the individual could perform within the stated residual functional capacity. When such jobs are identified, the VE is also asked to testify as to how many of those jobs exist in the national economy. How the VE answers the hypothetical and subsequent questions help the ALJ make a determination about the claimant’s disability status.

As the typical hearing description above illustrates, this work differs greatly from other forms of vocational assessment and testimony. Because no written assessment has been requested or prepared, there is no report for a VE to defend or explain. The VE’s exposure to the claimant is limited to reviewing the submitted documentation and listening to their testimony. The VE’s opinion rests in their expertise: knowledge of jobs and how they are performed, knowledge of the labor market, and ability to analyze occupations in vocational terms.

The Social Security Administration has very specific criteria that must be met in order to apply to become a VE. This includes a master’s degree in Rehabilitation Counseling, Psychology, Education, Human Services, or another behavioral science degree. The candidate must also have at least 5 years of experience working in vocational rehabilitation with individuals with disabilities and hold a Certified Rehabilitation Counselor (CRC) credential or the American Board of Vocational Experts (ABVE) credential. In addition, the VE must also maintain ongoing employment providing vocational counseling, vocational assessments, and job placement for individuals with disabilities during their service as a Social Security Vocational Expert (SSVE).

The Social Security Administration’s Vocational Expert Handbook is available online and provides more information about being a VE, its definitions of disability, determinations of disability, and much more (Social Security Administration, 2024).

To become a VE with the Social Security Administration, one will generally need to work under an existing Blanket Purchase Agreement (BPA) contract, as the application process for a new BPA opens every five years. These BPA contracts are held by firms and individual contractors who provide VE services to Social Security. Many of these contract holders are willing to add new VEs to their BPA and often provide support and mentorship as well.

The International Association of Rehabilitation Professionals (IARP) also offers a mentoring program for Social Security Vocational Experts (SSVEs). Additional information is available on the IARP website, where board members for each IARP section can be contacted directly regarding mentoring (International Association of Rehabilitation Professionals, n.d.).

IARP also has an SSVE list serve which allows and encourages contact between other VEs who are members of IARP. It provides opportunities to discuss issues relevant to SSVEs, and members can ask questions about classifying jobs, responding to complex hypothetical questions, and determining job numbers.

Work as an SSVE is not going to equate to a full-time, 40-hour-a-week position, but is typically performed as a supplemental role in addition to regular ongoing employment as a vocational rehabilitation counselor.

Marital Dissolution

During a marriage, one spouse may leave the workforce in order to care for the couple’s children. In the event of a divorce, a vocational expert (VE) may be retained to conduct a vocational assessment that estimates that spouse’s earning capacity in light of their break in employment.

Some questions that a vocational expert can answer include: Does the individual continue to have relevant skills? Are those skills competitive after a period of unemployment? And if so, to what capacity?

Answers to these questions can help determine the individual’s ability to be financially self-sufficient or whether they should be awarded spousal support. Either party can hire a vocational expert to complete such an assessment for either spouse.

The vocational assessment process is similar to those conducted in other settings. When possible, the assessment process begins with an interview of the spouse or evaluee. During this interview, discussions will take place about their age, educational attainment, employment background, volunteer experience, hobbies, interests, impacts of childcare, and any physical and/or mental limitations to work they may have. If an interview is not possible, such as when the VE is retained by one spouse to assess the other, and the evaluee is noncompliant with the assessment process, the VE relies on information about the evaluee obtained from the retaining spouse and their legal counsel.

Vocational testing may also be completed in order to further assess the spouse’s academic skills, aptitudes, and interests. These findings can help identify new areas for retraining or skills enhancement to assist the individual in returning to the workforce and improve their earnings capacity. Again, this may not be possible, depending on your access to the evaluee.

Next, the VE researches viable occupational options, regional wage data, employment outlook, and any training or education necessary for the evaluee to pursue them. All of this information is then presented in a written report, along with the VE’s opinion regarding the evaluee’s current earning capacity versus their potential earning capacity following a period of training (if deemed necessary).

Sometimes, opposing counsel may also hire a vocational expert to complete a vocational assessment for the spouse they represent, or the same evaluee. When this occurs, a review of the opposing VE’s report is completed. This might include noting points of agreement and/or disagreement with a rebuttal and independent opinion.

The VE will frequently be called to testify regarding the findings and recommendations contained in their vocational assessment. If there is an opposing expert, testimony may address any differences in the expert opinions and recommendations.

Keep in mind that the details matter. For example, a spouse was previously employed as an Employment Recruiter or Human Resources Assistant. In that role, they earned $38,000 annually. However, they were already in college, working towards finishing a bachelor’s degree. Upon completing the degree, they would have an earning capacity of $54,000 as a Human Resources Specialist. In this circumstance, the opposing counsel hired their own vocational expert. In reviewing their assessment report, they had used general state wage data rather than city or region specific, thereby underestimating earnings capacity at $45,000 annually. The details matter and their choices matter.

Marital dissolution assessments differ from other vocational assessments in that, depending on the state, a spouse’s vocational preferences may be considered. For instance, Washington’s jurisdictional requirements permit the judge to consider what the evaluee wishes to do, not just what they are qualified to do, which may give a spouse with an employment gap some choice in their retraining goal. The VE should confirm jurisdictional requirements with the referral source in every case.

Occasionally in marriage dissolution cases, special considerations are given to a spouse or child with a disability. In these cases, a life care plan may be completed, in addition to a vocational assessment, to determine the cost of future medical/rehabilitative care the spouse or child will need over their remaining lifetime.

Case Management

Case management is delivered through a structured, evidence-based methodology that integrates professional clinical judgment and compliance with applicable regulatory standards. This process may include a comprehensive review of relevant records, such as medical documentation, employment history, educational background, and prior vocational assessments. This review establishes the foundation for interpreting the vocational implications of the functional capacities identified by the treating and evaluating providers, identifying transferable skills, and determining realistic return-to-work options; though depending on the case management setting, this is not always required.

Case management may take place in a forensic setting, in which the plaintiff receives assistance with care coordination while simultaneously engaged in the litigation process. This would be considered acute case management. In this role, the case manager typically coordinates medical care, helps mitigate barriers to recovery, facilitates the acquisition of durable medical equipment (DME), and addresses other needs that arise to support the individual’s rehabilitation.

Typically, these referrals come from legal counsel. However, if these referrals come directly from the individual or their family, they would not be considered forensic. At times, the case manager may also be asked to complete a vocational assessment and/or a life care plan which is a case management tool discussed in greater detail below. The dual role is acceptable; however, it should be clearly communicated to the evaluee.

A case manager may assist an individual who has not dealt with litigation or after litigation resolves. This work involves helping an individual with an injury or disability meet their goals for employment and/or independent living. It may include implementing a life care plan or addressing needs outside of one, such as coordinating caregiving services, obtaining durable medical equipment (DME), arranging appointments and transportation, and navigating access to various insurance and benefit programs

Case management services are available to any individual with an injury or disability, regardless of whether litigation has occurred or a life care plan exists.

Case management may also involve helping an individual evaluate their employability and job prospects. This may include developing, implementing, and monitoring individualized vocational rehabilitation plans designed to support both medical stability and vocational feasibility. Interventions are guided by the worker’s documented physical capacities, treating physician recommendations, labor market conditions, and the worker’s skills, interests, and aptitudes. In case management, progress is continually assessed, and service strategies are adjusted as new clinical, vocational, or labor market information becomes available. This is the setting in which case managers are performing work very similar to that of a vocational rehabilitation counselor working under workers’ compensation.

Life Care Planning

Life care planning is an area in which rehabilitation counselors can expand and diversify their practice. What is life care planning? Life care planning is a transdisciplinary specialty practice (International Academy of Life Care Planners, 2022) and a tool of case management. According to the 4th edition Standards of Practice for Life Care Planners, a life care plan is:

A dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research, which provides an organized, concise plan for current and future needs with associated costs for individuals who have experienced catastrophic injury or have chronic health care needs. (International Academy of Life Care Planners, 2022, p. 7)

Life care planning has evolved over several decades and is now used in a variety of venues by different entities. These include but are not limited to health & rehabilitation organizations, case managers, wounded warrior support, elder care, third party payors, financial and trust managers, governmental bodies, and in administrative proceedings such as workers compensation, and civil litigation matters at state and federal court (International Academy of Life Care Planners, 2022). Although life care planning is used in a variety of venues and by various entities, the venue used most often is the forensic venue (i.e. civil litigation to include person injury, general liability, & medical malpractice) (Albee et al., 2017).

Each life care plan is unique and individualized to the evaluee, specific to that person’s medical, psychological, case management and rehabilitation needs; this is not a “cookie cutter” practice. The life care plan is intended to act as a roadmap to future care for the evaluee, to be implemented by the family, case manager, or the evaluee themselves over their remaining life expectancy (Robinson, 2024). In a litigation setting, a life care plan plays a similar role to a vocational assessment of earning capacity; it helps the referral source establish damages (i.e. the cost of future treatment/services/equipment).

A life care plan has four foundations: medical, psychological, case management, and rehabilitation resources (International Association of Rehabilitation Professionals, Life Care Planning Section, n.d.). Examples of items under the medical foundation include office visits with providers of various practice areas (i.e., orthopedics, physical medicine & rehabilitation, neurology, etc.), therapeutic modalities (i.e., physical therapy, occupational therapy, massage, etc.), medications, diagnostics (i.e., x-rays, MRIs, etc.), surgeries/procedures, injections, as well as many others. Examples of psychological foundational items include, but are not limited to, individual counseling, family and/or couples counseling, psychology, psychiatry, and neuropsychological evaluations.

Case management and rehabilitation resources, the third and fourth foundations, are rooted in the practice of translating impairment (as defined by the medical community) to independent living in the least restrictive environment with respect for independence and human dignity. Examples of items under these foundations include vocational services and related needs (i.e., vocational counseling, assistive technology, ergonomic equipment, etc.), home care needs (i.e., caregiving services, orthopedic equipment, ambulation aids, housekeeping, home modifications, etc.), supply needs (i.e., supplies for bladder/bowel programs, wound care, etc.), and case management.

The Life Care Planning Standards of Practice and the Consensus and Majority Statements were developed by life care planners, for life care planners, and serve as a guide for ethical, methodological, and professional standards as a life care planner (Williams et al., 2025). The recommendations for items in a life care plan under each foundation are derived from records, consultation(s), literature and clinical research (International Association of Rehabilitation Professionals, Life Care Planning Section, n.d.). In sum, the life care planning methodology includes reviewing records, interviewing the evaluee (although this may not occur in defense cases, pediatric cases, etc.) and family members when possible, consulting with medical provider(s) and/or medical experts, and researching the cost of items. The methodology also includes returning the draft life care plan to the consulting medical provider(s) and/or medical experts for review to confirm that each identified need/item, along with its frequency and duration through life expectancy, is accurate for that evaluee.

Life care planning is a collaborative process with each consulting professional contributing within their own scope of practice. The life care planner may not determine medical or psychological treatment; those recommendations come from the appropriate providers and are then incorporated into the plan. However, a life care planner with a rehabilitation counseling background is qualified to address needs within the case management and rehabilitation resources foundations (i.e., vocational services, assistive technology, household services, and transportation) by translating the functional limitations/impairment identified and defined by the medical community (i.e. treating and evaluating providers) to the supports necessary to maximize the evaluee’s independence and meet their goals, such as vocationally.

Life care planning and rehabilitation counseling under workers’ compensation share many similarities. In both settings, the medical and/or psychological providers define the nature and extent of the impairment(s) and identify current and future treatment needs, while the rehabilitation counselor translates those findings to the world of work and independent living, to include home care supports required for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). Additionally, developing a life care plan is similar to developing a retraining plan under a workers’ compensation claim. Both plans outline the timeline, frequency of needs, and identify associated costs. Both a life care plan and a retraining plan under a workers’ compensation claim serve as a roadmap to help the individual meet their goals, whether that goal is obtaining the skills for a certain occupation or securing the medical and/or home care needed for independent living.

One major difference between the two practices is that life care planners are regularly called to testify at depositions, arbitrations, and trials to defend their work product. This is less likely to occur in workers’ compensation; however, a rehabilitation counselor may be called to testify at times.

Rehabilitation counselors are one of the many disciplines to practice life care planning. Other backgrounds of those who practice life care planning include nurses’/nurse practitioners, physical therapists, occupational therapists, case managers, psychologists, and physicians, to name a few. There are 12 certifications commonly held by life care planners: American Board of Vocational Experts (ABVE), Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Certified Life Care Planner (CLCP), Certified Nurse Life Care Planner (CNLCP), Certified Rehabilitation Counselor (CRC), Certified Vocational Evaluator (CVE), Canadian Certified Life Care Planner (CCLCP®), Certified Health Professional Life Care Planner (CHLCP), Certified Physician Life Care Planner (CPLCP™), International Certified Cost of Care Professional (ICCCP), and Life Care Planner- Certified (LCP-C) (Bomberger & Choppa, 2025).

Several training programs are available for those interested in pursuing life care planning. These include AAACEU Certified Life Care Planner (CLCP) Training Program, FIG Education Certification Class in Life Care Planning, Kelynco Nurse Life Care Planning Course, Institute of Rehabilitation and Education Training (IRET) Life Care Planning Pre- Certification Program, Southwest Florida Training Institute Life Care Planning Bootcamp, Thomas Jefferson University Life Care Planning Graduate Certificate, and IARP Mentoring (Williams et al., 2025).

Medical Bill Review

For those who practice life care planning, particularly in a litigated setting, costing the medical needs is a major component of the process. This involves reviewing medical bills, receiving input from and communicating with billing departments of local providers, reviewing publications, and utilizing databases when appropriate (Stajduhar et al., 2019). As per life care planning standards of practice, the cost for items in a life care plan reflects a base charge and does not take into consideration self-pay discounts, insurance rates, Medicare/Medicaid, workers’ compensation, etc.

Performing the task of costing, routinely gives life care planners specialized knowledge of the usual, reasonable, and customary charges for the medical care, therapeutic modalities, diagnostics, home services and modifications, mobility aids, equipment, transportation, supplies, and medications included in a life care plan (Stajduhar et al., 2019).

Because life care planning is both a specialty practice and a tool of case management, life care planners acquire the specialized knowledge necessary to opine on the reasonableness of charges reflected on past medical bills. This work is typically performed in civil litigation, and depending on the jurisdiction, discounted or insurance rates may be excluded from the analysis. The opinion addresses reasonableness of charges only. Determinations regarding the nature and extent of impairment, and the medical necessity of the treatment reflected on the bills, remain with the medical community.

The collateral source rule prohibits the admission of evidence that a plaintiff has received compensation from sources other than the defendant, such as insurance or workers’ compensation benefits (T. F. Field et al., 2015).

Although the collateral source rule’s application varies across jurisdictions, it parallels the life care planning consensus and majority statements, particularly item (c) below:

Statement 85: Best practices for identifying costs in life care plans include:

a. Verifiable data from appropriately referenced sources.

b. Costs identified are geographically specific when appropriate and available.

c. Non-discounted/market rate prices.

d. More than one cost estimate, when appropriate. (Johnson et al., 2025).

In essence, a forensic medical bill review is a life care plan in reverse. Instead of researching what an item on a life care plan should cost, a charge on a medical bill is evaluated to determine if it was usual, customary, and reasonable for that geographic area and time period. The life care planner draws on prior life care plans containing charges for the relevant geographic area and time period and may contact local providers directly to confirm whether the charges reflected on the bills fall within the usual, reasonable, and customary range for that area.

As noted above, this parallels the work of a rehabilitation counselor under workers’ compensation, who becomes familiar with the costs of a retraining plan through routine practice. The life care planner develops the same familiarity with medical costs and applies it to the review of past medical bills.

Closing Thoughts

Rehabilitation counselors have access to a wide range of practice areas and settings beyond workers’ compensation. Some of these areas require additional education, certification, and experience, but the opportunities to diversify are substantial. Rehabilitation counseling remains an umbrella profession, encompassing life care planning, forensic vocational assessments of earning capacity, forensic vocational rehabilitation rebuttal, Social Security disability hearings, case management, marital dissolution assessments, and medical bill review.