Psych Claims for Workers' Compensation: What to Expect from Your QME Evaluation in California

If you’ve been scheduled for a Qualified Medical Evaluation (QME) in psychology as part of a workers’ comp claim in California, you may want to know what to expect from that process. As a psychologist conducting QME evals for psych claims with workers’ compensation I have found that applicants (injured workers) often have no preparation for the psychological evaluation, and sometimes don’t know what type of evaluation they’re coming in for. This can happen when folks have many types of injuries and have a lot of medical appointments, or when they expect a psych evaluation to be similar to other medical appointments. Here is a primer about what to expect.

WHEN YOU ARE REFERRED FOR A QME Psychological EVALUATION

Most of the time, injured workers are referred for a QME evaluation in psychology because their claim for a “psychological injury” (a mental health problem caused by something that happened at work) has been denied. The workers’ comp system in California sometimes requires testing to “prove” an occupational injury has occurred and also to understand how much of the injury was caused by work. When it comes to workers’ compensation claims for stress, depression, anxiety, PTSD, or other mental health concerns, it is not always clear that the cause was work, or how individual mental health history may play into the situation. That’s where a psychologist with testing expertise comes in.

REALISTIC EXPECTATIONS ABOUT THE TIMELINE for psych claims with workers’ compensation

If you’re reading this, you likely already know that the workers’ compensation system can move slowly. Unfortunately, it can take a long time to be seen for a QME evaluation. Expect:

  • At least two months from the time your QME evaluator is selected to when you are evaluated

  • After testing, the QME doctor has one month to write a report

  • If you’re referred for treatment, you may wait if:

    • the provider you’re referred to has a waitlist

    • the adjuster can’t find an appropriate provider with an immediate opening.

I recommend trying to be as patient as possible. Use your best coping skills and self-care! It can be frustrating, and no individual person involved has control over the overall timeline, including you.

QME Psychological EVALuations: THE DAY OF

For a QME evaluation for psych claims with workers’ compensation, as with any psychological or neuropsychological testing, you should expect a lengthy appointment. Depending on the question at hand and the approach your QME takes, testing and interview may last anywhere from three hours to eight hours.

tips for being prepared

You should usually expect an interview about what happened and your personal history, as well as some type of testing, either with pencil and paper, or on a computer or tablet. Here are some ways to prepare:

  • Sleep well the night before

  • Eat a good breakfast

  • Wear glasses, hearing aids, and any other assistive devices you use

  • Bring water

  • Bring snacks

  • Bring a list of your medications if you can’t remember them

  • Take your normal morning meds, unless you take anything that will make you very drowsy and can go without it (like an as-needed pain medication)

  • Be honest during the interview-the best way to advocate for yourself is to tell the truth

  • Give your genuine best effort on testing

  • Try to relax

The Best strategy for testing for Psych Claims

Testing days can be tiring, but the purpose is for the QME doctor to form an opinion based on all of the evidence, so it’s in your best interest to support that process as best you can. Some people think they should play up their symptoms or do very poorly on testing to show how distressed they are, but this tends to backfire because tests are designed to pick up on those types of behaviors.

Truly, the best test day strategy is to show up as well-rested and calm as possible, be honest with your evaluator, and give your best effort on the tests, so that the QME doctor gets a true sense of what’s going on for you and can make confident recommendations.

AFTER TESTING for psych claims with workers compensation

Once you have finished testing, you will wait for the QME doctor to write and send their report. You may never see that report, but it will go to the claims adjuster, both attorneys (if you have one), and the workers’ compensation judge. The QME doctor provides their medical opinion about any diagnosis and the cause. The judge will use the report (among other reports and information presented about the case) to decide your claim, and any award, medical care, or work restrictions are ultimately up to them.

get a QMe evaluation for your psych claims for workers compensation in Los Angeles, ca

Do you have psych claims for workers’ compensation and need an evaluation? Dr. Reger provides QME psychological evaluations at several locations in Southern California. To schedule your appointment with a Los Angeles Qualified Medical Examiner follow these steps:

  1. Contact (424) 262-1925 to schedule your appointment

  2. Meet with a Psychologist for your QME psychological evaluation

  3. Get answers that you need to continue with your work comp claim

OTHER MENTAL HEALTH SERVICES IN LOS ANGLES, CA

There are a variety of neuropsychological and psychological assessments that you can receive from Dr. Reger. Some of which inculde cognitive and dementia testing, pre-surgical assessments, and med-legal evalutaions.Besides evaluations she also provides individual therapy, counseling for older adults, and provides mental health consultations and presentations.