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.

What is A Neuropsychological Assessment?

Perhaps your older parent has noticed trouble with short-term memory lately. Perhaps your child has been having a hard time learning a subject at school. Maybe you are struggling to stay organized in the midst of your busy life, and seem to have more problems with this than the people around you. Perhaps a neighbor suffered a stroke or head injury. Or maybe someone you know is having unexplained and scary neurological symptoms, like numbness, weakness, forgetfulness, or headaches. In any of these situations, a neuropsychological assessment, sometimes shortened to “neuropsych testing” may be recommended. Here are some basics if you want to know more about neuropsychological testing and aren’t sure where to start.

What is A Neuropsychological Assessment For?

A neuropsych eval is a structured set of tests designed to understand a person’s brain function in order to answer a specific question. These are often questions about diagnosis, like whether a person has:

• Dementia

• Attention-deficit hyperactivity disorder (ADHD)

• A learning disorder

• A mental health diagnosis like depression or anxiety

A neuropsychological assessment can also help medical providers and teams understand the extent of problems caused by health conditions, for example:

• Stroke

• Traumatic brain injury (TBI)

• Multiple sclerosis (MS)

• Epilepsy

Cognitive evaluation might also be advised to understand the impact if there are brain changes after medical treatment, such as:

• Radiation

• Chemotherapy

• Surgery

• Surgery

• Effects of certain medications

Neuropsych testing may also be recommended every so often to monitor change and adjust treatment planning to someone’s needs. One example of this is in patients with MS or other progressive neurodegenerative disorders. These folks may have cognitive testing every few years to monitor brain change over time and to learn what additional support might be best for them as the MS progresses. This is testing for the purpose of treatment planning and can make a big difference in quality of life.

Who Does Neuropsychological Assessments?

Neuropsychological testing is a highly specialized skill, and can only be conducted by a neuropsychologist or clinical psychologist with specialty training in neuropsychology. Psychological assessment is something that only psychologists with Ph.D. or PsyD degrees are trained to do, and a skill that sets psychology apart from other mental health fields, and from mental health providers with master’s-level training.

Many psychologists do therapy and assessment, including neuropsychological assessment, though there are also many psychologists who only do therapy, or only do psychological assessments. Because psychology is a broad field, individual psychologists have different areas of expertise and typically choose to focus their training on a specific area. This is why it is so important to select a psychologist with expertise and experience that matches your needs. Some neuropsychologists have a board certification, which is an extra step that licensed psychologists can take to demonstrate their expertise. Unlike many medical specialties, board certification is not required for psychologists, and there are many licensed psychologists with a great deal of expertise and experience in neuropsychological testing who may not have pursued board certification.

It’s a good idea to ask questions about your psychologist’s training and experience when you are seeking a neuropsychological evaluation. It is helpful to ask things like:

• What age groups the psychologist works with

• What diagnoses or types of testing do they specialize in

• How long they have been doing neuropsychological testing

• What experience do they have with your specific concern (e.g., MS, dementia, ADHD, cancer, reading disorders, autism)

• What will happen at the testing appointment and afterward

• How long you can expect to wait for a feedback session and a report

What is Assessed in Neuropsychological Evaluations?

Cognitive testing gives a snapshot of functioning in different brain areas and often includes measures of:

• Memory

• Attention

• Processing speed

• Visual and spatial function

• Executive function

• Others depending on the question

Some of these, like memory and attention, may be familiar to you. Other areas or “domains” of brain function may be less clear. Most neuropsychological testing will include tests of executive function. Executive function is the job performed by the brain’s frontal lobes, located right behind the forehead, and includes things like organizing, decision-making, mental flexibility, and keeping us from acting on impulses. For folks with ADHD, executive function is usually lower than average, and neuropsychological testing will often show this as an area of vulnerability. Other neuropsychological domains that may be unfamiliar are processing speed, or how quickly we understand information, and visual-spatial function, or how well we make sense of visual information like pictures and shapes.

The Assessment will be tailored to your unique needs

An experienced psychologist who does neuropsych testing will put together a tailored collection of tests to gather the information they need so they can answer the referral question. This also allows them to provide individualized recommendations for the patient or the referring medical provider. Test batteries can look very different depending on the question asked, the age of the patient, and the purpose of the report. For example, a neuropsych evaluation for a teenager with concerns about ADHD will need to use some different tests than an assessment for an older adult with concerns about dementia or cognitive decline.

Generally, we’re looking at the same areas of brain function, because brains of all ages do the same basic functions. However, we might look at those functions in different ways and use different tests to fit the patient and their needs.

Why is Neuropsych Testing Helpful?

It Gives Insight & Answers

The results of testing can be very useful because a neuropsych assessment can help us understand the problems someone is having with their brain function and what diagnosis they may have. For people having worrisome cognitive symptoms, test results can offer answers and reduce anxiety. In my experience as a clinical psychologist doing neuropsych evaluations, people often feel anxiety leading up to testing, as they fear receiving bad news. But I have observed that even in situations where testing results in a scary diagnosis or prognosis, there is relief in having the information and knowing the answer. This allows individuals and families to move forward with a plan, rather than wondering and fearing the worst.

neuropsych testing can give unique management options

In addition to providing insight into a diagnosis or cause of symptoms, a neuropsych eval can also help doctors determine what treatments may help. Even in situations where there is no cure for cognitive deficits, neuropsychological assessment can help the psychologist recommend strategies for managing problems to help improve quality of life. For example, if cognitive testing shows that someone is having problems learning and remembering verbal information (sometimes called auditory learning), their doctors can provide written information to better support them.

Obviously, this is simple advice, but potentially very meaningful. If a patient has trouble remembering what they are told verbally, and they receive only verbal instructions about how to care for a surgical site after surgery, they are at risk of infection and re-admission to the hospital if they forget the details. Providing clear written steps for at-home wound care is an easy strategy a medical team can use to support that patient, and may mean their ability to go home independently after surgery! Neuropsychological assessment can offer insight into many areas of brain function, which allows the evaluating psychologist to create a “profile” of cognitive function, and make tailored recommendations about the best ways to treat or support brain health.

A Neuropsychological assessment provides treatment options

In addition to offering management strategies, a psychologist can give treatment recommendations based on the results of neuropsychological assessment. If there is a particular psychotherapy that is helpful for people with a diagnosis, the psychologist can recommend that. If it would be useful to see a physical therapist, a dietitian, a neurologist, or another specialist, the psychologist can recommend that. If medications would be helpful, the psychologist can recommend referral to a psychiatrist or other prescribing physician who can assess what is needed and manage those medications. The true value in a neuropsychological assessment is receiving recommendations unique to your situation that will help you navigate what is ahead.

How to Proceed with a Neuropsychological Evaluation.

If you believe you or a family member are in need of a neuropsychological evaluation, you may feel overwhelmed about where to start.

Find A Psychologist or Neuropsychologist

First, I recommend you seek out a reputable psychologist or neuropsychologist in your area. If you are not sure how to do that, there are a few resources you can use:

• Local or state psychological associations often have a directory (like this one on the Los Angeles County Psychological Association website)

• Psychology Today, Zencare, and other listing sites used by psychologists

• Ask your own medical provider for a recommendation

• If you have a psychotherapist, ask your therapist

• Ask around to family and friends. You might be surprised that others have needed a neuropsychological evaluation at one time or another

• Google search for exactly what you need (e.g., “cognitive assessment for dementia in Redondo Beach”)

Ask Your Psychologist Questions

Once you find a psychologist who can give a neuropsych evaluation, you will need to reach out to them to find out whether they’re a fit and learn about things like cost, availability of appointments, and so on. Neuropsychological testing is highly sought after, so be aware that you might have to wait for an appointment. When you call to find out if the psychologist is a fit for you, here are some questions I recommend asking:

• What types of testing do you do?

• What ages do you see? Are any of those age groups a specialty of yours?

• How long have you been in practice as a neuropsychologist?

• How much does a neuropsych eval cost at your clinic?

• Do you take insurance? (And ask about your specific insurance).

• What availability do you have for a testing appointment? Is there a wait to be seen? If so, how long?

• What does the testing day look like? How long does testing last?

• How long before you have the report and feedback to me?

In addition to these basic questions, I recommend asking anything particular to your situation. For example, if you are looking for an evaluation that will be used for disability accommodations at high school or college, ask whether the psychologist can provide that type of report. If you are interested in having the psychologist communicate with other medical providers, mention that and ask what they need from you in order to do so.

Get Prepared for Your neuropsychological assessment

Once you’ve made your appointment, you also need to come prepared on the day of testing. Your psychologist should tell you what to expect but here are some general tips:

• Expect a long day. Testing can take anywhere from 3 to 8 hours, or even require more than one day, depending on the assessment. It’s ok to ask for breaks!

• Be on time. Prepare by mapping your route, anticipating traffic or other possible delays, and leaving a bit early so you are sure to arrive on time.

• Be well rested. Poor sleep can impact testing, so try your best to get a good night’s sleep the night before testing.

• Eat well. Eat a good breakfast the day of testing, bring snacks and lunch, and bring water. Hunger can impact testing!

• Avoid alcohol and drugs. Drinking the night before testing, or taking any non-prescribed medications or drugs can all impact testing. It’s best to avoid taking anything other than your prescribed meds before a neuropsych testing appointment.

• Bring relevant medical records. If you have any medical conditions or a significant medical history, that information will be crucial for your psychologist. You can fill out a records request at your doctor or hospital to provide records to your psychologist. It’s also a good idea to bring a list of your prescriptions if you have any. This requires planning ahead!

• Try to relax. People often feel anxious about testing, but anxiety can impact testing too! Remember that neuropsych assessment is to help you so you should give your best effort, be honest, and try not to let anxiety about testing get in the way.

Hopefully, this information is a helpful introduction to some of the most important information about neuropsychological evaluations and what they are for.

Get A Neuropsychological Evaluation in Los Angeles, CA

If you are seeking a neuropsychological evaluation in Los Angeles or Orange County, Dr. Reger is a Psychologist who is experienced with neuropsych testing for adolescents, adults, and older adults. She has offices in multiple locations around LA and OC, as well as her primary office in Redondo Beach, CA.

1. Reach out today for a free 15-minute consultation about your testing needs.

2. Schedule your neuropsychological assessment.

3. Get answers and find management and treatment options that will help you.

A Look at Dementia Testing

Cognition (the way our brain works) changes over our lives.  As a geropsychologist – a specialist in the psychology of aging and the unique mental health needs of adults over age 65 – I often see people with concerns about their brain health as they age. It often leads them to wonder if they need dementia testing.  

Common Concerns that Lead to Dementia Testing

The most common worries I hear from patients when they come to me for cognitive testing for dementia include:

• I go into a room and forget why I went in

• After making new acquaintances I can’t remember their names

• I forget whether I’ve taken my medication that day 

• My thinking isn’t as quick as it was; I’ve slowed down

• I can’t focus on reading or other tasks like I used to

• Sometimes I can’t find the word I’m looking for, even though it’s on the tip of my tongue

Understanding the Normal Aging Process

The reality is that some small declines in brain functions like memory, attention, and processing speed (how quickly we understand and act on new information) are part of the normal aging process.   This normal age-related decline can begin in our 50s or 60s and increase slightly over time.  These issues are minor, not too frequent, and generally don’t get in the way of our ability to do our usual activities and tasks.

On the other hand, dementia is NOT part of the normal aging process.   Dementia is a broad term used to describe many types of cognitive decline.  It could mean Alzheimer’s disease, Parkinson’s, vascular dementia (cognitive change related to heart health), and many other neurodegenerative disorders.  I have seen people fearful that every forgotten detail is a sign of dementia, and others who excuse major memory symptoms that are truly concerning by saying “that’s just part of getting older.”  Unfortunately, we live in an ageist culture, and older adults are often portrayed on TV and in movies as extremely forgetful, among other unflattering stereotypes.  But these portrayals do not reflect reality for most people, and they give us a distorted idea of what normal aging looks like.

How to Determine if You Need Dementia Testing

So how can you tell whether you should be concerned about changes in your cognition?  

Pay Attention to Your Cognitive Habits

Think about your recent life, and notice if anything has changed in terms of your thinking.  For example:

• Have you started having trouble keeping track of finances, when you’ve always managed them with no problem?  

• Have you started missing appointments because you can’t remember when things are scheduled?  

• Are you noticing worrisome changes in your ability to care for your home or yourself?  

Make a list of the events or issues that have you worried.

Check-in With Your Loved Ones 

Ask them to be honest with you about what they have noticed when it comes to changes in your cognition or memory.  If you live with a spouse, partner, or adult child, they may have noticed things you haven’t, or they may not have noticed the little things you are worrying about.  It can be helpful to have the perspective of someone close enough to notice changes.  Add their observations to your own list of changes or concerns.

Talk to Your Physician About Your Cognitive Concerns

Show your primary care physician your list and the observations from others.  Tell them what you’ve noticed, what your spouse or child said they noticed, and see what they advise.  They may recommend seeing a neurologist or psychologist for a further evaluation, to rule out dementia.  If your doctor shrugs away your concerns, but you are still worried, you can also reach out to a psychologist or neuropsychologist on your own to schedule a cognitive test for dementia (also called neuropsychological assessment).  Often, you do not need a referral to schedule a neuropsych evaluation; you can reach out directly to the psychologist.

Is Getting Dementia Testing Worth it?

If you’re worried about symptoms that are happening frequently, it can be a good idea to seek dementia testing.  A cognitive assessment can give you a better understanding of the symptoms you’ve noticed.  Sometimes, testing results in a diagnosis of dementia.  This can be quite scary, and that fear can cause people to avoid a neuropsych evaluation to rule out dementia in the first place.  However, in my experience, although this type of diagnosis is frightening in some ways, it can also be a huge relief to know exactly what is going on.  A diagnosis can help you let go of worrying about the “what ifs” and begin planning with your loved ones for your future.  A diagnosis can give you some control over an uncontrollable situation and allow you to make the most of your time.

Other times, neuropsych testing results in an unexpected diagnosis, or even no diagnosis.  Some causes of dementia, like vitamin deficiencies, are reversible.  Some people have stable, mild cognitive changes that never turn into dementia.  Some people are worried about symptoms that are just part of normal aging, and cognitive testing for dementia can reassure them that their experiences are normal, not cause for concern.

Whatever the outcome, there is power in knowing an answer and being free from the burden of uncertainty.  If you are concerned about problems with memory, attention, mental speed, or other brain functions as you age, you can reach out to me for a consultation to discuss whether testing might be helpful.

Get Dementia Testing in Los Angeles, CA

Are you worried about changes in your cognition? Have your loved ones brought up concerns? As a psychologist, I can help you find answers and understand if what you are going through is part of the normal aging process or not. To find out more about dementia testing with Dr. Reger follow these steps:

1. Reach out for a complimentary consultation

2. Schedule your cognitive test for dementia

3. Find answers and gain freedom from uncertainty

Other Services Available in Los Angeles, CA

I offer a variety of different types of psychological evaluations and neuropsychological assessments. Do you need an assessment for a workers’ compensation psych claim? Are you preparing for surgery or a medical procedure and need a psychological evaluation? Are you needing a med-legal assessment for a legal case? As a Los Angeles psychologist, I can help you find the answers that you need. Additionally, I offer therapy for older adults, consultations, and professional speaking.

Bariatric Surgery Psych Eval: Why, What, & How

So, you are considering bariatric surgery and you’ve learned of the need for a pre-surgery psychological evaluation. Patients often have questions about why a psych eval is part of the plan for weight loss surgery, what an assessment is like, and how they may “pass” the testing. Patients sometimes feel irritated by having to complete a bariatric surgery psych eval, as though the need for a preoperative assessment means their doctor thinks they are “crazy.” But a pre-surgical psych eval is a standard part of any weight loss surgery screening.

Why Require a Psych Eval for Weight Loss Surgery?

If you are considering weight loss surgery, you are likely aware that there are many reasons for carrying extra weight. Some of those reasons are physical, like health conditions and genetics. Other reasons are mental or emotional, like binge eating patterns or eating to cope with stress or emotions. Just as the decision for weight loss surgery is deeply personal, the factors that led to weight gain are individual.

A bariatric surgery psych eval can give your medical team (and you) insight into:

• Why you are seeking surgery – your motivation

• The food and health habits you have

• Your understanding of the surgery

• Your emotional and psychological readiness for surgery

• What, if any, anxieties you may have about surgery

• What your expectations of surgery are (and how realistic they are)

• Your support system

• Your understanding of what you will need to do after surgery, including major lifestyle and behavior changes

Weight loss surgery is a major medical procedure with strict post-surgical requirements. It is common to have emotional challenges in adjusting to a new way of life as well as your changing body and reactions from other people. Because of this, a pre-surgery psychological evaluation is an important part of the preparations.

What Happens During a Bariatric Surgery Psych Eval?

A psych eval for weight loss surgery consists of meeting with a psychologist for a clinical interview, and often a few questionnaires designed for pre-surgery psychological evaluations. This means the psychologist will ask many questions about you and your history, including:

• Current and past behaviors related to eating and exercise

• Previous attempts to lose weight

• Any mental health history

• Childhood experiences, including any trauma

• Current and past alcohol and drug use

• Medical problems and medications

• Social support

The goal of the interview and questionnaires is not to invade your privacy, but to gather the information needed to foresee any potential complications. For example, if you have a history that includes depression, you may be at higher risk of developing depression after surgery. If your team knows this, it’s easier to have support in place, like psychotherapy or medication to help manage your mood as you adjust to the changes in your lifestyle and body.

How Do I “Pass” a Bariatric Surgery Psych Eval?

It is natural to have anxiety about testing, especially when you have made the decision to pursue bariatric surgery and a psych eval seems like a roadblock in the way of that goal. But psychological assessment is not a pass/fail endeavor. Most people seeking weight loss surgery have areas of risk. Some common examples:

• Many efforts to lose weight that have ended with returning to old habits and regaining weight. This does not mean you “fail” the psych evaluation. It means this will be an area for you and your medical team to be aware of and an area in which to offer extra education and support so you have the best chance of successful surgery.

• A previous mental health history. Mental health diagnoses do not automatically mean you are not a good candidate for surgery. You and your team will need to plan for the support you need before and after surgery.

Part of the evaluation is a feedback session with your psychologist, who will discuss areas of concern, and offer recommendations. For example, if you’re a smoker, it is a good idea to quit before a major surgery, since nicotine gets in the way of wound healing. A psychologist might refer you to a smoking cessation program to give you the best chance of healing well.

Why might A Psychologist not recommend surgery

Rarely, there are serious concerns that would cause a psychologist to recommend against surgery right now. Some examples include:

• Uncontrolled/untreated severe psychiatric symptoms

• Suicide attempts or psychiatric hospitalization within the past year

• A history of not following medical recommendations

• Active substance or alcohol abuse

If you do have a serious mental health issue, it is important to treat that before considering any surgery, and particularly weight loss surgery, which can be a challenging adjustment accompanied by many emotions. If a psychologist recommends that you wait for surgery until another mental health concern is treated, it is because this will give you the best odds of having a successful weight loss surgery.

The most important thing to do during a bariatric surgery psych eval is to be honest. Your psychologist wants you to succeed, and they are well-equipped to provide you with support, education, and information about your areas of risk, to help you prepare and go on to a successful surgery.

Get A Bariatric Surgery Psych Eval in Los Angeles, CA

Dr. Reger offers assessments at several locations throughout Los Angeles and Southern California. If you are preparing for a weight loss surgery follow these steps to get your pre-surgery psychological evaluation:

1. Reach out to speak with a Los Angeles Psychologist

2. Schedule your bariatric surgery psych eval

3. Get the answers you need for a successful weight loss surgery

Other therapy & Assessment Services Offered by dr. reger in Los Angeles, CA

There are several different types of assessments that Dr. Reger provides as a Los Angeles Psychologist. She can provide assessments for workers comp, med-legal situations, dementia, and cognitive decline. Besides evaluations and assessments, she also offers counseling for older adults, public speaking, and consultations.