Neuropsychological Assessments in California Workers' Compensation Cases – A Short Guide for Defense and Applicant Attorneys

As a defense or applicant attorney in California workers' compensation cases, you're likely familiar with the complexities surrounding head injuries, strokes, and other neurological issues that arise in the course of employment. Understanding the role and nuances of neuropsychological assessments can be crucial for building strong cases and advocating for your clients.

For Defense Attorneys:

Evaluating the Validity of Claims:

A neuropsychological assessment is often a valuable tool in evaluating the legitimacy of a claimant's cognitive complaints. The objective data obtained can identify inconsistencies between self-reported symptoms and test results, potentially revealing issues of exaggeration or malingering. Although there is no perfect way to assess for malingering of cognitive or emotional problems, well-validated tests designed to measure effort and performance validity are one of the best and most evidence-based options.

Assessing the Extent of Impairment:

While subjective reports of cognitive difficulties are present in many work injury cases, a neuropsychological assessment provides a more concrete picture of the functional limitations caused by the alleged injury. This information can be critical when determining the extent of disability and have a major impact when negotiating settlements.

Developing Return-to-Work Strategies:

Identifying the specific cognitive strengths and weaknesses of the claimant via neuropsych testing allows for the development of targeted recommendations for accommodations, work restrictions, and treatment to facilitate a safe and effective return to work. This can benefit both your client, by minimizing long-term disability, and the employer, by reducing lost productivity costs. And, as a bonus, this also helps the injured worker get back to work and move on with their life!

For Applicant Attorneys:

Building a Strong Case for Benefits:

A comprehensive neuropsychological assessment can significantly strengthen your client's claim for compensation by providing objective evidence of cognitive impairments directly linked to the work injury. This scientific data carries significant weight compared to solely relying on subjective complaints, and in cases where the neuroimaging doesn’t show structural changes (which is often the case in mild or moderate brain injuries), neuropsych testing can validate a person’s subjective report.

Maximizing Recovery:

Understanding the nature and severity of cognitive impairments helps develop tailored treatment plans and rehabilitation programs, aiming for optimal recovery and potential vocational retraining. This can significantly improve your client's long-term well-being and earning capacity.

Addressing Malingering Concerns:

A thorough neuropsychological assessment conducted by a reputable professional minimizes the risk of malingering accusations. The in-depth evaluation process and standardized testing protocols are designed to detect inconsistencies and ensure the assessment's validity.

Key Considerations for Both Sides:

Choosing the Right Expert:

Since neuropsych is not its own QME specialty, you will most likely need to seek out a clinical psychologist with specialty training in neuropsychological assessment as an Independent or Agreed Medical Evaluator. This can feel daunting, but here are a few tips.

This does not necessarily have to be a neuropsychologist, as long as the doctor has training and experience in neuropsychological assessment.

For example, I identify professionally as a clinical psychologist because I did not select an exclusively neuropsych training track when I got my doctorate and did my postdoctoral training. However, I did a great deal of psych and neuropsych assessment training throughout my education and fellowship in geropsychology (which requires expertise in neuropsych testing, among other things), including at highly regarded clinics like Cleveland Clinic, the UCSF Memory and Aging Center, and the San Francisco VA. I then went on to work in a rehabilitation/gero psychology setting, where I developed and directed the neuropsych assessment clinic in Spinal Cord Injury, and later directed the predoctoral psychology training program at the Long Beach VA. Now I run my own assessment and treatment practice.

As you can see, I have plenty of excellent training and experience with neuropsych assessment, but because I also do treatment, capacity assessment, and medical psychology, I don’t call myself a neuropsychologist; it is only one aspect of my work. So, let me be the example that broadening your search, from only self-proclaimed neuropsychologists to include clinical psychologists with experience and competence in neuropsych, might open up some doors in terms of finding an AME to do neuropsych evals in your cases.

Board certification is a great way for neuropsychologists to legitimize themselves in the field of neuropsychology.

However, board certification is not as emphasized or necessary in the field of psychology as it is in the medical field. According to the American Psychological Association, only about 4% of psychologists in the US are board certified, and I am confident there are many more than this who are highly trained, competent, and doing excellent work. Board certification is great, but it is only one marker of a high-quality psychologist.

Selecting a qualified and experienced psychologist with competence in neuropsych and workers' compensation cases is crucial. Look for professionals who adhere to best practices and have a track record of producing reliable and defensible reports; finding referrals by word of mouth is usually a good idea. A good psychologist doing neuropsych evals in work comp cases should approach from an objective lens and be honest about their findings, and in fact, this is an ethical obligation.

As psychologists, our job is not to support an attorney’s or injured worker’s opinions or desires; it’s to consider the data objectively and explain it honestly in a way that non-psychologists can understand. If an expert guarantees their findings will support your side of the case, they are overpromising and may not be credible under scrutiny!

Understanding the Assessment Process:

Both parties should have a basic understanding of the assessment process, including the types of tests administered, the information gathered, and the typical timeline for receiving the report.

Open Communication and Collaboration:

Open communication and collaboration between attorneys and the psychologist can ensure a smooth and efficient evaluation process, ultimately benefiting everyone involved by expediting resolutions and ensuring fair outcomes.

Start a neuropsychological evaluation in los angeles, ca

Neuropsychological assessments are not a perfect tool, but they can be valuable in navigating the complexities of workers' compensation cases that involve a neurologic injury with cognitive symptoms. Understanding their role and the nuances allows defense and applicant attorneys to effectively advocate for their clients and achieve fair and just outcomes. As a psychologist, I would be happy to offer support with a neuropsychological evaluation and other services. Start the evaluation process with Dr. Reger by following these simple steps:

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

2. Meet with Dr. Reger for an evaluation

3. Get a better understanding of neurological issues!

Disclaimer: This blog post is intended for informational purposes only and should not be construed as legal or medical advice. Always consult with qualified legal and medical professionals regarding your specific situation.

Other Services Offered by Dr. Reger in Los Angeles, CA

Neuropsychological assessments aren’t the only service I offer. I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple psychological assessments as well. Other assessments include capacity assessments, cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!

Understanding Adult Psychodiagnostic Evaluations

If you've been struggling with mental health concerns that seem difficult to define, or if past treatments haven't yielded the results you'd hoped for, you might be a good candidate for a psychodiagnostic evaluation. People might find the idea of a psychodiagnostic evaluation (or even anything to do with a psychologist!) intimidating or mysterious, but this type of assessment provides a valuable opportunity to gain deeper insight into what may be driving your experiences and a path forward. I do psych evals with adults, and here is some information that you might find helpful if you’re considering an assessment.

What Exactly Is a Psychodiagnostic Evaluation?

Think of it as a comprehensive psychological detective mission focused on precisely understanding what's happening beneath the surface of how you think, feel, and behave. A psych eval goes beyond a few small questionnaires. In an adult psychodiagnostic eval, a skilled psychologist dives into:

• Deep-Dive Interview(s): I will get to know you through a thorough exploration of your personal history, current symptoms, and everyday experiences. In some cases, it’s also important to interview someone close to you, who can speak to what they have observed; this could be a parent, partner, caregiver, or close friend. Obviously, this type of additional interview is only with your consent.

• Testing and Measures: A carefully chosen battery of tests will shed light on your thought patterns, personality traits, and emotional states. This is tailored to your personal reasons for doing testing.

• Medical Records: Sometimes, though not in every case, I will want to look at past medical records relevant to the evaluation, for example, a cognitive assessment you did while in school for testing accommodations or records related to therapy, a brain injury, or a hospital stay.  

Why Seek a Psychodiagnostic Evaluation?

Several compelling reasons exist for seeking out a psychological evaluation:

Untangling Diagnostic Confusion:

Is it depression or bipolar disorder? Social anxiety or a posttraumatic stress disorder? A psychodiagnostic evaluation helps determine the accurate diagnosis (or diagnoses) even when the picture is complex. This is the number one reason I see adults for psych testing; they know something is going on and want to get a clear diagnosis.

Personalized Treatment Planning:

Diagnostic clarity and a deep understanding of your emotional and psychological landscape allow your psychologist to tailor a treatment plan to your needs. The right resources, education, therapy, medication (if appropriate), and support system become far more effective with a clear diagnosis.

Understanding and Validation:

In my experience, although it can be painful to get a psychological diagnosis, most people also feel a profound sense of relief when a diagnosis finally makes sense and validates their struggles. Understanding the nature of your mental health challenges is inherently empowering because it makes sense of things that have happened in your past and gives you a lens for understanding yourself. It can also help you give yourself some grace and compassion, rather than being hard on yourself for the ways you may be different from others in your life.

Identifying Strengths:

While focusing on challenges, a psychodiagnostic evaluation also illuminates your strengths and resilience. This creates a balanced, complete picture of who you are and the resources available to you in moving forward. 

What Happens During the Evaluation Process?

Although a psych eval will be tailored to your specific needs, most psychodiagnostic evaluations generally involve:

1. Initial Intake: You'll collaborate with your psychologist on understanding your concerns and goals, as we gather background information.

2. The Evaluation Itself: This typically spans several hours, or sometimes multiple sessions, and includes the interview(s), testing elements, and possibly observations.

3. Results and Feedback: I will carefully analyze the information gathered and share my findings. This includes clear explanations of the diagnosis, potential contributing factors, and your unique areas of strength. In my practice, I spend a great deal of time and energy scoring and interpreting the test results and writing up a comprehensive report for you. Although it’s many hours of work, this is helpful, because then you always have a record of that day – what your history was up to that point, your presenting concerns that day, your test results at that time, and my professional recommendations in black and white. The report gives you a reference to guide your treatment and lifestyle changes, and acts as a great baseline for comparison in the future.

4. Recommendations: As mentioned, in the report, you'll receive tailored treatment recommendations, which might include specific therapies, medication options, lifestyle adjustments, recommended readings or other tools for understanding your diagnosis, or resources for additional support, such as a referral for executive coaching or a support group.

Common Fears and Misconceptions

Feeling a bit nervous about this process is perfectly normal! Here's why you can relax:

• Judgment-Free Zone: I see evaluations as collaborative. I am not judging you but seeking to understand so I can help.

• It's Not About Labels: While precise diagnosis is valuable, a diagnostic label doesn't define you. This is only a tool for unlocking personalized support and self-understanding. I also believe that finally getting the correct diagnosis, sometimes after years of misdiagnosis or imprecise care, can allow you to move beyond the label in a way that being in the dark can’t.

• You're In Control: You participate every step of the way. You can ask questions, share what feels comfortable, take your time, and decline any tests you don't want to take.

Empowering Yourself: When to Consider an Evaluation

If any of these resonate, feel free to reach out to me about a psychodiagnostic evaluation:

• Previous treatments haven't produced the desired outcome.

• You suspect there's more going on than your current diagnosis suggests.

• You want a truly personalized plan for improved mental health.

• You long for a clearer understanding of yourself and your experiences.

• You have adopted negative beliefs about yourself as a result of mental health challenges, and these beliefs hold you back at your job, in relationships, or from personal growth.

A Journey Worth Taking

While it requires an investment of time, money, and effort, a psychodiagnostic evaluation often proves incredibly beneficial. Think of it as an investment in yourself – a chance to understand unanswered questions that hold you back and step into the clarity that allows healing and growth. As a psychological evaluator in Los Angeles, Dr. Reger would be honored to provide support in better understanding your mental health concerns. You can start the evaluation process by following these simple steps:

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

2. Meet with Dr. Reger for an evaluation

3. Start addressing the mental health challenges affecting you most!

Other Services Offered by Dr. Reger in Los Angeles, CA

Psychological assessments aren’t the only service I offer. I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological assessments. Other assessments include capacity assessments, cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!

Top 10 Reasons to Get Neuropsych or Psych Testing in Los Angeles: Maintaining Brain Health and Emotional Wellbeing in the City of Angels

As a Los Angeles-based clinical psychologist specializing in neuropsychological assessment, I sometimes encounter confusion or hesitation when discussing cognitive testing – what exactly is it and why might someone need a neuropsych eval? Amidst the sunshine and diverse life of LA, prioritizing brain health is crucial so we can make the most of the wonderful city we live in. Here are 10 common reasons why cognitive testing can be valuable for Angelenos:

Navigate Hollywood's Demanding Environment:

Actors, musicians, and creatives in LA's competitive scene can benefit from understanding their cognitive strengths and weaknesses to optimize performance and manage demanding schedules. Sometimes, great creativity can come with intense emotions, problems with attention and follow-through, or other mental health concerns. A psychological assessment can also help with a diagnosis and getting the right support for a balanced life and self-care.

Stay Active and Independent:

Seniors in LA who cherish their active lifestyles sometimes want a neuropsychological evaluation to monitor mental fitness and identify any concerns early, ensuring continued independence, early intervention for any brain health concerns, and participation in the city's diverse offerings.

Address the Unique Challenges of a Multicultural City:

LA's large and diverse population means we need culturally competent providers in all areas to ensure accurate results and avoid bias. As a clinical psychologist who trained in Las Vegas and San Francisco before coming to LA 10 years ago, I have experience providing compassionate, culturally-informed care for patients crossing many varied identities – ethnicity, gender identity, sexual orientation, neurodivergence, disability status, age, socioeconomic status, immigrant status, and religious background. I am committed to educating myself, checking my own bias, and approaching each psych assessment, capacity evaluation, and neuropsych eval with cultural humility.

Access Renowned Research Opportunities:

UCLA, USC, and other research institutions in LA offer opportunities to participate in cutting-edge studies on brain health and cognition. Sometimes cognitive testing is a gateway to contributing to scientific advancements in this city!

Manage the Stress of LA Life:

From traffic jams and high cost of living to competitive environments, LA can also be stressful. A psych assessment in Los Angeles can identify potential emotional, social, and cognitive impacts of stress and guide you toward effective stress management strategies.

Make Informed Decisions about Retirement:

Whether enjoying the beaches or exploring local culture, Angelenos planning for retirement, either well in advance or coming soon, can use a neuropsychological assessment to get a baseline measurement of brain health, which improves readiness for the future, and can help with early identification of any concerning patterns. I have seen many patients who use their neuropsych evaluation results to make informed decisions about future care and living arrangements.

Support Loved Ones:

If you're concerned about a loved one's cognitive abilities or capacity to continue living on their own or manage finances, neuropsych testing conducted by a Los Angeles psychologist can provide insight, clear and personalized treatment recommendations, and guide you towards local support groups, resources, and care options.

Get Answers:

Many adults live with unexplained symptoms that have a real negative impact on every life, such as attention problems that get in the way of work and relationships, lifelong difficulty in social situations that they’ve never understood, or intense highs and lows in mood.  Angelenos can seek psych testing to finally get answers about those symptoms, as well as an understanding of how to manage them for a balanced life and well-being.

Find Personalized Brain Fitness Solutions:

From executive function coaches to mindfulness groups, LA boasts a plethora of brain-healthy activities, and I am connected with many professionals in a variety of fields doing excellent work. Neuropsych testing can help personalize your approach and maximize the benefits of these resources.

Embrace a Holistic Approach to Wellness:

In the wellness-conscious culture of LA, cognitive testing or psychological testing complements your dedication to physical and mental fitness, providing a complete picture of your overall well-being.

Begin Neruopsych or Psychological Testing in Los Angeles, CA

A psych assessment or neuropsych assessment is an investment in your future. You are always welcome to reach out to me as a qualified Los Angeles-based psychologist to discuss your unique needs and explore whether testing is right for you. Take charge of your brain health and embrace the vibrant life LA offers with confidence and clarity by following these simple steps:

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

2. Meet with a Los Angeles Psychologist for an evaluation

3. Start receiving the support your loved ones deserve!

OTHER SERVICES OFFERED BY DR. REGER IN LOS ANGELES, CA

Psychological assessments aren’t the only service I offer. I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological assessments. Other assessments include capacity assessments, cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!

When is A Capacity Assessment Needed?

As a psychologist with specialties in assessment and aging, I do many types of testing with adults of all ages. One type of testing that can be complex and may not be well-understood is capacity testing.

It's a nuanced area, and understanding when a capacity assessment is needed can be confusing. First of all, age, physical illness, disability, or a diagnosis of dementia, schizophrenia, or intellectual disability are not enough, on their own, to know whether a person lacks capacity. A condition that causes impairment in judgment is necessary to determine that someone does not have the capacity, but it’s not sufficient on its own to take away someone’s right to make their own decisions. This is incredibly important to remember as a frame for thinking about capacity.

Let's delve into some common situations where a capacity evaluation might be needed.

Medical Decision-Making:

Many of us have faced difficult medical situations, either for ourselves or loved ones, where major medical interventions are needed. In some situations, the person who needs treatment may not be able to fully comprehend the situation to make decisions. For example, if someone has an infection and is confused, they may not have the capacity to consent to a medical procedure they need to heal.

In other situations, a family member with cognitive impairment may need surgery or other serious treatment. If concerns arise about a person’s ability to understand the situation and make informed choices, a capacity assessment might be necessary. This involves a psychologist or sometimes a physician asking specific questions designed to assess the person’s ability to understand their condition, appreciate the consequences of being treated (or not), reason through their decision, and express a clear choice. This ensures their preferences are heard and respected, even when facing challenging health decisions.

Conservatorship or Guardianship Proceedings:

Sometimes, people need support in managing their daily lives because of an illness or disability, like dementia or schizophrenia. Family or medical professionals might begin the process of putting in place a conservatorship or guardianship that allows a family member or court-appointed fiduciary to manage finances, healthcare, or living arrangements for someone.

By the way, conservatorship and guardianship are the same thing, the language just differs somewhat from state to state.

Where I work as a psychologist doing capacity assessments in Los Angeles, this arrangement is called a conservatorship. Before any legal decisions are made, a capacity assessment helps determine if the individual can independently manage aspects of their life.

As a psychologist, my goal in these cases is always to prioritize a person’s right to autonomy over their own life, while also recognizing and balancing the need for safety. For example, if an older adult with dementia really wants to continue living independently in their home, but has recently had many brushes with danger, such as leaving the gas on the stove burning overnight, leaving without locking the doors, falling down the stairs, or failing to feed themselves consistently, there may be a need for a conservator to step in and make decisions about a safer living arrangement. 

Financial Management:

Concerns about someone's ability to manage their finances responsibly can be another trigger for a capacity assessment. This might involve protecting individuals from exploitation or ensuring their well-being is not jeopardized by risky financial decisions. For example, if an older adult with dementia has lost thousands of dollars to a financial scam, and cannot demonstrate the judgment and reasoning to safely manage their finances, then the sacrifice of their independence in this area may be necessary to preserve their safety and financial security. These evaluations take into account the person’s current abilities, reasoning, history, values, and situation.

It's important to remember:

Capacity is decision-specific:

Just because someone might struggle with one type of decision, it doesn't mean they lack the capacity for all decisions. Each situation requires a specific assessment. For example, I have seen many people who can make their own healthcare decisions, but who cannot safely manage their finances and need support in that area.

Individual rights are paramount:

Every individual has the right to make their own choices, even if those choices seem unwise to others. Capacity assessments ensure these rights are upheld and protected, while also ensuring a person’s safety within reasonable boundaries. The goal is not to be overprotective or treat older adults like children this is the opposite of the purpose of a capacity assessment. Balancing autonomy and safety is the key.

The assessment process is collaborative:

Psychologists work closely with individuals, families, and other professionals to gather information and conduct a comprehensive evaluation. For example, I may need to review medical records or financial records or interview the patient and their caregiver or family member.

What does a fair and accurate assessment look like?

• Respectful and person-centered: I always aim to conduct capacity evaluations in a way that is respectful of the individual's dignity and autonomy.

• Culturally sensitive: I consider cultural background, personal values, and individual communication style, and I try to be aware of my own bias (which we all have!) coming into each capacity assessment.

• Multifaceted: The assessment goes beyond cognitive testing or diagnosing dementia and considers the individual's understanding, communication, reasoning, and decision-making abilities, as well as their values and practical skills.

• Independent and objective: It is very important that a capacity assessment is conducted by a neutral professional, such as a clinical psychologist, who isn't involved in any potential decisions arising from the evaluation.

Understanding capacity is crucial for older adults with conditions that alter their ability to make decisions, but there is no one-size-fits-all answer. Everyone deserves a nuanced and respectful approach to ensure their voice is heard and their rights are protected, for the best possible quality of life.

Begin a Capacity Assessment in Los Angeles, CA

Ultimately, capacity assessments are crucial tools for safeguarding individual rights and ensuring informed decision-making in many situations. If you have questions or concerns about someone's capacity, you can reach out to Dr. Reger for guidance through the process and advocate for fair and accurate evaluation. Start your therapy journey by following these simple steps:

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

2. Meet with a Los Angeles Psychologist for an evaluation

3. Start receiving the support your loved ones deserve!

OTHER SERVICES OFFERED BY DR. REGER IN LOS ANGELES, CA

Capacity assessments aren’t the only service I offer. I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological and psychological assessments. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!