Initial Evaluations & Permanent and Stationary Assessments

What an initial psychological evaluation involves

An initial evaluation establishes whether a psychological injury is present, how severe it is, and what treatment is reasonable and necessary. For an injured worker it is usually the first structured opportunity to describe what happened and how it has affected sleep, concentration, mood, relationships, and the capacity to work.

The evaluation combines a clinical interview with standardized psychological testing and a review of the available medical and claim records. It produces a written report addressing diagnosis, causation, functional limitations, and treatment recommendations in the terms the California workers' compensation system uses.

What the appointment looks like

Most initial evaluations run two to four hours and may be scheduled across more than one visit when testing is extensive or when an interpreter is involved. The interview covers the injury itself, the medical treatment received since, current symptoms, psychiatric and medical history, substance use, and the practical effects on work and daily life.

Testing is selected to fit the referral question rather than applied as a fixed battery. Measures of symptom validity are included where appropriate, because a report that does not address effort and consistency is of limited use to any party reviewing the claim.

Permanent and Stationary assessments

A claim reaches permanent and stationary status when the condition has stabilized and is unlikely to change substantially over the next year with or without further treatment. At that point an assessment documents what has permanently changed and what the worker can and cannot do.

What a Permanent and Stationary report addresses

• Current diagnosis and how it relates to the industrial injury

• Whole person impairment, rated using the AMA Guides as applied in California

• Apportionment between industrial and non-industrial causes

• Permanent work restrictions and functional capacity

• Future medical care that is reasonably anticipated

• Vocational implications, including whether a return to the prior occupation is realistic

Where this fits in a California claim

Psychological evaluations enter a workers' compensation claim through several routes. A primary treating physician may request a consultation. A claims administrator may authorize an evaluation to clarify a disputed diagnosis. Where the parties disagree, the dispute may be resolved through a Panel Qualified Medical Evaluator or an Agreed Medical Evaluator, and the resulting med-legal report becomes part of the record.

Reports are written with that audience in mind. Adjusters, utilization review nurses, applicant attorneys, defense counsel, and judges all read the same document, and each needs to find the reasoning, not only the conclusion.

Who requests an evaluation

• Claims adjusters seeking clarity on a psychological component of a claim

• Applicant attorneys documenting the psychological consequences of an injury

• Primary treating physicians referring for specialist assessment

• Nurse case managers coordinating a complex recovery

• Injured workers whose psychological symptoms have not been formally assessed

What to bring

Bring photo identification, your claim number and the name of the claims administrator, a list of current medications, and any medical records or prior reports you have. If English is not your first language, say so when the appointment is booked so that services can be arranged in Russian or with a qualified interpreter.

After the report

The completed report is served on the parties entitled to receive it under California law. If treatment is recommended, a Request for Authorization is submitted to the claims administrator, which is then subject to utilization review. Where treatment is authorized, care can begin promptly, in person in Walnut Creek or by telehealth anywhere in California.

Request an evaluation

To discuss a referral or check availability, contact the practice and we will respond within one to two business days.

Terms you will meet in the process

The vocabulary of a California workers' compensation claim is unfamiliar to most injured workers, and the same terms recur throughout the file.

• Panel QME — a Qualified Medical Evaluator selected from a panel issued by the Division of Workers' Compensation (DWC) to resolve a disputed medical issue

• AME — an Agreed Medical Evaluator, chosen jointly by the parties where both are represented

• Med-legal report — a report prepared to resolve a contested issue rather than to direct treatment

• P&S — permanent and stationary, the point at which a condition has stabilized

• WPI — whole person impairment, the percentage figure derived from the AMA Guides

• Apportionment — the division of permanent disability between industrial and non-industrial causes

• RFA — a Request for Authorization, the form used to seek approval for treatment

• UR — utilization review, the process by which a claims administrator evaluates an RFA

Nobody expects a worker to arrive fluent in this. Anything in a report that affects you will be explained in plain language, in English or Russian.