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May 29, 2026
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Michael Burgis & Associates, P.C
A psychiatric QME evaluation can feel stressful, especially when you already deal with anxiety, depression, pain, trauma, or other emotional symptoms related to your workers’ compensation claim.
This appointment may play a major role in your case because the doctor’s report can affect findings on permanent disability, future medical care, and whether your psychiatric injury is considered work-related.
The most important thing you can do is be prepared, honest, and clear about how your symptoms affect your daily life, work, relationships, sleep, focus, and ability to function. You do not need to argue, exaggerate, minimize, or try to guess the “right” answers. You need to tell the truth, explain both good days and bad days, and understand what the doctor may be evaluating.
If you have questions before your psychiatric QME evaluation, contact MB&A to help you prepare and feel confident.
Transcript:
Hi. My name is Michael Burgis, and I’m the managing attorney of MB&A. If you’re watching this video, you’re likely about to see a neutral panel qualified medical examiner in psychiatry or psychology.
Here at MB&A, we’re a bit different, and most firms don’t do this, but I want to take the time to prepare you for that doctor’s evaluation, because I find it’s better to be proactive than reactive. And again, the better the information is going into this doctor, the better the evidence I get coming out.
Your Workers’ Compensation Case
Okay. First off, if you’re seeing a neutral psychologist, I know you’re going through a lot, and I want you to take a deep breath and relax, because the one thing you don’t need to worry about is the legal stuff. I gotcha.
Have You Sustained a Permanent Disability?
Now, before I get into the advice for this evaluation, I want to go over and explain some quick fundamental things.
First, remember that in the California workers’ compensation claim, the real value is based on a doctor finding that not just that you’ve sustained an injury, that you’ve sustained a permanent disability. That is that you did not have a full recovery and that you have permanent residual disability.
The value of a workers’ comp case, at least for settlement purposes, generally tends to be compensation for permanent disability and entitlement for future medical care. So at the end of day, I’m not a doctor. The workers comp judges are not doctors. They can only award based on the medical evidence.
So our goal is that this neutral psychiatrist generally likes you, feels sympathetic for you, and writes an unbelievably good report for you.
Again, that’s the evidence for me to go in and either get your case settled or try the case. And again, I want a report finding the greatest amount of industrial injuries and the greatest amount of permanent disability with the greatest need for future medical care.
Have You Worked More than Six Months?
Now, in psych, there are also a handful of defenses that I want to go over. First, you have to work more than six months. If you don’t, the claim is generally barred unless it is sudden and extraordinary. Don’t worry about that. That’s the legal stuff. I’ll take care of that.
What Is the Predominant Causation?
However, the next one is something called predominant causation. That means that the psychiatrist or psychologist needs to determine that the majority cause of your emotional injuries, stress, depression, anxiety is due to work or work related.
So, again, not issues with your spouse, drugs, arrests, you know, everybody has a past. But again, that doctor needs to determine that the predominant cause, that means 50% plus a feather, is because it’s work.
Good Faith, Non-Discriminatory Personnel Action
Now, there are also some defenses that I like to avoid here. And one is called a good faith, non-discriminatory personnel action. So there’s a few types of psych cases.
There’s the catastrophic orthopedic injury that has psych as a compensable consequence because of the catastrophic injury. There’s a case, there’s recent law that’s come out that says if the psych injury is a compensable consequence of the ortho, the permanent disability isn’t added to the case, but the future medical is. The truth is, it is what it is.
QME Psychiatric Evaluation
My general advice is just be honest and let the cards fall where they fall. Don’t worry about trying to manipulate things because, especially when it comes to psych, you’re going to be doing a lot of testing, and they can point out when somebody is lying or exaggerating or purposely malingering. So understand that.
Be Prepared for a Long Appointment
Now, ultimately, you’ve got to also remember that this appointment is going to be very lengthy, because especially if we have to show predominant causation, what is the defense going to want to show? That it’s not predominantly caused.
So, one, be prepared for a long appointment, be prepared for a lot of personal questions about things that you probably don’t want to answer. Drugs, convictions, spousal issues, arrest, child custody, anything you think that could cause you stress, depression, anxiety, because that’s what the defense is going to look for. And they’re going to want to argue that is the predominant cause, not your work related injury.
Be Honest in Your Evaluation
At the end of the day, just be honest. Let the cards fall where they fall. Assume that your medical records, including your psychiatric medical records, will be subpoenaed. They’ll have those records, and that neutral doctor will see them and evaluate.
So be honest about prior injuries. Be honest about prior treatment. You know, understand that nobody’s perfect, and just because you’ve treated before for depression, stress, anxiety, ADHD, whatever it may be. Be honest about it. That doesn’t mean you didn’t sustain an industrial injury. That just means we might have to show that it was aggravating a prior injury or show that your prior injury was a depressive disorder, now you have a pain disorder. But again, just be honest. Let the cards fall where they fall.
Now, again, you’re going to have a lot of testing. One of them is called the MMPI. This test is going to ask you lots of questions. And if you try to give the answer that you think will best help your case, it’s probably going to come out as invalid and look like you’re exaggerating or malingering. So, again, don’t try to trick anybody. Don’t try to trick the system. Just be honest. Let the cards fall where they fall. All right.
So we have to show a six month rule, predominant causation. If the psych is due to orthopedic injury, what that means is the disability may not add to the value of your case unless it’s catastrophic. If your injuries are determined to be catastrophic, it would.
Don’t worry about it. This is the legal stuff. I’m just trying to educate you.
Defense Against Your Workers’ Comp Case
And ultimately, there’s a defense as well that I’m concerned about. Again, that is that even if you’ve worked more than six months and the doctor does find predominant causation, again, the majority of your stress, depression, anxiety related to work. The doctor might address if your psychiatric injury could be apportioned to any personnel action like write ups, disciplinary action, termination, separation.
If ultimately the psychiatrist or psychologist determines that a substantial cause is attributed to some personnel action, then it’s up to the trier of fact to determine if that personal action was what’s called good faith or bad or in bad faith. Right. And there’s a case called Rolda that this doctor needs to do the analysis.
Now, it is what it is. I tell my clients to be honest, but I would avoid discussing and focusing on issues with supervisors or management because that opens up that defense.
Let me give you an example. Let’s say your case is that, same scenario, you got somebody who’s working and, you know, COVID happens and nobody’s working, and now they’re doing five people’s jobs and they’re overworked, and their boss is getting on them and yelling at them for not getting it all done. They’re all stressed out.
Well, if this person went to the neutral psychiatrists and psychologists and said, I’m just being overworked, this is insane. I’m doing, you know, five people’s jobs. And I just, it’s too much. And I’m getting anxiety. Guess what? That is a direct injury, and it’s valid, and there’s no defense there.
But as soon as that person says, my supervisor keeps writing me up because I’m not doing all the work she thinks I, he or she thinks I should do. Soon as you say management, as soon as you say a write up, soon as you say they’re overlooking my shoulder. Now that’s a personnel action.
So to the extent you can avoid focusing on stress coming from management, I recommend that. Because it opens up that defense.
Direct vs a Compensable Consequence
Now, ultimately, if your injury is direct versus a compensable consequence, direct injuries are compensable. Again, the compensable consequences, catastrophic or significant orthopedic injury psych overlay. That may or may not be compensable, but no matter what the medical treatment would be.
And if it’s catastrophic, the disability would be compensable. But again, if it’s a direct injury, the permanent disability is compensable. What do I mean by direct versus indirect? Well, we just went over indirect. Let me go over direct.
Direct is PTSD. This accident caused PTSD. I keep thinking about it. I have nightmares about it when I hear the sound, it freaks me out. That’s PTSD. That’s a direct injury.
A direct injury is also harassment. It is also being overworked. Those are direct injuries. Again, I would just avoid focusing on any management or personal action that sets up a defense. All right. That’s just the foundational issues here.
Advice for Your Psychiatric QME Evaluation
Now, at the end of the day, here’s the advice. Be on time. Be honest. Don’t argue with this person. Even if you think they’re being rude or condescending, kill them with kindness. We want this doctor to like you and write a good report for you.
Don’t exaggerate, but don’t minimize. Don’t say you can’t do things that you do or that you know you can’t do things that you can or that you don’t do things that you do. But don’t say that you’re fine when you’re not. Being stoic or minimizing is not going to help you here. Just be honest.
Now, also, remember, the doctor might ask you about your current complaints. Well, that second, you might be feeling okay, but that the word current doesn’t mean that second, it means the last month. Okay.
I also like to discuss good days and bad days because, you know, people with emotional injuries, stress, depression, anxiety, pain disorders, they have good days. They have bad days. So it’s okay to smile and have a good day. But be honest about the bad days and be honest about the good days, but discuss what a bad day looks like and discuss what a good day looks like. All right.
Your Disability Is Based on the AMA Guides
Normally your disability is based upon this book called the AMA Guides. And that’s the case here.
GAF Scale
However, the AMA guides incorporate something called the Global Assessment of Functioning, or what’s called the GAF scale. So I’m going to go into a little bit more detail here on this one because I want you to truly see how they rate your disability.
So in a psychiatric injury or a psychological injury, the way they look at this is they look at how your injuries affect you in your ability to socialize, in your ability to work or maintain school functioning.
So ultimately, if you say, oh, I could work just fine. I get along with everybody just fine. Guess what? You probably don’t have a psychological injury.
So I’m going to show you and read verbatim, literally, what the GAF scale is. Now, ultimately, in a GAF scale of above 71. So 71 to 80 is one code, 81 to 90, and it goes up. But if you’re above roughly 71%, there really isn’t significant disability here. And let me read to you what that is. And honestly, once I read this, everybody can fall in any one of these categories.
Transient Symptoms
So for a psychiatric injury and no disability, it is this. If symptoms are present, they are transient and expected reactions to physio or social stressors, and that is no more than slight impairment in social, occupational and school functioning.
So basically this is everybody has a little bad day, but you’re fine and generally don’t have any permanent disability.
Mild Symptoms
Now this is when it starts getting a ratable disability, ready. Some mild symptoms. So as soon as you have mild symptoms you’re into ratable disability. Examples, depressed mood, mild insomnia or some difficulty in social, occupational, or school functioning. Some examples: occasionally truant, theft within the household. I know that’s a weird one. But generally functions pretty well, has some meaningful interpersonal relationships, so some mild symptoms live ratable disability.
Moderate Symptoms
Ready, the next one that gets much higher disability, moderate symptoms. Flat affect and circumstantial speech, occasional panic attacks or moderate difficulty in social, and occupational/school, functioning. Some examples, few friends, conflicts with peers or coworkers. This is almost everybody here, okay. Occasional panic attacks.
Let me discuss this. Very often when you have an anxiety disorder, you’ll have people that used to be able to function pretty well socially or at work, and now all of a sudden they’re having bouts of anxiety. You might feel that your palms get a little sweaty, your heart rate bounces a little bit or increases, you might feel that you get a little pale or cool or sweaty, and you get this urge to just get away and sort of isolate. That’s a panic attack.
So any of those panic type symptoms that are reoccurring, tell the doctor about this. And if you get this frequently, take some notes on it so you don’t have to remember it. Doctor, I had three last week. I had four the week before. Take notes in there. Okay.
Serious Symptoms
Now, when you’re getting really high impairment, it is serious symptoms. Okay. So not mild, not moderate, but now serious. And some examples of this: suicidal ideation, severe obsessive rituals, frequent shoplifting, or serious impairment of social, occupational, school function. Examples, no friends, unable to keep a job.
At the end of the day, the way they calculate your impairment, psychiatrically, again, is based on what’s called the GAF scale, Global Assessment of Functioning. And it really just breaks down whether you have mild symptoms, moderate symptoms, or serious symptoms. And again, it’s looking at impact on social; friends, family, social interaction. Occupational or school, work or school. That is, unable to learn new things, can’t focus, this type of stuff. All right.
Information About Suicidal Thoughts
Don’t minimize, don’t exaggerate. There is a barrage of testing that can really figure out whether you’re being honest or dishonest. So, again, don’t try to game the system here. Avoid focusing on personnel action to the extent that’s applicable.
Let me also caution you that, you know, if you are watching this and you have thoughts of harming yourself or others, there’s a big difference between having those thoughts in the past and having those thoughts currently. If you are having those thoughts, it’s unbelievably important to talk to the doctor about that. That’s important so that they can figure out what they need to do for you to make sure to take care of you medically and make sure that that is not coming into fruition.
But it’s also fundamentally important on your case because you’re entitled to an insane amount of disability if you are having suicidal ideation or suicidal thoughts. But I want to caution you, there’s a difference between having them and currently having them. So if you said, “Doctor, listen. Yes, I have. Unfortunately, you know, the pain is so bad. The symptoms are so bad. I have had thoughts of ending it.”
Then they’re going to be, probably very high impairment and it’s going to be good evidence for you. But if you say, doctor, I’m currently having that. The doctor potentially has to put you on a three day hold for suicide watch. So if you say I want to harm myself now or someone else, they’ve got to call the police, they got to put you on a hold.
But saying I’ve had thoughts of it is different and they don’t have to put you on the hold. But if you are currently having it, honestly, tell the doctor you’re currently having it. Because that hold might save your life. And that hold, if that happens, is something that shows how seriously disabled you are.
Summary of Advice for Your Psychiatric QME Evaluation
So again, it’s important to realize that the goal of this evaluation is that really this doctor just likes you, wants to write a good report for you. And we want to report finding the greatest amount of psychiatric disability. And the greatest need for a future medical on an industrial basis.
Ultimately, be honest about prior injuries and prior treatment. They’re going to find out about it. And again, as long as you’re honest, the cards will fall where they fall, and we will do our job to take that medical evidence and advocate for you on your behalf.
Avoid, again, speaking about personnel action as that opens up a defense. But it is what it is. And if there is a direct harasser, if there’s like somebody harassing you as the cause, be honest. It is what it is. Focus on that. Tell the truth.
But if you have problems with coworkers or people below you, that’s a compensable injury. So if I’m overworked, if my coworkers are rude or condescending and causing me stress, if I’m dealing with patrons or customers who are irate, I can’t tell you how many DMV workers I have that file stress claims because they’re dealing with customers that are just going off on them because they’ve waited so long. But all those are valid.
But as soon as you open the door to the personnel action, it opens up that defense, which then we have to prove that it wasn’t in good faith, it was in bad faith. And that likely increases the probability of your case going to trial.
But again, this is just a general prep video for psychological PQME evaluations. I covered a lot. A lot of this may not be applicable to you. A lot of it may. But the general take home again is this. If you take home anything, it’s this. Be on time. Be polite, be respectful, don’t minimize your pain or symptoms. Don’t exaggerate your pain and symptoms.
Be honest about all your prior treatment records. Be honest about what is currently going on. Don’t try to game the system. Be prepared for a long, lengthy evaluation and lots of testing. Also, be prepared for them to ask lots of personal questions because the defense will want to try to contend that there’s no predominant causation. It’s outside stressors that are causing it, not work.
Don’t worry about the legal side of the stuff. That’s why we have it. And honestly, take a deep breath. You’re going through a lot, and this upcoming evaluation is a big part in your case. And if that if we get good evidence coming back from that, that really is very helpful. And probably the single biggest piece of evidence on your case to help us help you. That is, help us get your case resolved or go to trial and get a verdict to make sure that we show that you sustained a valid industrial injury, that you’re entitled to compensation and you’re entitled to future medical.
Contact Burgis Law with Questions About Your Psychiatric QME Evaluation
I hope this video has been helpful. If you have any questions or concerns, call us. We can go over and do a more individual approach for you. I look forward to timely adjudicating your case. Just remember that there’s light at the end of the tunnel and we’re almost here if you’re getting this video, and I look forward to a happily ever after.
