Attorneys Guide to Neuropsychological Evaluations in Workmen’s Compensation Claims

The consistent problem facing attorneys who take on workman’s compensation claims is that the cognitive and emotional changes that often follow a brain injury are invisible. Unlike a broken limb, it is hard to see and prove that an individual is experiencing cognitive challenges. As such, the legal profession has been referring their clients more and more often for neuropsychological evaluations. Going well beyond being generally accepted, neuropsychological testing is considered the gold standard of cognitive assessment within the medical community. Specifically, tests neuropsychologists commonly use are considered valid, reliable, repeatable and have known rates of error. These tests have also been extensively researched and repeatedly subjected to peer review.

In short, a neuropsychologist’s approach to diagnosis and treatment planning is uniquely suited to demonstrate, to a reasonable degree of certainty, what kinds of cognitive and emotional injuries an individual has sustained.

Making Neuropsychological Terms Make Sense

Head injuries experienced on the job are referred to by a number of different names.  The most common names for these head injuries include:

  • concussion
  • traumatic brain injury, (TBI)
  • mild traumatic brain injury (mTBI).

Attorneys are painfully aware that, neither these terms nor the accompanying medical records convey much about the severity of changes in thinking abilities i.e., cognitive functioning, or emotional functioning someone is experiencing. Often times, it is very clear to the individual who has suffered a brain injury that things “just aren’t the same.” At other times, the brain injury may limit their ability to see how much has changed. Instead, it may be their loved ones who notice them being forgetful, confused or quick to anger.

 A “Behavioral MRI” Can Show What MRIs and CT Scans Miss

Complicating an attorney’s efforts to demonstrate the true extent of their client’s injury is that even the most advanced brain imaging techniques cannot show changes in an individual’s actual abilities or their capacity to return to work, for example. Beyond this, neurologists or psychiatrists are limited by their clinical judgment to make educated guesses about the extent of brain damage sustained. This is where neuropsychological testing, sometimes referred to as a ‘behavioral MRI,’ becomes indispensible.

Objective Proof of Cognitive Disability

Through the use of objective, evidence-based techniques, neuropsychologists who are familiar with workers compensation evaluations can determine what abilities have changed and how much. The measured nature and severity of these so-called posttraumatic sequelae provide information regarding whether an individual can eventually return to work, or what the healing time needed to regain their previous level of functioning may be.

Fortunately, the majority of brain injured individuals’ thinking abilities improve with time, but not everyone’s memory, ability to think clearly, to speak, to understand others and so on return to their previous baseline. Neuropsychological evaluation can address these issues as well.

How a Neuropsychological Evaluation Works

All neuropsychological evaluations measure a variety of areas or domains, which often include attention, memory, executive functioning (i.e., organizing and planning), memory, language, visual and spatial abilities and fine motor skills.

The tests themselves can be thought of as high tech ‘brain teasers,’ which include specialized puzzles and memory tests that allow the clinician to evaluate a patient’s strengths and weaknesses within each cognitive domain. It is the specific pattern of deficits in these domains that neuropsychologists use to determine the correct diagnosis.

Importantly, this same pattern can be used to help develop a treatment plan that is specifically tailored to help the patient use their remaining strengths to make up for their weaknesses – and improve their chances of recovery. When clinically indicated, some neuropsychologists also employ a different type of brain imaging called functional neuroimaging (tools such as PET, qEEG and SPECT) to answer certain questions.

The Forgotten Symptoms of a Brain Injury

Much of the focus on individuals with brain injuries involves their altered thinking skills. Indeed, these abilities can severely limit day-to-day functioning, but all to often debilitating changes in emotional functioning are overlooked. In addition to being the kinds of topics that attorneys may find too personal to ask about, legal professionals may not know what kinds of questions to ask or how to follow up if their client starts talking about their emotional challenges. Again, a neuropsychologist’s interview accompanied by a variety of objective measurements makes navigating this otherwise daunting task rather easy.

It is very common for people who have sustained any kind of brain insult to experience depression following their injury. Of course people get depressed when their thinking, their lifestyle and their livelihood are threatened, but there are also strictly neurologic reasons for why a brain injured person’s outlook on the world may turn hopeless and dark. Anxiety and worry similarly can be caused directly by the brain injury, and than can be exacerbated by changing life circumstances.

Commonly, brain injured individuals are quick to become emotional. Sometimes this takes the form of crying at what seems like a minor frustration, or some times it takes the form of being irritable, easily frustrated or quick to anger. It is quite common for a brain-injured individual to be unaware of their irritability, feel criticized when asked or prefer to deny that this is a problem.

As a result, attorneys are urged to speak to a family member if a neuropsychological evaluation is impractical.

Deciding When a Client Can Benefit From a Neuropsychological Evaluation

As an attorney, you are in a unique position to assist your client in getting the help they need to recover while simultaneously obtaining reliable, objective data of what difficulties they truly are having. These two pieces of the puzzle are essential to making a person whole again.

Neuropsychological reports themselves deserve their reputation as being confusing, and those written by neuropsychologists not familiar with worker’s compensation claims or forensic evaluations can be downright terrible.

In my practice, I make a concerted effort to ensure that my reports are as clear as possible, but there are limits because this is the brain we are talking about. As such, I offer feedback sessions, whenever practical, to both attorney and the patient/family to discuss the final report and recommendations. This feedback session is spent explaining what the report means, why they did or did not meet criteria for certain diagnoses, and most importantly, where to go from here.

In the end, it is important to me that my evaluations are useful to all involved. Because of this, I make great efforts to avoid the ‘diagnose and adios’ approach to neuropsychological evaluation.