From Trauma to Recovery: Identifying Psychological Trauma in a Workers’ Compensation Case

By: | July 30, 2025

Dr. Ronda McCarthy is the senior director of Medical Operations, Medical Surveillance, and Telebehavioral Health Services at Concentra®. She leads a panel of medical experts who advise on hazardous chemicals and physical exposure standards. A recognized industry speaker and published researcher, McCarthy has testified before Congress on heat stress and its prevention. Board-certified in occupational medicine, she earned her medical degree from the University of Texas Health Science Center in Houston and completed her residency training at the University of Pennsylvania Perelman School of Medicine.

Integrating mental health into a workers’ compensation case can be a delicate but essential balancing act. Structured assessments conducted by trained mental health professionals can help distinguish between genuine symptoms and exaggerations to validate psychological trauma in a workers’ compensation claim.

That being said, focusing on mental health can benefit all workers’ compensation stakeholders. Employers can better support their workforce by recognizing mental health issues, leading to more accurate claims management and reduced costs. Adjusters receive clearer assessments, while clinicians can address both physical and psychological injuries for more holistic care.

Some states allow mental health claims tied to compensable physical injuries, while other states permit claims without any bodily injury. Treating physicians should be skilled in early detection, documentation, and appropriate referrals to mental health professionals to support functional recovery and ensure legal compliance. Recognizing psychological trauma early can also help reduce workers’ compensation costs linked to delays in recovery. Understanding the complexities of integrating mental health into the workers’ compensation process is essential. A critical component in this integration involves validating a mental health claim.

Mental Health Assessment Process

Validating symptoms of psychological trauma reported by the treating physician is vital for ensuring effective treatment and wisely allocating resources. Validation is pursued primarily in workers’ compensation injury cases in which a treating physician suspects malingering, which involves intentionally fabricating or exaggerating symptoms for financial gain, work avoidance, or other reasons.

Malingering could be suspected when a treating physician notices inconsistencies in a patient’s reported symptoms or behaviors compared to medical findings. In these scenarios, the treating physician may refer the patient to a mental health professional, such as a psychologist, for evaluation. A psychologist would conduct a thorough assessment to understand the individual’s mental health status.

Screening Tools

Psychologists use structured screening measures combined with conversation and patient interviews as part of the mental health assessment process. Some standard screening tools include:

Patient Health Questionnaire 9-Item (PHQ-9)

  • Screens for depressive symptoms
  • Utilized if the patient exhibits a low mood or poor motivation during the initial consultation

Generalized Anxiety Disorder 7-Item (GAD-7)

  • Assesses anxiety levels
  • Utilized if the patient presents with worry, fear, tension, etc.

Impact of Event Scale-Revised (IES-R)

  • Evaluates trauma-related distress
  • Utilized if the patient’s injury involved a traumatic event (e.g., workplace violence)

Fear-Avoidance Beliefs Questionnaire (FABQ)

  • Evaluates fear of movement/reinjury
  • Utilized if the patient is hesitant to resume regular physical activity (e.g., work duties)

Another useful screening tool is the Structured Inventory of Malingered Symptomatology (SIMS) questionnaire, which helps determine if someone is genuinely experiencing symptoms or exaggerating. A score below the cutoff indicates no exaggeration, while a score above suggests the need for further investigation.

While patient interviews and discussions allow psychologists to understand the patient’s experiences and emotions on a more personal level, a comprehensive screening approach provides a thorough and objective view of the patient’s mental health. It can facilitate more accurate diagnosis and treatment planning.

The Urgency of Mental Health in Workers’ Compensation

When addressing workplace injuries, it’s essential to recognize that physical recovery may only be one piece of the puzzle. Some workplace incidents can leave invisible scars that are as debilitating as physical injuries. Psychological trauma can take many forms — from stress or situational anxiety to depression or post-traumatic stress disorder (PTSD) — which can impact injury recovery, treatment compliance, and return-to-work (RTW) readiness. Prioritizing mental health alongside physical recovery can foster a healthier work environment and help improve workers’ compensation system effectiveness. &

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