The Psychiatric QME Changed the Opinion: Compare What Changed in the Cause Analysis

If a psychiatric qualified medical evaluator changes from supporting your workers’ comp claim to rejecting work causation, start with the explanation for the change. Compare the work events the doctor accepted in each report, the new information reviewed and the allocation among all causes. A new percentage has to rest on a reasoned medical analysis.

The distinction matters in California because an ordinary psychiatric-injury claim requires actual employment events to be predominant—more than 50 percent—among all combined causes. The statute has a different substantial-cause rule for specified violent-act circumstances. Our guide to psychiatric percentages explains that branch distinction. The separate defense for lawful, nondiscriminatory, good-faith personnel actions adds another question. A report can blur the two if it treats a disputed work event and an employer’s response as the same cause. The employer bears the burden of proving the personnel-action defense.

Compare the factual premise before comparing percentages

Read the first report’s history and causation sections beside the later report. Identify precisely what the doctor originally assumed. Did the opinion depend on an unsecured worksite, repeated threats, a particular supervisor’s conduct or a version of a disciplinary meeting?

Then find the evidence said to change that premise. A witness statement may disprove an event, dispute who caused it or describe an employer’s response to it. Those changes have different effects. If the doctor describes evidence that was never actually reviewed, the factual basis for the medical opinion needs scrutiny. Keep the document and its actual language beside the doctor’s description so you can see whether the evaluator addressed the same fact.

For example, an employer may show that a worker was responsible for leaving a door unlocked. That evidence addresses responsibility. It does not erase the unlocked-door condition or establish its medical effect. In Tedla v. Santa Rosa City Schools, the Board required that distinction after the evaluator changed her opinion in response to employer evidence.

Ask what replaced the original cause analysis

Mark every stated cause and percentage in both reports. Look for the explanation connecting the new information to the revised allocation. If the doctor reduces the employment contribution, identify which other causes now account for the difference and the medical basis for that conclusion.

A useful review asks:

• Which employment events does the later opinion still accept?
• Which records did the evaluator actually review, and which are merely mentioned?
• What nonindustrial causes are identified and explained?
• Does the report distinguish the cause of the psychiatric injury from who was at fault for a work event?

These questions identify the gap for counsel and the evaluator. They are not an invitation to choose a preferred percentage. A doctor can change an opinion after receiving accurate new information; the resulting explanation still needs to support the conclusion.

Keep personnel actions identifiable

A performance warning can appear beside evidence of the underlying working condition. Record each separately. The medical cause may be fear during a night shift, distress over an accusation, the disciplinary response, or a combination. The legal classification of a personnel action is the judge’s task, while its medical contribution calls for medical evidence.

The Tedla decision’s discussion of Rolda explains the sequence: Determine actual employment events, evaluate predominant medical causation, and then address the personnel-action defense where applicable. A single label such as “work stress” does not supply those separate answers.

Other statutory requirements can also affect a psychiatric claim. This comparison is directed at a changed causation report; the claim’s employment history, alleged injury and asserted defenses still need their own review.

Preserve the report sequence and request the right clarification

Keep the original reports, supplements, deposition transcripts, exhibit lists and correspondence transmitting records. Make a short comparison with three columns: The earlier factual premise, the new evidence and the later medical explanation. Include unfavorable evidence accurately. Omitting it can conceal the very reason the doctor changed course.

Have counsel decide whether the problem calls for correction of an inaccurate history, supplemental reporting, deposition questions or another appropriate procedural step. Medical-legal communications have governing rules; avoid sending an unsolicited merits explanation to the evaluator yourself.

Finally, preserve any decision and its proof of service. In Tedla, the Board addressed failure to serve the worker directly and applied the rule that the filing period for a defectively served order runs from actual receipt. That service question required separate attention before the Board reached causation. If an order has issued, obtain advice promptly about the actual deadline rather than waiting for the medical-report problem to resolve itself. The Tedla opinion sets out the findings and remand. Our guide to psychiatric percentages addresses the separate question of what a stated percentage measures.