Workers' Compensation Psychological Report
Created by
Rebecca Thompson
Specialty
Psychologist
Last edited
10/20/2026
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About this template
A structured template for documenting a psychological evaluation related to a work-related injury, including patient, referral, employer, incident, work-status, pain, emotional-functioning, diagnostic, recommendation, and follow-up information.
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Psychological Report
Patient Information
The patient's full name is Marcus Vance.
The patient's date of birth is 14/08/1982.
The patient resides at 42 Banksia Street, Parramatta, NSW 2150.
The patient can be contacted via mobile on 0412 345 678 or by email at m.vance82@email.com.au.
Referral Information
The patient is a 42-year-old male.
The patient was referred for psychological assessment and intervention by Dr Sarah Jenkins at Parramatta Medical Centre.
Employer Information
The patient is employed by Metro Logistics Pty Ltd.
The employer is located at 18 Industrial Drive, Wetherill Park, NSW 2164.
The employer's return-to-work coordinator, David Chen, can be contacted on (02) 9876 5432.
Work Incident Details
The workplace injury occurred on 12/01/2025.
The incident took place at approximately 14:15.
The injury occurred in Loading Bay 3 of the Wetherill Park distribution warehouse.
The patient was operating a pallet jack when a nearby shelving unit collapsed, pinning his lower back and right leg beneath heavy freight and causing him to fear for his life until coworkers extracted him.
Current Work Status
The patient is currently certified as unfit for any duties.
The patient has strict physical restrictions against lifting over 2 kg, prolonged sitting or standing exceeding 15 minutes, and a psychological restriction against entering warehouse environments due to trauma triggers.
These work restrictions are estimated to remain in place for at least the next 4 weeks pending further clinical review.
Pain and Current Functioning
The patient reports constant, dull aching pain in the lumbar spine rated at 6/10, with intermittent sharp radicular pain down the right leg reaching 8/10.
The pain commenced immediately following the workplace crush incident on 12/01/2025.
The persistent pain significantly limits his mobility, prevents him from driving for more than 20 minutes, and impairs his ability to perform household chores.
Recent MRI findings noted an L4-L5 disc protrusion with mild neural impingement, and his GP has prescribed pregabalin (Lyrica®) 75 mg PO BID and paracetamol (Panadol®) 1,000 mg PO QID PRN.
Current Emotional and Behavioural Functioning
The patient presents with a depressed and anxious mood, flat affect, frequent irritability, and hypervigilance regarding his physical safety.
He experiences severe initial insomnia and frequent nocturnal awakenings due to both physical pain and recurrent nightmares of the shelving collapse, averaging 4 hours of broken sleep per night.
He requires assistance from his spouse for heavy domestic tasks and grocery shopping, though he remains independent in basic personal hygiene.
The patient has withdrawn from his local social cricket club and avoids speaking with work colleagues due to feelings of helplessness and anxiety.
He reports a reduced appetite resulting in an unintentional weight loss of 3 kg over the past two months.
The patient identifies his supportive wife and his adherence to daily gentle hydrotherapy exercises as his primary protective factors.
Impression and Recommendations
The patient meets the DSM-5-TR diagnostic criteria for Post-Traumatic Stress Disorder (PTSD) and Adjustment Disorder with Depressed Mood, secondary to his workplace injury and chronic pain.
His clinical presentation is characterised by intrusive trauma memories, avoidance of workplace reminders, hyperarousal, sleep disturbance, low mood, and pain-related functional impairment.
Treatment goals focus on stabilising his sleep hygiene, reducing trauma-related hyperarousal, developing adaptive pain-coping strategies, and facilitating a graded return to safe work duties.
It is recommended that the patient attend weekly 50-minute psychological sessions utilising Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and pain management psychoeducation for an initial block of 8 sessions.
Follow-Up
The patient's next appointment is scheduled for 24/04/2025 at 10:00.
It is recommended that his referring GP review his current analgesic and psychotropic regimen to optimise sleep, and a referral to an occupational rehabilitation provider is advised when he is medically cleared for light duties.
How to use this template
This template can be used to assist with various tasks in the medical field. You can use it to generate notes, manage patient information, or assist with diagnosis and the Assessment and Plan. To use this template, simply click the “Use Template” button above. If you have any questions or need assistance, feel free to reach out to the support team or refer to the description and example output provided above.