Signs an Employee Needs a Referral to an FFDE Psychologist in Los Angeles for Cognitive Decline

KEY TAKEAWAYS

Recognizing when an employee's cognitive functioning warrants a fitness-for-duty evaluation (FFDE) requires attention to objective, job-related performance changes. Warning signs include memory lapses, declining attention and processing speed, poor judgment, difficulty learning new tasks, behavioral changes linked to cognitive strain, safety incidents, and credible supervisor reports. When properly documented and tied to essential job functions, these indicators provide the foundation for a legally defensible FFDE referral.

Cognitive decline can stem from numerous causes, but the employer's focus must remain on whether the employee can safely and effectively perform their role. A neuropsychological FFDE provides an objective assessment of cognitive abilities in relation to job demands, offering clarity and legal protection for all parties involved.

If you're unsure whether an employee's cognitive changes warrant a fitness-for-duty evaluation, consulting with an experienced FFDE psychologist in Los Angeles, like Dr. Reger, can clarify your needs. Understanding these signs helps employers make informed decisions that prioritize workplace safety and employee well-being.

Employers, HR directors, and attorneys in Los Angeles are increasingly encountering situations where an employee’s cognitive functioning appears to be changing in ways that affect workplace safety, reliability, or performance. When these concerns are sipurpose of an FFDEgnificant, job-related, and objectively documented, a Fitness for Duty Evaluation (FFDE), often conducted by an FFDE psychologist with neuropsychological expertise, may be the appropriate next step.

Cognitive decline is not limited to older adults. It can arise from medical conditions, neurological illness, psychiatric disorders, sleep problems, substance use, or even untreated stress. The key question for employers is not why the decline is occurring, purpose of an FFDE, but whether the employee can safely and effectively perform essential job functions. That is the purpose of an FFDE.

Below are the most common workplace indicators that suggest an employee may need a referral for a psychological or neuropsychological FFDE in Los Angeles.

1. Noticeable Changes in Memory and Recall

One of the earliest signs of cognitive decline is difficulty retaining or retrieving information. In the workplace, this may appear as:

• Forgetting critical steps in routine tasks

• Repeatedly asking the same questions

• Losing track of deadlines or instructions

• Misplacing important documents or equipment

When memory lapses begin to compromise safety, productivity, or workflow, an FFDE can help determine whether the employee’s cognitive functioning is adequate for their role.

2. Declining Attention, Focus, or Processing Speed

Employees experiencing cognitive decline may struggle to sustain attention or process information efficiently. HR teams often notice:

• Increased errors in detailed work

• Slower completion of tasks that were previously routine

• Difficulty multitasking

• Trouble following conversations or meetings

In safety-sensitive industries like transportation, healthcare, utilities, and public safety, these changes can create significant risk exposure.

3. Poor Judgment or Decision-Making

Cognitive decline can impair executive functioning, leading to questionable decisions or lapses in judgment. Examples include:

• Inappropriate responses to routine problems

• Difficulty prioritizing tasks

• Misinterpreting workplace cues or safety protocols

• Overlooking obvious risks

When judgment concerns intersect with essential job duties, a neuropsychological FFDE provides a structured, defensible assessment of functional capacity.

4. Difficulty Learning New Tasks or Adapting to Change

Employees with emerging cognitive impairment may appear overwhelmed by new procedures, technology updates, or workflow changes. Warning signs include:

• Requiring excessive retraining

• Becoming confused by routine updates

• Inability to retain new information

• Resistance to change due to cognitive strain rather than attitude

In Los Angeles workplaces where technology and compliance requirements evolve rapidly, this pattern is often one of the earliest red flags.

5. Behavioral or Emotional Changes Linked to Cognitive Strain

Cognitive decline can manifest behaviorally, especially when the employee is aware of their difficulties. Employers may observe:

• Irritability or frustration

• Withdrawal from colleagues

• Increased anxiety or emotional volatility

• Defensive reactions when errors are pointed out

These behaviors alone do not justify an FFDE—but when paired with objective performance concerns, they strengthen the case for evaluation.

6. Safety Incidents or Near Misses

For safety-sensitive roles, even minor cognitive changes can have serious consequences. Red flags include:

• Operating equipment incorrectly

• Forgetting safety steps

• Near-miss accidents

• Inconsistent adherence to protocols

Under ADA and FEHA, employers may request an FFDE when there is objective evidence that an employee’s condition may pose a direct threat or impair essential job functions.

7. Reports or Concerns From Supervisors or Coworkers

Supervisors often notice subtle changes first. When multiple individuals independently report concerns, especially about reliability, confusion, or errors, an FFDE may be warranted. Documentation is essential, and the referral must be tied to job-related concerns.

Cognitive decline is a sensitive issue, and employers must balance compassion with legal and safety obligations. A psychological or neuropsychological FFDE provides a structured, objective, and legally defensible way to determine whether an employee can continue performing their role safely and effectively.

DO YOU NEED A COGNITIVE FFDE IN LOS ANGELES? AN FFDE PSYCHOLOGIST in LOS ANGELES can help you decide on fit for duty testing

Choosing the right type of fitness for duty evaluation when cognitive decline is suspected can feel complex, but working with the right FFDE psychologist in Los Angeles means you don't have to figure it out alone. Dr. Stacy Reger specializes in neuropsychological fit for duty testing for employees showing signs of cognitive impairment, bringing the clinical expertise needed to assess memory, attention, judgment, and decision-making in relation to essential job functions. Serving employers, HR directors, attorneys, and safety-sensitive industries across California, Dr. Reger is based in Los Angeles and available statewide for fitness for duty evaluations addressing cognitive concerns. Here's how to get started:

1. Request a consultation: Contact Dr. Reger to discuss your workplace concerns, clarify whether cognitive decline is impacting job performance, and determine whether a neuropsychological FFDE is the right fit for your situation

2. Gather and submit documentation: Performance reviews, incident reports, job descriptions, supervisor observations, and other relevant materials help inform a thorough and objective evaluation of cognitive functioning

3. Schedule your FFDE: Work with an experienced FFDE psychologist in Los Angeles who understands both workplace law and neuropsychology. Dr. Reger will coordinate an evaluation time and setting that works for your organization's needs

4. Receive your report: A clear, thorough, and legally defensible report with findings and recommendations will be delivered upon completion of the evaluation, helping you make informed decisions about workplace accommodations, safety, and next steps

OTHER SERVICES WITH DR. STACY REGER IN LOS ANGELES, CALIFORNIA

When it comes to cognitive fitness for duty evaluations, having a psychologist who specializes in neuropsychological assessment means your organization receives the most accurate, objective evaluation for employees showing signs of cognitive decline. Dr. Stacy Reger has extensive expertise in neuropsychology and workplace capacity assessments, ensuring that when cognitive concerns arise, you can expect a rigorous, well-documented evaluation that holds up to legal scrutiny. The result is a defensible report that gives employers, attorneys, and organizations the clarity needed to make sound, confident decisions.

Fitness for duty evaluations represent only one dimension of Dr. Reger's extensive practice. She offers psychological testing and neuropsychological assessments for issues ranging from cognitive decline to learning difficulties, as well as capacity evaluations addressing financial and testamentary decision-making. Her med-legal services encompass Independent Medical Evaluations and workers' compensation psychological and neuropsychological evaluations, available through her roles as both a Qualified Medical Evaluator and Agreed Medical Evaluator. Dr. Reger also performs adult neuropsychological evaluations for conditions such as TBI, stroke, ADHD, and dementia, and conducts pre-surgical psychological evaluations for patients preparing for spinal cord stimulator implantation, bariatric surgery, and organ transplants. Rounding out her practice, she is available as an expert witness, public speaker, and consultant, and provides individual psychotherapy and therapeutic support specifically designed for older adults.

Take some time to explore Dr. Reger's blog for deeper insight into her areas of expertise. When you're ready to take the next step, she encourages you to reach out directly.

ABOUT THE AUTHOR

With nearly two decades of experience in neuropsychological assessment, Dr. Stacy Reger, Ph.D., is uniquely positioned to evaluate cognitive decline in workplace settings and determine when an employee's functioning raises legitimate fitness for duty concerns. After completing her Ph.D. in Clinical Psychology from an APA-accredited program at the University of Nevada, Las Vegas, Dr. Reger went on to build and direct a neuropsychological testing clinic at the Long Beach VA Healthcare System, an experience that sharpened her ability to identify subtle cognitive changes affecting memory, judgment, attention, and executive functioning in real-world contexts. Her advanced training in clinical geropsychology at the San Francisco VA Medical Center further deepened her expertise in detecting and documenting cognitive impairment across diverse populations and clinical presentations. A licensed clinical psychologist (PSY #27639), Dr. Reger has spent her career working across complex medical, neurological, and aging-related settings, giving her the real-world perspective and clinical precision that employers, HR directors, and attorneys rely on when they need clear, objective, and legally defensible FFDE findings related to cognitive capacity and workplace safety.

Psychiatric vs. Neuropsych Fit-For-Work Testing: Exploring the Difference

Key Takeaways

Psychiatric and neuropsychological fitness-for-duty evaluations (FFDEs) are essential tools for assessing employee capabilities when behavioral or cognitive concerns arise. Psychiatric FFDEs focus on emotional and mental health factors, while neuropsychological FFDEs evaluate cognitive functioning and brain-based abilities. Each type addresses different issues: psychiatric evaluations are sought for emotional instability and risk factors, while neuropsychological assessments are used for cognitive decline and related job performance issues.

Choosing the right evaluation is crucial for legal defensibility, accurate risk assessment, and appropriate recommendations. If you're unsure which evaluation fits your situation, consulting with an experienced FFDE psychologist in Los Angeles, like Dr. Reger, can clarify your needs. Understanding these distinctions helps employers make informed decisions that prioritize workplace safety and employee well-being.

When an employee’s behavior, emotional stability, or cognitive functioning raises concerns about workplace safety or performance, employers and attorneys often turn to Fitness for Duty Evaluations (FFDEs). These evaluations help determine whether an individual can safely and effectively perform essential job duties, whether accommodations are appropriate, or whether temporary removal from duty is warranted.

But not all FFDEs are the same. Two common types are psychiatric and neuropsychological fitness-for-work evaluations. While both fall under the broader umbrella of psychological assessment and are usually performed by a licensed psychologist with expertise in testing, they answer different referral questions, rely on different methods, and address different domains of functioning. Understanding the distinction is essential for employers, HR leaders, risk managers, and legal counsel who need clear, defensible information to guide personnel decisions.

This article breaks down the key differences, clarifies when each type of evaluation is appropriate, and explains what employers can expect from the process.

What Is a Psychiatric/ Psychological Fitness-for-Duty Evaluation?

A psychiatric FFDE focuses on an employee’s emotional, behavioral, and mental health functioning as it relates to job performance and workplace safety. These evaluations are often conducted by a licensed psychologist with expertise in mental health disorders and occupational functioning.

What psychiatric FFDEs assess

• Mood stability (e.g., depression, mania, irritability)

• Anxiety, panic, or trauma-related symptoms

• Impulse control and behavioral regulation

• Stress tolerance and coping skills

• Interpersonal functioning and conflict patterns

• Thought processes, including potential psychosis or delusional thinking

• Risk factors such as suicidality, aggression, or impaired judgment

When psychiatric FFDEs are typically requested

Employers and attorneys often seek psychiatric evaluations when there are:

• Reports of emotional instability or unpredictable behavior

• Concerns about workplace conflict, threats, or boundary violations

• Incidents involving use-of-force

• Sudden changes in demeanor, reliability, or professionalism

• Indications of stress-related impairment

• Questions about whether a mental health condition is affecting job performance

A psychiatric FFDE answers questions such as:

• Is the employee psychologically stable enough to perform essential job duties?

• Is there a mental health condition contributing to the observed behavior?

• What is the level of risk to self, coworkers, or the public?

• Are accommodations or treatment recommendations appropriate?

• With accommodations or treatment recommendations, what is the likelihood that this employee can continue working in their role?

What Is a Neuropsychological Fitness-for-Duty Evaluation?

A neuropsychological FFDE evaluates cognitive functioning, that is, the brain-based abilities required for safe, consistent, and effective job performance. These evaluations are conducted by a clinical psychologist or neuropsychologist trained in brain-behavior relationships and standardized neuropsychological testing.

What neuropsychological FFDEs assess

• Attention and concentration

• Memory and learning

• Processing speed

• Executive functioning (planning, organization, judgment, inhibition)

• Problem-solving and reasoning

• Visual-spatial skills

• Language abilities

• Cognitive fatigue and consistency of effort

When neuropsychological FFDEs are typically requested

These evaluations are appropriate when there are concerns about:

• Cognitive decline or dementia

• Traumatic brain injury or concussion

• Stroke or neurological illness

• Long COVID or post-viral cognitive symptoms

• Significant attentional or memory lapses that impact work performance

• Slowed processing or difficulty keeping up with job demands

• Safety-sensitive errors or near-miss incidents

A neuropsychological FFDE answers questions such as:

• Does the employee have cognitive impairment affecting job performance?

• What specific cognitive domains are impacted?

• Is the impairment temporary, progressive, or stable?

• What accommodations or restrictions are necessary for safe work?

• With accommodations or treatment, can this employee remain in their role?

Psychiatric vs. Neuropsych FFDEs: Key Differences at a Glance

• Psychiatric FFDE

  • Focuses on emotional, behavioral, and mental health functioning

  • Evaluates mood, anxiety, impulse control, thought processes, and risk

  • Uses clinical interview, behavioral observation, and psychological testing

  • Appropriate for behavioral instability, emotional dysregulation, or psychiatric symptoms

  • Answers “Is the employee emotionally stable and behaviorally safe?”

• Neuropsychological FFDE

  • Focuses on cognitive functioning and brain-based abilities

  • Evaluates memory, attention, processing speed, and executive functioning

  • Uses clinical interview, behavioral observation, and standardized neuropsychological tests

  • Appropriate for cognitive decline, neurological conditions, or safety-sensitive cognitive errors

  • Answers “Does the employee have the cognitive capacity to perform essential duties?”

Both types of evaluations may overlap, and in some cases, a combined FFDE that evaluates both psychological and neuropsychological functioning is recommended.

Why Does the Distinction Matter for Employers and Attorneys?

Choosing the correct type of evaluation is essential for:

1. Legal defensibility

A well-matched evaluation ensures:

• The referral question is answered directly

• The assessment is job-related and consistent with business necessity

• The findings align with ADA, FEHA, EEOC, and/or POST guidelines

2. Accurate risk assessment

Psychiatric and cognitive risks manifest differently. A misaligned evaluation can miss critical information or over-pathologize normal behavior.

3. Appropriate recommendations

Treatment, accommodations, and return-to-work decisions depend on understanding the root causes of impairment, whether they are emotional, cognitive, or both.

4. Efficient case resolution

Clear, targeted evaluations reduce delays, minimize disputes, and support timely personnel decisions.

How Employers and Attorneys Can Choose the Right Evaluation

Consider the primary concern:

• Behavioral instability, emotional volatility, or interpersonal conflict → Psychiatric FFDE

• Memory lapses, slowed processing, errors, or suspected neurological issues → Neuropsychological FFDE

• Both emotional and cognitive concerns → Combined evaluation

A brief consultation with Dr. Reger can help refine the referral question and ensure the correct assessment pathway. If you are unsure, reach out for a consultation, and she can help you decide what is necessary in your case.

Final Thoughts From a Fit For Duty Clinician

Psychiatric and neuropsychological fitness-for-duty evaluations serve distinct but complementary purposes. For employers, attorneys, risk managers, and HR leaders navigating complex personnel issues, understanding the difference is helpful for making informed, defensible decisions that protect both organizational safety and employee well-being.

When conducted by a qualified psychologist with expertise in occupational functioning, like Dr. Stacy Reger, FFDEs provide clear, objective, and actionable information. This can help your organization move forward with confidence.

Do You Need a Psychiatric or Neuropsych FFDE in Los Angeles, CA? Dr. Reger Can Help You Decide

Choosing the right type of fitness for duty evaluation can feel complex, but working with the right psychologist means you don't have to figure it out alone. Dr. Stacy Reger specializes in both psychological and neuropsychological FFDEs, bringing the clinical expertise needed to match the evaluation type to your specific workplace situation and referral question. Serving employers, attorneys, and safety-sensitive industries across California, Dr. Reger is based in Los Angeles and available statewide for fitness for duty evaluations. In certain qualifying situations, telehealth may also be a practical option for completing the evaluation process. Here's how to get started:

1. Request a consultation

   Contact Dr. Reger to discuss your concerns, clarify the referral question, and determine whether a psychiatric or neuropsychological evaluation is the right fit

2. Gather and submit documentation

   Incident reports, job descriptions, medical records, and other relevant materials help inform a thorough and accurate evaluation

3. Schedule your FFDE

   Work with an experienced FFDE clinician in Los Angeles. Dr. Reger will coordinate an evaluation time and setting that works for your organization's needs

4. Receive your report

   A clear, thorough, and defensible report with findings and recommendations will be delivered upon completion of the evaluation

Other Services With Dr. Stacy Reger in Los Angeles, California

When it comes to fit-for-work testing, having a psychologist who is equally skilled in both psychiatric and neuropsychological evaluations means your organization receives the most accurate, appropriate assessment for the situation at hand. Dr. Stacy Reger has dual expertise, ensuring that no matter which type of FFDE your case calls for, you can expect a rigorous, well-documented evaluation that holds up to scrutiny. The result is a defensible report that gives employers, attorneys, and organizations the clarity needed to make sound, confident decisions.

Fitness for duty evaluations represent only one dimension of Dr. Reger's extensive practice. She offers psychological testing and neuropsychological assessments for issues ranging from cognitive decline to learning difficulties, as well as capacity evaluations addressing financial and testamentary decision-making. Her med-legal services encompass Independent Medical Evaluations and workers' compensation psychological and neuropsychological evaluations, available through her roles as both a Qualified Medical Evaluator and Agreed Medical Evaluator. Dr. Reger also performs adult neuropsychological evaluations for conditions such as TBI, stroke, ADHD, and dementia, and conducts pre-surgical psychological evaluations for patients preparing for spinal cord stimulator implantation, bariatric surgery, and organ transplants. Rounding out her practice, she is available as an expert witness, public speaker, and consultant, and provides individual psychotherapy and therapeutic support specifically designed for older adults.

Take some time to explore Dr. Reger's blog for deeper insight into her areas of expertise. When you're ready to take the next step, she encourages you to reach out directly.

About the Author

With nearly two decades of experience in psychological and neuropsychological assessment, Dr. Stacy Reger, Ph. D., is uniquely positioned to evaluate the nuanced distinctions between psychiatric and neuropsychological fit-for-work testing. After completing her Ph.D. in Clinical Psychology from an APA-accredited program at the University of Nevada, Las Vegas, Dr. Reger went on to build and direct a neuropsychological testing clinic at the Long Beach VA Healthcare System. An experience that sharpened her ability to identify when cognitive factors, behavioral concerns, or both are at the root of a workplace fitness concern. Her advanced training in clinical geropsychology at the San Francisco VA Medical Center further deepened her neuropsychological expertise. A licensed clinical psychologist (PSY #27639), Dr. Reger has spent her career working across complex medical, behavioral, and cognitive settings, giving her the real-world perspective and clinical precision that employers and organizations rely on when they need clear, defensible FFDE findings.

Can an Employee Refuse to Participate in a Fitness for Duty Evaluation?

Key Takeaways

Employees can refuse to participate in a Fitness for Duty Evaluation (FFDE), but this refusal can lead to significant employment consequences. FFDEs are assessments conducted by qualified psychologists to determine if an employee can safely perform their job, particularly in safety-sensitive roles. While participation is voluntary under U.S. employment law, employers may require an FFDE if there are objective concerns about the employee's ability to perform essential job duties or if they pose a direct threat.

If an employee refuses an FFDE, employers might place them on administrative leave, restrict their duties, or even terminate their employment to ensure workplace safety. Employees may decline due to fear of stigma, misunderstanding the evaluation's purpose, confidentiality concerns, distrust, or legal advice. For employers, a defensible FFDE request should be well-documented, job-related, and consistently applied.

In summary, while refusal is an option, it often leads to consequences as employers must prioritize safety in the workplace. Clear communication and a transparent process can help mitigate misunderstandings and support fair decision-making.

When an employee’s behavior, emotional stability, or cognitive functioning raises legitimate concerns in the workplace, employers and attorneys often turn to a psychological or neuropsychological Fitness for Duty Evaluation (FFDE) to determine whether the individual can safely and effectively perform essential job duties. These evaluations are especially critical in safety-sensitive roles like healthcare, law enforcement, transportation, public safety, and high-risk corporate environments, where impaired functioning can have serious consequences.

But one question arises in nearly every consultation with employers and legal counsel:

Can an employee refuse to participate in a Fitness for Duty Evaluation?

The short answer is yes. Employees can refuse. However, refusal often carries significant employment consequences. Understanding the legal, procedural, and practical implications of refusal is essential. Not only for employers, but also for HR leaders and attorneys navigating these complex situations.

This article breaks down what refusal means, how employers can respond, and what makes an FFDE request legally defensible.

What Is a Fitness for Duty Evaluation?

A Fitness for Duty Evaluation is a formal, job-related assessment conducted by a qualified psychologist or neuropsychologist. It can determine whether an employee can perform essential job functions safely and effectively.

Depending on the referral question, an FFDE may evaluate:

• Psychological stability, including mood, behavior, and emotional regulation

• Cognitive functioning, such as memory, attention, processing speed, and executive functioning

• Behavioral risk, including judgment, impulse control, and workplace conduct

• The impact of medical, neurological, or psychiatric conditions on job performance

FFDEs are not punitive. They are risk-management tools designed to protect the employee, coworkers, and the public.

Is an Employee Legally Required to Participate?

Under U.S. employment law, including the ADA, FEHA, and EEOC guidance, employees are not forced to undergo a medical or psychological evaluation. Participation is voluntary.

However, employers are permitted to require an FFDE as a condition of continued employment when:

• There is objective evidence that the employee may be unable to perform essential job duties, or

• There is reasonable concern that the employee poses a direct threat to themselves or others

In these cases, refusal may justify administrative action on the part of the employer.

What Happens If an Employee Refuses?

While employees can decline an FFDE, refusal often triggers employment consequences because the employer still has a duty to maintain a safe workplace.

Common employer responses to refusal include:

• Administrative leave, either paid or unpaid

• Removal from safety-sensitive duties

• Revocation of workplace privileges

• Fitness-based separation or termination

• Inability to return to work until the evaluation is completed

In other words, refusal does not prevent the employer from making decisions based on the information available. If the employer cannot verify that the employee is safe and fit for duty, they may restrict or end employment to mitigate risk.

Why Employees Refuse and What It Means

Employees may decline an FFDE for several reasons:

1. Fear of stigma or judgment

   Mental health evaluations can feel intimidating, especially in high-stress industries.

2. Misunderstanding the purpose

   Employees may believe the evaluation is punitive or disciplinary.

3. Concerns about confidentiality

   Many employees worry their personal health information will be shared broadly.

4. Distrust of the process

   If the referral is not clearly explained, employees may feel targeted or unfairly singled out.

5. Advice from legal counsel

   Attorneys may recommend refusal if the referral appears retaliatory or unsupported.

Refusal does not automatically indicate impairment. However, it does prevent the employer from verifying fitness, which is often the core issue.

What Makes an FFDE Request Legally Defensible?

For employers, HR, risk managers, and attorneys, the key to managing refusal is ensuring the FFDE request is job-related, necessary, and well-documented.

A defensible FFDE referral includes:

1. Objective, observable behaviors

   Vague concerns (“seems off,” “acting strange”) are not enough. Concrete examples are essential.

2. Clear connection to essential job duties

   The employer must articulate how the concerning behavior impacts safety or performance.

3. Consistent application of policy

   FFDEs should be used uniformly and fairly, not selectively or punitively.

4. Written notice to the employee

   The referral should explain why the evaluation is being requested, what it will involve, what information will be shared, and what happens if the employee declines.

5. Use of a qualified evaluator

   Psychologists conducting FFDEs must have expertise in occupational functioning, psychological and neuropsychological assessment, risk evaluation, and legal and ethical standards.

A well-structured referral reduces the likelihood of refusal. It also strengthens the employer’s position if a refusal occurs.

How a Psychologist Handles Refusal

As an evaluator, my role is to remain objective. Although I am retained by the employer, part of my ethical obligation is to provide an unbiased opinion based on evidence and data. These cases are often complex, as human psychology is complicated, but my goal is always to reach a conclusion based on the medical facts available, results of standardized testing, the nature of the work, the level of safety risk involved, and the probability of harm. When an employee refuses to participate in an FFDE through my California practice, I:

• Document the refusal

• Notify the referring party

• Do not speculate about impairment

• Do not make conclusions without data

The employer then determines next steps based on their organization’s policy, safety considerations, and legal guidance.

What Should Employers and Attorneys Do When Refusal Occurs?

1. Review the referral documentation

   Ensure the request is clearly tied to job duties and supported by objective evidence.

2. Communicate consequences clearly

   Employees should understand that refusal may impact their ability to return to work.

3. Offer clarification—not persuasion

   Employers can explain the FFDE process, but should avoid pressuring the employee.

4. Maintain confidentiality

   Only those with a legitimate need to know should be informed.

5. Consult legal counsel

   Especially in unionized, public safety, or high-risk environments.

Final Thoughts From an FFDE Psychologist in Los Angeles, CA

Employees can refuse to participate in a Fitness for Duty Evaluation, but refusal does not prevent employers from taking necessary steps to ensure workplace safety. When an FFDE request is well-documented, job-related, and consistent with policy, employers are on solid ground to act appropriately even if the employee declines.

In my experience as an FFDE psychologist in Los Angeles, who does both psychological and neuropsychological FFDEs, refusal is relatively rare. Most employees understand that if there is a concern about risk that is supported by evidence, their employer has the responsibility to ensure their fitness for work. They are often anxious about the evaluation, and sometimes resentful or angry, but most employees do not refuse to participate.

For attorneys and employers, the key is understanding that FFDEs are not punitive; they are risk-management tools designed to protect everyone involved, including the employee. A clear, transparent process reduces confusion, minimizes conflict, and supports fair, defensible decision-making.

Ready to Pursue Fit For Duty Testing in Los Angeles? Dr. Reger Can Guide The Process

Understanding your rights and responsibilities as an employer, including how to handle an employee who resists or refuses a Fitness For Duty Evaluation, starts with having the right professional in your corner. Dr. Stacy Reger provides thorough, legally defensible FFDEs that give organizations the documentation and direction they need to move forward with confidence.

A licensed psychologist serving employers, attorneys, and safety-sensitive industries throughout California, Dr. Reger is based in Los Angeles and conducts evaluations statewide. Depending on the circumstances, telehealth may also be a viable option for certain fitness-for-duty evaluations. Starting the process is simple:

1. Schedule a consultation

   Reach out to discuss your situation, the referral question, and whether an FFDE is the appropriate next step

2. Share supporting documentation

   Relevant materials such as incident reports, job descriptions, and medical notes help ensure a comprehensive evaluation

3. Book your evaluation

   Dr. Reger, an experienced FFDE psychologist in Los Angeles, will work with your organization to schedule an assessment at a time and location that fits your needs

4. Receive a clear, actionable report

   Findings and recommendations are presented in a well-supported, defensible format that your organization can rely on

Other Services Dr. Stacy Reger Provides in Los Angeles, California

Navigating a fitness for duty situation requires a psychologist with the experience and credentials to support your organization every step of the way. Especially when an employee pushes back or refuses to participate. Dr. Stacy Reger brings a thorough, methodical approach to every evaluation, ensuring that employers walk away with a clear, well-documented report they can stand behind. Whether the process moves smoothly or presents legal and procedural complications, Dr. Reger is equipped to guide you toward a well-supported outcome.

While FFDEs are a significant focus of her practice, Dr. Reger offers a wide range of psychological and neuropsychological services to meet diverse clinical and legal needs. These include testing and neuropsychological assessments for cognitive decline and learning difficulties, capacity evaluations for financial and testamentary matters, and Independent Medical Evaluations. Her med-legal offerings extend to workers' compensation, psychological and neuropsychological evaluations in her capacity as both a Qualified Medical Evaluator and Agreed Medical Evaluator.

She also conducts adult neuropsychological evaluations for conditions including TBI, stroke, ADHD, and dementia, along with pre-surgical psychological evaluations for spinal cord stimulator implantation, bariatric surgery, and organ transplants. In addition, Dr. Reger serves as an expert witness, public speaker, and consultant, and provides individual psychotherapy and therapeutic services for older adults.

To explore the full scope of Dr. Reger's expertise, browse her blog. And when you're ready to move forward, don't hesitate to get in touch.

About the Author

With nearly two decades of experience in neuropsychological and psychological assessment, Dr. Stacy Reger, Ph.D., is uniquely qualified to help employers navigate the complexities of Fitness for Duty Evaluations, including cases where employee participation is contested or legally complicated. Dr. Reger built and directed a neuropsychological testing clinic at the Long Beach VA Healthcare System, where she collaborated across interdisciplinary teams in demanding medical, cognitive, and behavioral environments. Experience that directly informs her methodical, defensible approach to FFDEs. She completed advanced clinical training in geropsychology at the San Francisco VA Medical Center and holds a Ph.D. in Clinical Psychology from an APA-accredited program at the University of Nevada, Las Vegas. Licensed in California (PSY #27639), Dr. Reger brings both clinical depth and practical insight to every evaluation, giving employers and organizations the well-supported findings they need to make sound workforce decisions.

Fitness for Duty Evaluations: What Employers Can Expect From the Process

Key Takeaways

Fitness for Duty Evaluations (FFDEs) help employers assess whether an employee can safely perform their job due to concerns about their psychological or cognitive health. Employers consider FFDEs when there are signs of behavioral changes, emotional instability, or declining performance that may affect safety or job duties.

The FFDE process includes several steps:

Referral & Clarification: Discuss concerns and evaluation scope.

Document Review: Examine relevant records.

Clinical Interview: Conduct a structured interview with the employee.

Testing: Administer standardized psychological or neuropsychological tests.

Collateral Information: Gather insights from others, if authorized.

Analysis: Combine all findings to assess the employee's fitness for duty.

Written Report: Provide a report detailing fitness, safety concerns, and recommendations without disclosing unrelated medical information.

FFDEs are not disciplinary actions; they focus on job-related functioning and help employers make informed decisions while ensuring compliance with legal standards like the ADA and FEHA. Properly conducted FFDEs protect both employees and employers by clarifying concerns and recommendations.

When is a Fitness for Duty Evaluation (FFDE) Appropriate?

Employers and attorneys often reach out to me when they’re facing one of the most challenging situations in workforce management: an employee whose behavior, emotional functioning, or cognitive abilities have raised legitimate concerns about safety, performance, or judgment. These moments are stressful for everyone involved. Leaders want to do the right thing; protect the organization, support the employee, and comply with legal requirements, but they often don’t know where to start.

A Fitness for Duty Evaluation is designed to answer one essential question:

Is the employee psychologically and/or cognitively capable of performing their job safely and effectively?

This blog will walk you through what employers can expect from the FFDE process, what I am evaluating in a psychological or neuropsychological FFDE, how decisions are made, and how the results can support defensible, ethical workforce management.

Before we begin, one important clarification: I do not conduct Fitness for Duty Evaluations for FAA-regulated pilots or aircrew. These evaluations require FAA-designated examiners and specialized aviation protocols and are outside my scope.

Let’s explore what the FFDE process looks like for the many other safety-sensitive and high-responsibility roles employers manage every day.

Why Do Employers Request Fitness for Duty Evaluations?

Employers typically consider an FFDE when there is objective evidence that an employee may be struggling with psychological, emotional, or cognitive functioning in a way that affects their work. Common triggers include:

• Behavioral changes or erratic conduct

• Emotional instability or difficulty regulating mood

• Cognitive concerns following medical or neurological events, or as a result of noticeable cognitive decline over time

• Safety incidents or near-misses

• Declining performance that appears health-related

• Concerning interactions with coworkers, patients, students, or the public

• Return to work after psychiatric hospitalization or extended leave

• Reports of impaired judgment, confusion, or disorientation

In these situations, employers are often balancing multiple priorities: safety, legal compliance, employee rights, and organizational risk. An FFDE provides the clarity needed to move forward responsibly.

What an FFDE Is—and What It Is Not

A Fitness for Duty Evaluation is a clinical and occupational assessment, not a disciplinary action. It is not designed to punish or “catch” an employee doing something wrong. Instead, it is a structured, evidence-based process that evaluates:

• Psychological functioning

• Cognitive abilities

• Behavioral patterns

• Risk factors

• Job-specific demands

The exact type of testing (psychiatric/emotional vs. cognitive/neuropsych) will depend on the referral question, the nature of the problem, and the nature of the job. The goal of testing is to determine whether the employee can safely perform essential job duties with or without accommodations.

An FFDE is not:

• A general medical exam

• A routine wellness check

• A performance evaluation

• A substitute for supervision or HR processes

• A tool for diagnosing unrelated medical conditions

It is a targeted assessment focused solely on job-related functioning, performed to answer a specific question.

The Legal Framework: ADA, FEHA, and Business Necessity

Employers often worry about whether they are “allowed” to request an FFDE. The answer is yes, when it is job-related and consistent with business necessity.

Under the Americans with Disabilities Act (ADA) and California’s FEHA, employers may request an FFDE when:

• There is objective evidence that an employee may be unable to perform essential job functions safely

• The employee’s behavior raises legitimate concerns about safety or impairment

• The evaluation is necessary to determine fitness, accommodations, or risk

The key is documentation. Employers should be able to articulate the specific behaviors or incidents that prompted concern. This is where legal counsel can be invaluable in FFDE cases. An attorney can help ensure the referral question is clear, appropriate, and defensible. This protects everyone involved, including the employee.

What Can Employers Expect From the FFDE Process?

Although each case is unique, the FFDE process generally includes the following steps.

1. Referral and Clarification of the Evaluation Question

The process begins with a consultation between the employer (or attorney) and the evaluating psychologist. During this conversation, we clarify:

• The specific concerns prompting the referral

• The employee’s essential job functions

• Relevant policies, safety standards, or regulatory requirements

• The scope of the evaluation

• What the employer needs to know to make a decision

• If there are any company-specific forms required from the evaluation

A well-defined referral question is the foundation of a defensible FFDE.

2. Document Review

Before meeting the employee, I review all relevant materials, which may include:

• Incident reports

• Supervisor statements

• HR documentation

• Medical notes (if provided by the employee)

• Job descriptions

• Performance records

• Prior evaluations or accommodations

This information helps contextualize the concerns and ensures the evaluation is tailored to the job.

3. Clinical Interview

The employee participates in a structured clinical interview covering:

• Psychological history

• Current symptoms or concerns

• Work history and job demands

• Stressors, coping strategies, and functioning

• Medical or neurological conditions

• Substance use (if relevant)

The interview is conducted respectfully and professionally. Employees often arrive anxious, which is understandable; part of my role is to create a calm, neutral environment where they can provide accurate information.

4. Standardized Psychological and/or Neuropsychological Testing

Testing is a core component of working with an FFDE psychologist in Los Angeles because it provides objective data. Depending on the referral question, testing may include:

Psychological Testing

• Mood and anxiety measures

• Personality assessments

• Trauma-related symptom inventories

• Behavioral and impulse-control measures

Neuropsychological Testing

• Memory

• Attention and concentration

• Processing speed

• Executive functioning

• Problem-solving and reasoning

• Cognitive flexibility

These tests help identify whether cognitive or emotional factors are impairing job performance. A test battery will be tailored to meet the needs of the individual evaluation, and only standardized, validated scientific measures are used.

5. Collateral Information (When Appropriate)

With proper authorization, I may gather collateral information from:

• Treating providers

• Supervisors

• HR representatives

• Occupational health

• Attorneys involved in the case

This step is especially important when there are discrepancies between reported symptoms and observed behavior, or when an employee has limited insight into their behavior or cognitive changes.

6. Integration and Analysis

Once all data is collected, I integrate:

• Interview findings

• Test results

• Behavioral observations

• Collateral information

• Job-specific requirements

This comprehensive analysis allows me to determine whether the employee is:

• Fit for duty

• Fit with accommodations

• Temporarily unfit

• Unfit for duty

The goal is clarity that allows employers and employees to move forward with a plan, with a rationale based on substantial evidence.

7. The Written Report

Employers receive a functional, job-focused report that addresses:

• Whether the employee is fit for duty

• Any safety or risk concerns

• Recommended accommodations (if applicable)

• Return-to-work guidance (if applicable)

• Suggested monitoring, treatment, or follow-up

Importantly, the report does not include private medical details or diagnostic information unrelated to job functioning. This protects employee privacy and ensures compliance with ADA and FEHA.

Profession-Specific Considerations

Different industries have different expectations, risks, and regulatory frameworks. Here’s what employers in key sectors can expect.

Law Enforcement and Public Safety

Law enforcement FFDEs require specialized expertise. Evaluations may include:

• Use-of-force decision-making

• Impulse control and emotional regulation

• Trauma-related symptoms

• Judgment and reliability

• Cognitive functioning relevant to situational awareness

Reports are written with awareness of POST-related expectations, union considerations, and administrative review processes.

Healthcare Professionals

Healthcare FFDEs often involve concerns about:

• Impairment affecting patient care

• Boundary issues or professionalism

• Stress, burnout, or emotional exhaustion

• Cognitive functioning relevant to clinical decision-making

These evaluations are conducted with sensitivity to licensing implications and hospital system requirements.

First Responders

Firefighters, EMTs, and dispatchers face unique stressors. Evaluations may assess:

• Trauma exposure

• Stress tolerance

• Emotional resilience

• Cognitive functioning under pressure

Corporate, Industrial, and High-Risk Roles

For employees in high-liability roles such as heavy equipment operators, security personnel, or laboratory workers, evaluations may focus on:

• Attention and concentration

• Reliability and judgment

• Behavioral concerns

• Psychological stability

• Safety-critical cognitive skills

How Do FFDEs Protect Employers and Support Employees?

A well-conducted FFDE benefits everyone involved.

For Employers

• Reduces liability

• Supports defensible decision-making

• Ensures compliance with ADA, FEHA, and EEOC

• Protects workplace safety

• Provides clear, actionable recommendations

For Employees

• Ensures concerns are evaluated fairly

• Identifies needed accommodations

• Supports safe return-to-work planning

• Helps connect employees with appropriate care when needed

An FFDE is not about “siding” with the employer or the employee—it is about providing objective, evidence-based information that gives everyone involved a clear path forward.

Confidentiality and Information Sharing

Employers often worry about what they can legally receive. The answer is simple:

You receive a functional, targeted report, not private medical details.

This includes:

• Fitness determination

• Safety considerations

• Job-related recommendations

The employee’s personal health information that is unrelated to the fitness for duty evaluation remains confidential.

Clarity, Safety, and Fairness: Final Thoughts From an FFDE Psychologist in Los Angeles, CA

Fitness for Duty Evaluations are one of the most powerful tools employers have for navigating complex situations involving employee behavior, emotional functioning, or cognitive concerns. When conducted properly, they provide clarity, protect safety, reduce liability, and support ethical decision-making.

If you are an employer, HR manager, attorney, or risk manager facing a challenging situation, you don’t have to navigate it alone. A well-structured FFDE through my California practice can give you the information you need to move forward with confidence.

Get the Expert Evaluation Your Organization Needs With Fit for Duty Testing in Los Angeles

Making sound, legally defensible decisions about employee fitness doesn't have to feel overwhelming. The right process makes all the difference. A Fitness for Duty Evaluation (FFDE) gives employers the clarity and confidence needed to protect both their workforce and their organization's integrity.

Dr. Stacy Reger is a licensed psychologist specializing in psychological and neuropsychological FFDEs for employers, attorneys, and safety-sensitive industries across California. Based in Los Angeles, Dr. Reger conducts evaluations statewide, and in qualifying circumstances, telehealth options may be available. Getting started is straightforward:

1. Request a consultation: Contact us to discuss your referral question and determine the right evaluation approach

2. Submit relevant documentation: Incident reports, job descriptions, medical records, and related materials help shape a thorough evaluation

3. Schedule with a qualified FFDE psychologist in Los Angeles: Dr. Reger will coordinate a time and location that works for your organization

4. Receive your report: Expect a clear, well-supported report with findings and actionable recommendations

Additional Services Dr. Stacy Reger Provides in Los Angeles and Throughout California

When you partner with Dr. Stacy Reger for a Fitness for Duty Evaluation, you're working with a psychologist whose depth of experience extends well beyond the workplace. From the initial evaluation through a comprehensive, defensible report, Dr. Reger is committed to providing clarity and actionable insight at every step of the process.

Fitness for Duty Evaluations are just one component of Dr. Reger's broad range of psychological and neuropsychological assessment services. She also conducts neuropsychological testing and psychological assessments addressing cognitive decline and learning difficulties, as well as capacity assessments for financial and testamentary matters. Her med-legal assessment services include Independent Medical Evaluations, workers' compensation psychological and neuropsychological evaluations as both a Qualified Medical Evaluator and Agreed Medical Evaluator, and adult neuropsychological evaluations for conditions such as TBI, stroke, ADHD, and dementia.

Dr. Reger also performs pre-surgical psychological evaluations for procedures including spinal cord stimulator implantation, bariatric surgery, and organ transplants. Beyond assessments, she is available as an expert witness, public speaker, and consultant, and provides individual psychotherapy and specialized therapy for older adults. To learn more about the full scope of Dr. Reger's services, explore her blog. And when you're ready to take the next step, she welcomes you to reach out directly.

About the Author

Dr. Stacy Reger is a licensed clinical psychologist (PSY #27639) with nearly two decades of experience in psychological and neuropsychological assessment. She earned her Ph.D. in Clinical Psychology from an APA-accredited program at the University of Nevada Las Vegas, and completed advanced training in clinical geropsychology at the San Francisco VA Medical Center. Her extensive background in neuropsychological testing, including building and directing a neuropsychological testing clinic at the Long Beach VA Healthcare System, gives her a uniquely rigorous foundation for conducting Fitness for Duty Evaluations. Having worked across interdisciplinary teams in complex medical, cognitive, and behavioral settings, Dr. Reger brings both clinical precision and real-world insight to every FFDE, helping employers and organizations make informed, defensible decisions about workforce safety and employee wellbeing.