I've read a lot of other psych's reports. For supervision, for review, and sometimes because a client has changed over to me.
The ones that hold up aren't the longest. They're the ones where you can see the thinking.
Here's my favourite case study (made up client) Miyuki: an ED nurse, assaulted at work. She's now avoiding patient contact, and she's stopped using buses, trains and rideshare. There's also a minor car accident a few months before the assault, as a passenger, after which she reported no symptoms at all.
The insurer's read almost writes itself. She's avoiding transport because of the car accident. Not the work related incident.
Five things I'm looking for in the report that answers that.
1-Evidence sitting next to the opinion. Not three pages back. If the reader has to join the dots themselves, they'll join them the insurer's way.
2-Actual causation reasoning: Timing of the avoidance started after the assault, and she commuted by train without difficulty for the months in between, which the rosters confirm. Mechanism - the assault at work generalised her sense of danger from the hospital ward to unpredictable public settings, which is why the avoidance generalised rather than staying the same.
3-Alternatives need to be named and dealt with - the car accident, her perfectionism, her fear of being seen as not coping. Then characterise it: the assault is the substantial cause, the car accident at most a vulnerability that made the later generalisation easier. Name the alternatives yourself, or the other side will and it'll look like you never considered them.
4-Inconsistencies out in the open. She said the car accident didn't bother her. Now she won't get in an Uber. Left unaddressed, that reads as a changed story. Explained, it's two very ordinary things: people under-report at the time, and avoidance after trauma generalises to whatever shares the feeling of being trapped and unable to act. Say what would worry you too. If you only ever explain inconsistencies away, you're an advocate. Show you can go both ways and your explanations start to count.
5-Work capacity: Make specific recommendations about restrictions and hours of work, as well as what she can do. Not "avoid patient contact initially".
Try: "four hours a day, three days a week, on admin duties. No face-to-face contact with unfamiliar patients for six weeks, due to startle response and hypervigilance following the assault. Phone contact fine. From week seven, if trauma-focused treatment has started, supervised contact with known patients with a second staff member present. And note she can't currently use public transport, so the placement has to be somewhere she can actually get to".
None of it is about writing more. It's structure, which is the first thing to go on the fourth report of a rough week.
Keen to hear what others would add. I'll include another five tips next time with your ideas of what else would be beneficial