Workers compensation insurance companies will desperately try to rely on their preferred so called “insurance doctors” and “expert witnesses”, best known as “hired guns” to disprove your injury or the extent of your injury.
There are alleged hired guns in a variety of medical specialties, but they appear to be most frequent, and most vicious, in psychiatry – probably because, as a ‘soft’ science, lacking the hard evidence of X-rays and tissue examination, psychiatry is more open to opinions, no matter how outrageous.
In this situation the injured worker is usually claiming for post-traumatic stress disorder, and the hired gun’s task is to show that he/she does not or could not have such a condition, despite in some cases the precipitating event having been extraordinarily traumatic by normal standards, e.g. the Voyager disaster in America, or cases where an employee saw another employee being cut to pieces by a machine etc.
In these cases the hired gun, has to perform complicated mental gymnastics to show there is nothing wrong, however compelling the evidence that the plaintiff (the injured worker – whether mentally and/or physically ill) is genuinely ill.
If the injured person shows signs that would normally be taken as symptoms of illness, the hired gun will interpret this as malingering.
An REAL (true) example:
“The prominent feature at this interview was what I consider to be overacting. The appearance of great anguish was so excessive that I can only regard it as histrionic. It is my impression that [his complaints] are manufactured for the purposes of elaborating upon what may have been a genuine disorder in the past………….In my opinion the state of the patient no longer meets the criteria of PTSD, but rather impresses me more as malingering hysteria……”
Or he will provoke the patient and interpret their response as indicating hostility rather than legitimate illness. An example:
The injured person’s account of the examination:
“I found Dr X’s attitude from the start to be provocative and intimidating. He frequently smirked when I replied to his questions, and the whole interview with him was more in the nature of an interrogation. At a later stage of the interview Dr X sat me in a chair and asked me to hunch up my shoulders. [Dr X has no orthopaedic qualifications or expertise.] I indicated to him that I was in pain and that pushing down caused me pain. He asked me to hunch up my shoulders again and I refused. He pushed down on my shoulders hard.”
Dr X’s report of that examination:
“He was bristling with anger and hostility. Although diagnosed as suffering from major depression by Drs A and B, I have reservations about the diagnosis and note he failed to respond satisfactorily to any treatment prescribed…..”
That patient subsequently killed himself, which would seem to indicate Drs A and B were right about his major depression. He was one of a series of suicides by patients who had been examined in this manner by Dr X, and while it would not be valid to say without further evidence that Dr X’s examinations helped to cause those deaths, it is self-evident that such abusive behaviour could hardly have helped.
It is bad enough to suffer an injury at work, but if the injured person then tries to obtain redress through the ‘justice’ system, they are likely to suffer further injury from the system itself- in some cases, more severe and damaging than the original one! How’s that! Imagine sitting in a court of law and having to listen to some of this crap read aloud from a hired gun? OMG! I would be ready to either throttle him or hang myself!
That this sh*t really happens everyday in Australia is just terrible for us; the workcover victims, and on two (2) counts: firstly, a psychiatric diagnosis carries a severe stigma in our society, and however sane the victim may in fact be, some mud can be expected to stick, particularly among their enemies. It is thus an extremely effective way to discredit the victim together with their complaints, and supposedly confidential reports are commonly overtly or covertly circulated where they can do most damage (i.e. think about these really private and often completely false documents going to your current or past employer, to other doctors, to those insurance people 0- who half the time seem to “loose” you paperwork; to the ACCS, to god-knows-where-else!!!).
Secondly, a psychiatric examination, on a traumatic issue, is often traumatic in itself because the injured worker/victim is compelled to relive the trauma. This is acceptable for the purpose of therapy, but purely for medico-legal purposes will almost inevitably add another injury to the psyche.
If the psychiatrist is an abusive hired gun, and if the patient is forced by the system, as many are, to see a number of them, the additional injury can be severe.
Also, let’s face it, many workers compensation claimants, like myself for example, do develop secondary psychiatric problems such as depression, anxiety, and post-traumatic stress disorder, for which they will need help, usually from a psychiatrist and/or a psychologist.
(Geez, the way the workcover agent treats us, it is no wonder we need psychological or psychiatric help! In my case, whilst I had certainly developed PTSD from the accident itself ( I was assaulted at work!), and very soon also developed some depression (had to stop all my hobbies etc, had many surgeries), I really feel that my depression got a lot worse because the way my case manager has been treating me and because I am constantly treated like I am some criminal. Add to that the financial hardship, the severe chronic pain and well..yeah.. I am pretty “flat” indeed).
If the trust necessary for an effective therapeutic relationship has been damaged or destroyed by a traumatic earlier encounter with a hired gun psychiatrist, the effect can be devastating, and a condition that should have been relatively easy to treat can become crippling.
Tactics of hired guns
The conduct of a typical examination is clearly aimed at avoiding the possibility of developing any rapport or empathy with the patient – the reverse of a normal examination. The hired gun would no doubt deny that this is the intent, but it is hard to find any other explanation.
The process usually starts with secret briefings from the workcover insurer agent or the employer, usually inaccurate and sometimes wildly misleading, which paint the patient as paranoid or impossible, and which the patient, unaware of their existence, has no chance to refute.
The psychiatrist will refuse to accept written information offered by the patient, or to allow a support person into the interview ; may arrive late with no explanation or apology; will not introduce himself or otherwise make any attempt at normal politeness or making the patient comfortable; will use distractions such as wandering round the room behind the patient, dropping noisy objects, or sitting with his feet up on the desk, eating his lunch.
He will be hostile and adversarial in manner, sometimes yelling at the patient, accusing them of lying, and may be verbally abusive, trying to provoke an angry reaction which can then be used as ‘evidence’ of a personality disorder or malingering, depending what is required.
Other common tactics are to use a standard report that is already on their word-processor, the hired gun simply filling in the gaps. ‘Verballing’ patients is common, e.g. a throw-away, leading question at the end of the interview on the lines of supposing they must have some bitterness about what has happened then becomes the focus of the report.
One notorious hired gun regularly uses a urine test for drugs, including prescribed drugs. The patient is asked what they are taking, and the psychiatrist then says in his report that what the patient claimed to be taking or not taking is contradicted by the test – additional ‘evidence’ that the patient is untruthful.
Without a witness at the interview, or a tape-recording, there is no independent evidence of what the patient really did say.
There is however one thing that hired guns almost never do – try to check the patient’s information with other, independent, sources. Indeed I think it safe to say that someone who makes such an effort is not a hired gun.
To remediate this terrible situation, we, workcover victims should have the following:
- have a choice of psychiatrist, from a list provided by the insurance company
- be informed by the insurance company that you have the right to take a support person to the interview, and that it is to your advantage to do so
- the psychiatrist must agree to allow a support person to accompany the injured worker, and/or allow the interview to be recorded
- rudeness and abusive behaviour by a psychiatrist towards an injured worker with a possible psychiatric injury must lead to his removal from the insurance company’s list
- all psychiatric reports on a patient must be disclosed to the other side
Note that in Victoria, as far as I know, we are still NOT allowed to have a support person present during the interview – and that is why I recommend you to tape-record (openly or secretively) your session.
Yeah… shall we just dream on until the day we do get treated like human beings…or do something about it now!?
When I am send for an IME psychiatry I always:
- have a recent pre-written letter with me (for that purpose), from my treating psychologist and/or psychiatrist, detailing my history, diagnosis, treatment and the letter also always asks that the IME please does NOT MAKE ME RELIVE THE TRAUMA(S) OVER AND OVER AGAIN (as it is the 5th, or 6th IME in 12 months, whatever) and that the reliving of those trauma(s) are detrimental to me and my recovery (which is true).
- provide the IME with a pre-prepared file with all previous (favourable) psychiatric IMEs, as well as ALL relevant phsyical material. Make sure they are certified copies, so there is no way out. You will rapidly learn (once you’re in the system for a while) that workcover is extremely selective in providing the relevant material/documents to any IME. They will usually omit anything that is in your favour, anything recent, and will write a personal “briefing” letter. One one occasion my stupid case manager wrote in her briefing letter that “it has been suggested that there is a psychiatric/psychological overlay [with my phsyical symptoms]”!!! Not one IME or none of my treaters has ever suggested that I am basically ‘malingering’ or ‘faking’ whatever!!!! And I am pleased to say that the physical IME replied to that stupid woman that “there is no evidence of this whatsoever… on the contrary I am actually amazed how this woman takes these series of surgical failures with such an equanimity…”
- I always tape-record the session – I ask and if they refuse I do it secretively anyway
- I always make sure I receive a copy of the IME’s report, and I will go out of my way to have lies and inaccuracies corrected by the IME (if they refuse I simply tell them that I have taped the session and would they like to hear it)
- if the IME is in any way or shape verbally abusive, impolite or whatever, I walk out but ensure it is taped (and the reason I walked out to)
- I always ensure I have an appointment with my psychologist on the same day – so she can document in what true mental state I am on that particular day.
Also remember that you can refuse to see a particular IME.
You might also be interested in our previous post Psychiatric IMEs: don’t get fooled
Addition (added on 9 September 2011)
Serbian man who worked for tyrant Slobodan Milosevic is jailed for fraud
A SERBIAN man who worked for former president Slobodan Milosevic’s secret police has been jailed in Victoria for defrauding WorkSafe and the Transport Accident Commission (TAC).
Dusan Milosevic, 48, was found guilty of providing false university qualifications to work as a psychologist in Australia.
Victorian County Court Judge Liz Gaynor said Milosevic provided the false documents purporting to be from the University of Belgrade to register as a psychologist in NSW and Victoria.
He was then employed by WorkSafe and the TAC to counsel people injured in car accidents and in the workplace, treating 29 clients without being qualified to do so.
Judge Gaynor said Milosevic received more than $1 million in fees from the TAC alone.[Source: The Telegraph.com.au: read entire story here]