I couldn’t sleep last night due to severe shoulder pain and was up all night, initially watching crap on TV and then surfing the net on my partner’s iPad. For fun I entered the key words “malingering + workers compensation” and was shocked to see how much bullsh*t came up! Needless to say that the added frustration and anger of reading these “articles”ensured that I could forget sleep altogether! Anyways here are some highlights I found… brace yourself.
How to deal with malingering in workers comp cases:aargghh!
According to a recent report for American Medical News (AMN), malingering presents, er, a serious problem for health professionals, both in work compensation cases and also in other circumstances ranging from simple work avoidance to requests for special accommodations.
Over the past year, a number of high-profile workers comp cases have come to light in which claimants exaggerated illness for the sake of monetary gain. [WHAT money????]
A review of the frequency with which medical professionals face instances of malingering and the many obstacles to accurate detection reinforces the necessity of thorough psychological evaluations in work comp cases — both in order to prevent work comp fraud and to optimize fair assessment for workers and employers alike.
What is malingering?
Malingering is defined as “the intentional production of false or grossly exaggerated symptoms motivated by external gain,” according to the AMN. Based on a study published in the Journal of Clinical and Experimental Neuropsychology in 2002, 29% of personal injury cases and 30% of disability claim cases exhibited signs of “probable malingering,” with chronic pain and mild head injury cases resulting in the highest levels of likely symptom exaggeration among patients. In a tough economy, the likelihood of patients attempting to increase illness or disability benefits through malingering is even higher.
And thanks to a number of obstacles present in today’s medical system – ranging from short physician visits and perfunctory patient-physician relationships, to deceptive mental conditions that may cause patients to mimic malingering behavior – it can be challenging for doctors to distinguish between honest claimants and those with falsified symptoms.
The impact of malingering on medical care and workers compensation, according to those ignorant authors
Easy access to symptom information online is yet another tool in the hands of malingering patients – one that, as some experts point out, is made even more effective by most physicians’ desire to trust their patients and act as advocates for better health. But the bottom line is that, when it comes to malingering, failing to detect falsified symptoms can cause real harm to other patients in the form of lost financial resources, medical tests and treatments – and to employers in the form of unnecessary workers comp payments and allowances.
Therefore, it is essential for physicians to perform objective assessments and keep an eye out for red flags (such as a patient listing too many symptoms, or failing to exhibit purported symptoms), and for employers to seek out the advice and expertise of a Qualified Medical Evaluator (that should read: a biased “independent medical doctor who will see you for 10-30 minutes max.) in those cases where mental health concerns are in question.
How to identify us, all malingerers!
Patients Injured workers who exaggerate illnesses /injuries often demonstrate signs of suspicious behavior. Physicians can detect such false conditions by observing how patients act.
Obtain and review past records. Physicians should check documents that relate to prior claims and medication history to determine if a patient’s background is being presented accurately.
Check for consistency. Doctors should repeat questions to a patient to observe whether the patient’s statements remain congruent. Consistency of both presentation during the visit and over time should be evaluated.
Use tests and questionnaires. Established tests provide doctors with standardized data to measure if a patient’s result or response is unusual compared with most cases. Doctors interested in such testing tools can find a specialist to help in the evaluation if necessary.
Doctors should ask themselves: How do patients act when they think no one is looking?( I.e. Dr has seen patients walk in his building who appear to be in normal physical condition but act differently when they notice him watching. WTF!)
Another red flag: the person’s demeanor corresponds with the medical problem. For example, check to see if a person complaining of serious depression laughs and jokes with the doctor and other staff members -WTF!
Focus on facts. When interacting with legal or criminal claims, physicians might feel pressured to give opinions. Instead, they should concentrate on factual information from the patient’s visit such as test results.
Check past compliance. Physicians should review a patient’s prior adherence with medical treatment and cooperation to take tests. Lack of compliance could be a red flag.
Look at social history. Reviewing past occupational or social functioning can help doctors determine what’s behind a patient’s behavior. For example, a history of multiple lawsuits, legal difficulties or workplace conflict may suggest purposeful intent or malingering.
Oh Boy, oh boy….
Source: “Malingering and Other Validity Considerations,” AMA Guides Newsletter, January/February
[post dictated by workcovervictim and entered on workcovervictim’s behalf]