How to deal with malingering in workers comp cases:aargghh!

injured-worker-fraud

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.

Yeah… WTF!

How to identify us, all malingerers!

malingering1

click to read article

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.

Refusal to release medical history suggests that the patient may be hiding information.WTF!

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

and http://www.ama-assn.org/amednews/2012/09/10/prsa0910.htm

 

[post dictated by workcovervictim and entered on workcovervictim’s behalf]

 

14 Responses to “How to deal with malingering in workers comp cases:aargghh!”

  1. “Malingering” hasn’t been used on me (yet).  I was labelled as “misrepresenting my injury”, well at least that was the excuse used on the referral form for the investigation agency.  Actually, they wrote “adequate evidence of misrepresentation”, even though none actually exists. All my doctors want to know what this evidence is, since the injury is psychological but guess what, they cannot provide any, the PI couldn’t provide any and the Ombudsman will not investigate the $$$$$ they spent on needless investigation, trying to find “evidence” or something they can use to terminate my claim, since the last 3 IME Reports could not be used.  Another example of how insurers manipulate vague legislation to suit their corrupt and unethical activities!

    Sticks & Stones & Words will hurt October 22, 2012 at 3:53 pm
  2. im not a malingerer mmm ok just a little bit

  3. Thanks for the post. It’s more of that same crap as “lie catchers”. Part of the ongoing process of demonising injured workers. We need support so we must be “cheats”. They’ve spent years honing their processes by demonising the unemployed, single mothers, aboriginal people, asylum seekers and others who need social support. Now they’re using the culture they’ve created to argue for cutting back even more on what supports are available. I’m quite frightened, seeing what’s happening in NSW, that all the Workovers are about to become even more inhumane.

  4. There’s nothing that stuffs one around emotionally than an workplace injury. It’s a damned if you do and damned if you don’t scenario. Why don’t they write up in the Workcover Act how a person in pain is supposed to present. I’ve been off work for the last two weeks with an aggravated injury. In the last few days things have settled. I’ve been a little happier. Today I’m a little sore and not so happy. Malingering is a bullying term. In my case the first one who calls me that will get a mouthful for not abiding by my return to work program. It’s a dirty brush to paint a person. Kicking the defenseless while they are down. If those who label the injured malingers go through the same circumstances their tunes would quickly change.

  5. This is simply some of the dumbest stuff I have ever read. So, having depression means you can never, ever smile or make a joke? Honestly, this kind of thing really shows just how DUMB some doctors and psychologists really are.

    Like the IME who saw me crying my eyes out during the interview and then commented in the report that I was not showing any signs of anxiety or PTSD and had totally normal speech patterns.

    This is just as dumb as the “concentration” test she made me do, to test if I ACTUALLY had PTSD. She asked me to remember 3 words: “paper”, “apple”, “cat” and then asked me to repeat those words back to her a few minutes later. This kind of test may be applicable to say……… a 5 YEAR OLD, but certainly not to an adult with a tertiary education. Maybe words with more than one or two syllables could be SLIGHTLY more challenging!

    Oh the other one was “count backwards from 100 in multiples of 7″….. again….. something a primary school student could easily do……. what does this even have to do with the PTSD symptoms? And this person actually has a degree in psychology!

    It just seems that the shonky-ness never ends!

    • Annie, What was the outcome of the shonky IME’s report?  I’m a total mess at all my Insurer Medical Examinations – cry from start to finish.  I am surprised they can even understand what I’m saying.  I get so upset that I would have added a few “F – U” in the middle of those “paper” “cat” “apple” repetitions.  Oh I suppose the genius psych would’ve diagnosed Tourettes!

  6. Who make those statements and standard guidelines must be people bullied in their life. They must be mentally sick aka “stupid” NOT like us injured workers who is suffering from mental injuries due to sick work places and dysfunctional work cover system.

  7. Don’t know if anyone of you has seen this typical insulting injured workers’ perceptive video ) also on our funnies page). Must have been created by the same authors…

  8. The other that kills me is “check to see if a person complaining of serious depression laughs and jokes with the doctor and other staff members -WTF!” – Same applies to those pathetic PIs and Case Managers out there who believe they have hit the “jackpot” when they find a picture on Facebook of a seriously depressed person “laughing/smiling”! Tell me, suffering from major depression myself, I do appreciate a good laugh now and then and in fact I will go out of my way everyday to visit this site’s forum which has a “joke” section that I cannot live without. I live in a very sad and dark world and I feel that only injured workers understand me, and, yes, are able to make me laugh big time. So what? Does this mean I am “not depresses”? WTF!

    What about those who “pose” for a picture for their kids’ birthday parties, engagements, whatever and as such are “caught” smiling on “Facebook”?

    And oh, what about those who feel so miserable and utterly ashamed of their condition that they’ll indeed pretend to “laugh and joke” with medical staff?

    For God’s sake, wake up!

    But, yet, it is enough to be “thoroughly assessed” by an IME who does not know us from a bar of soap in a 10-30 minute session????

    Arrrrggggggghhhh!

    workcovervictim3 October 18, 2012 at 12:07 pm
  9. It pisses me off how they see injured people. How can they claim that the injured have over exaggerated their pain. There is no mechanism or any medical person out there that can say you are exaggerating your level of pain every person has a different threshold and it cant be independently measured.

     

     

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  1. Lyndsay Farlow (@LyndsayFarlow) - October 18, 2012

    RT @WCVictimsdiary: How to deal with malingering in workers comp cases:aargghh! http://t.co/9XZZNbC6