How to deal with malingering in work comp cases: ensuring fair assessment for workers and employers alike
By Stephen M. Pfeiffer, PhD
Determining the right diagnosis in work comp cases can be a tricky business – one in which subtle or complex symptoms may be overlooked in some cases, and dishonest workers get away with malingering, or exaggerating illness for the sake of increased benefits, in others. According to a recent report for American Medical News (AMN), malingering presents a serious problem for health professionals, both in work comp 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. 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
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 in those cases where mental health concerns are in question.
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