The government has determined work disability to be the inability to perform work resulting from physical, mental or other health conditions for at least six months or more. An estimated ten percent of the population has some disability resulting from a mental disorder that a treating physician has diagnosed. A forensic psychiatrist must understand many aspects of a case that determine decisions made to find or change employment, become unemployed, or seek permanent disability status. Many factors come into play, including cultural, social, biological and psychological considerations, as well as social limitations and psychological illnesses.
Workers compensation claims are often disputed by insurance companies and employers and brought to trial. In such cases, a psychiatric expert witness will need to consider and determine such issues as whether or not the worker in fact has a disorder or condition impairing his or her ability to work, the type and duration of the symptoms, how those symptoms relate to work in order to make a determination of the outcome of the condition and treatment recommendations. Furthermore, the expert needs to evaluate whether vocational evaluation or rehabilitation is needed and when or even if improvement might be reached.
It cannot be emphasized enough the fundamental skills treating physicians need to evaluate and communicate patient impairments. And it cannot also be emphasized enough the skills required of the forensic psychiatrist if a case is brought to trial.
A forensic psychiatrist may often need to make a determination of whether the plaintiff is truly disabled or merely malingering. Malingering in disability claimants is the act of conscious, gross exaggeration of or pretense of symptoms or impairment to obtain or maintain disability income. It has been estimated to occur in 7.5% to 33% of disability claims. Because malingering is difficult to detect solely on the basis of unstructured interviews, other sources of information are needed. These include interviews with claimants, treatment providers, family members, and co-workers; clinical records; psychological test reports; laboratory investigations; and work reports. Indicators of malingering may include atypical or exaggerated symptoms, inconsistencies in interviews with plaintiffs, and activity and behavior that is inconsistent with the claims. Factors that argue against malingering include aggressive treatment that does not improve the condition, objective collateral evidence, and obvious and significant loss of functioning.
Malingering can be a complex issue for the inexperienced practitioner treating the claimant. The forensic psychiatrist often is much more astute in making an evaluation. A systematic examination of the claim using as many sources of information as possible is necessary to make a determination about the presence of malingering to a reasonable degree of medical certainty. Circumstances of the claim, claimants’ symptoms, and behavior in and out of the interview situation need to be investigated in detail to determine the presence or absence of malingering. Psychological tests are useful additional measures that can help determine malingering. A forensic psychiatrist can supervise the performing of these tests working in conjunction with a psychologist.
Stephen Kelly is a entrepreneur and freelance writer. Be sure to check out this Forensic Psychiatry website for more great articles like this one.