By: Ron L Hilley II
Employers and insurers often deal with claims in which it seems
the injured employee is exaggerating his or her symptoms, particularly when
there is no objective testing that can explain the levels of reported
pain. At this year’s workers’ compensation seminar, psychiatrist Dr.
Matthew Norman discussed the difference between the medical terms “malingering”
and “conversion” within a worker’s compensation claim and how employers and
insurers can determine if the claimant is, in fact, malingering.
A claimant is considered to be malingering when he or she intentionally
produces false or grossly exaggerated physical symptoms to obtain financial
compensation, drugs, or avoid work. Conversion, on the other hand, is the unintentional
manifestation of physical symptoms (such as blindness, paralysis, etc.) without
any “real” pathology causing those symptoms.* The difference can be
difficult to grasp, especially since the diagnosis is largely dependent upon
the patient’s word.
Dr. Norman discussed what is known as the Rogers’ adaptation model which
suggests that claimants are more likely to malinger when:
- an evaluation is perceived as adversarial;
- the personal stakes are very high; and
- no alternatives appear viable.
Workers’ compensation claimants are therefore prone to malingering as
litigation is inherently adversarial and often there is at least perceived
money on the table in possible settlement.
How can employers and insurers detect malingering versus conversion? One option
is a psychiatric Independent Medical Evaluation (IME). Employers and Insurers
often only consider psychiatric IMEs in cases where the injured employee is
asking for coverage of psychological treatment, but they can also use a
psychiatric IME when a claimant is suspected of malingering and expensive
medical treatment is being considered. These IMEs involve analyzing the
claimant’s past history, including prior worker’s compensation claims and
medical history, as well as screening and testing to determine whether the
claimant is in fact malingering. However, the doctors guard the exact method of
the testing to protect the accuracy of the results. An IME which detects
malingering may influence the authorized treating physician’s treatment plan going
forward and save employer and insurers medical costs.
American Psychiatric Association, Diagnostic and Statistical Manual of Mental
Disorders, (5th ed. 2013).