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:

  1. an evaluation is perceived as adversarial;
  2. the personal stakes are very high; and
  3. 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).