November 2011 Worker's Compensation Issues for authorstream

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Worker's compensation claims - Some aspects about how to try to determine which are legitimate and which are not.

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MOST RECENT THOUGHTS ABOUT SOLVING YOUR MOST CHALLENGING WORKERS COMP DILEMMAS :

MOST RECENT THOUGHTS ABOUT SOLVING YOUR MOST CHALLENGING WORKERS COMP DILEMMAS

Joel S. Steinberg, M. D. Psychiatry, Forensic Psychiatry and Internal Medicine :

Joel S. Steinberg, M. D. Psychiatry, Forensic Psychiatry and Internal Medicine

EVERYTHING IS NOT ALWAYS AS IT SEEMS TO BE:

EVERYTHING IS NOT ALWAYS AS IT SEEMS TO BE False clues lead to false conclusions. “Garbage in, garbage out…”

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In the next 50 minutes or so, I hope to affect some of your thinking about both physical and mental issues in the Workers Compensation area. I hope to convince you that rapid return to work is beneficial to the worker and to the company. Everybody has to be somewhere. Work is as good a place to be as any other.

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I hope to explore with you some of the difficulties that mental health professionals have with making diagnoses, no matter how dedicated they might be… And what can be done to be as sure as possible that your IME consultant is carefully evaluating the complaints offered by an injured worker.

What’s green and has wheels?:

What’s green and has wheels ?

There is probably no reason to explain to this group how expensive workers compensation claims can be for employers, but I would like to offer you some information that recently came into my hands.:

There is probably no reason to explain to this group how expensive workers compensation claims can be for employers, but I would like to offer you some information that recently came into my hands.

In a report from the CDC for calendar year 2000 it was reported that the lost time cost per hundred workers per year was $458,150. More than $90,000 of that was for wage replacement.:

In a report from the CDC for calendar year 2000 it was reported that the lost time cost per hundred workers per year was $458,150. More than $90,000 of that was for wage replacement.

The costs are not only to the employer or the State agency, but to the society as a whole. The medical community is overutilized. There is a loss of productivity and there is a large personal cost.:

The costs are not only to the employer or the State agency, but to the society as a whole. The medical community is overutilized. There is a loss of productivity and there is a large personal cost.

Interestingly, it has been clearly demonstrated that without an effective return to work program, medical care alone is relatively ineffective in reducing time lost from work.:

Interestingly, it has been clearly demonstrated that without an effective return to work program, medical care alone is relatively ineffective in reducing time lost from work.

Maybe part of that is because only 20 to 22% of everything done medically has been proven to be effective in valid studies!:

Maybe part of that is because only 20 to 22% of everything done medically has been proven to be effective in valid studies!

The answer is “GRASS”, I was “lying” about the wheels. This exemplifies the problem in psychiatry … If you cannot rely on the history and on the person offering it, you cannot rely on conclusions based on that history.:

The answer is “ GRASS ”, I was “lying” about the wheels. This exemplifies the problem in psychiatry … If you cannot rely on the history and on the person offering it, you cannot rely on conclusions based on that history.

Early return to work is probably the most critical ingredient in successful rehabilitation. These facts were discovered in the Israeli experience comparing the outcomes of sophisticated behind the lines treatment with immediate and simple treatment.:

Early return to work is probably the most critical ingredient in successful rehabilitation. These facts were discovered in the Israeli experience comparing the outcomes of sophisticated behind the lines treatment with immediate and simple treatment.

In 1973 mentally stressed Israeli soldiers were given state-of-the-art treatment. A very high percentage of them became permanently disabled.:

In 1973 mentally stressed Israeli soldiers were given state-of-the-art treatment. A very high percentage of them became permanently disabled.

In the war with Lebanon a program called “forward treatment” was begun. Soldiers were treated at the front with their peer group. They were returned to full duty within 72 hours.:

In the war with Lebanon a program called “forward treatment” was begun. Soldiers were treated at the front with their peer group. They were returned to full duty within 72 hours.

What’s the relevance? You might ask. The disability was medically induced in the former case. This has a relevance to the workers compensation system.:

What’s the relevance? You might ask. The disability was medically induced in the former case. This has a relevance to the workers compensation system.

Early return to even transitional work, ongoing involvement with peers at work, the continuation of the sense of earning a living by working for it, and so on seem to be the more important components of these results.:

Early return to even transitional work, ongoing involvement with peers at work, the continuation of the sense of earning a living by working for it, and so on seem to be the more important components of these results.

Similarities between the military and industrial populations are: both are healthy both are required to function in terms of team needs both receive benefits if they cannot work.:

Similarities between the military and industrial populations are: both are healthy both are required to function in terms of team needs both receive benefits if they cannot work.

Even the terminology used influences outcomes… in a review of the readings of 200 CT scans of the lumbar spine, it was found that only 86 of them were accurate. 50 used vague terminology.:

Even the terminology used influences outcomes… in a review of the readings of 200 CT scans of the lumbar spine, it was found that only 86 of them were accurate. 50 used vague terminology.

“herniated disc” led to an average $85,000 settlement. Disc protrusion led to an average $30,000 settlement. Disc bulge led to an average $12,000 settlement.:

“herniated disc” led to an average $85,000 settlement. Disc protrusion led to an average $30,000 settlement. Disc bulge led to an average $12,000 settlement.

Other studies have clearly demonstrated that the best treatment for low back pain is activity and believe it or not, running is better than walking!:

Other studies have clearly demonstrated that the best treatment for low back pain is activity and believe it or not, running is better than walking!

The last point that I would like to make about these features is that the mortality rate is increased for people who do not work and who receive workers compensation benefits.:

The last point that I would like to make about these features is that the mortality rate is increased for people who do not work and who receive workers compensation benefits.

So far everything that I have said to you is generally true about all workers compensation issues. Now I would like to talk more specifically about psychiatric issues.:

So far everything that I have said to you is generally true about all workers compensation issues. Now I would like to talk more specifically about psychiatric issues.

I am also sure that most of you are aware that one of the most common times for additional allowances for psychological conditions to be requested [coincidentally] is when temporary total benefits come to an end.:

I am also sure that most of you are aware that one of the most common times for additional allowances for psychological conditions to be requested [coincidentally] is when temporary total benefits come to an end.

There might be very good reasons for that. Losing your income can be depressing. Perhaps those conditions were present before, but no request had been made for an additional allowance.:

There might be very good reasons for that. Losing your income can be depressing. Perhaps those conditions were present before, but no request had been made for an additional allowance.

There may be other compelling reasons as well. Sometimes, though, it seems that the application for additional psychological benefits is simply a means to continue receiving support on an ongoing basis.:

There may be other compelling reasons as well. Sometimes, though, it seems that the application for additional psychological benefits is simply a means to continue receiving support on an ongoing basis.

Recently, I found a book written by Richard E. Sall, a physician with multiple specialties and a particular interest in the workers compensation sector.:

Recently, I found a book written by Richard E. Sall, a physician with multiple specialties and a particular interest in the workers compensation sector.

It is called, ”STRATEGIES IN WORKERS COMPENSATION”. I recommend it to each of you who may have an interest in considering this area in some further depth.:

It is called, ” STRATEGIES IN WORKERS COMPENSATION ”. I recommend it to each of you who may have an interest in considering this area in some further depth.

Information on the next few slides are from Dr. Sall’s book.:

Information on the next few slides are from Dr. Sall’s book.

The 1993 “Little Hoover Commission” report did an investigation in California and concluded that 30% of the workers compensation system’s costs were related to fraudulent activities.:

The 1993 “Little Hoover Commission” report did an investigation in California and concluded that 30% of the workers compensation system’s costs were related to fraudulent activities.

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Miller and Miller reported that as many as 50% of people post injury had malingered symptoms [1992].

Other estimates of the amount of fraud in the workers compensation system run to as low as less than 1%. I have no way to reconcile these remarkable discrepancies for you. I only intend to point them out.:

Other estimates of the amount of fraud in the workers compensation system run to as low as less than 1%. I have no way to reconcile these remarkable discrepancies for you. I only intend to point them out.

Is fraud really a problem in the workers compensation system? If so, what can be done about it? What are some of the tipoffs that it is actually taking place?:

Is fraud really a problem in the workers compensation system? If so, what can be done about it? What are some of the tipoffs that it is actually taking place?

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A common error that I see goes by the Latin phrase “Post hoc ergo propter hoc” meaning “This followed that, therefore this was caused by that.” Or as I like to say it, subsequent is not the same as consequent. Another tipoff is that life before the accident was almost perfect, but now the claimant is no more than a shell of himself .

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Pain is constant and unrelenting since the accident despite few [or no] objective findings. Medication provides no relief. Dramatic presentation when questioned about the accident. Reporting that the independent medical examiner was abusive, threatening or inappropriate and some other manner.

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The claimant describes memory problems, but can describe the accident and his/her symptoms in great detail. Excessive vagueness about details that might reveal other causes for the current reported problems. Attributing substance abuse to the accident and denying prior substance use problems. S/He uses a cane in the wrong hand.

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Making inappropriate comparisons, for example comparing the current injury to the death of a child, especially in cases where there is little or no objective evidence of injury. Multiple cell phone calls, but reports no social life. Multiple and varied histories about have the accident took place and the events around the accident… for example loss of consciousness reported +/-.

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Inflated reports about prior earnings, business success or work productivity. Self-diagnosis of the condition made by the claimant using the Internet. A history of multiple claims… BWC/PI, etc.

What does seem to be true is that even when fraud is discovered, most typically there is no prosecution or punishment. It reminds me of “Heads, I win… Tails it’s a draw.”:

What does seem to be true is that even when fraud is discovered, most typically there is no prosecution or punishment. It reminds me of “Heads, I win… Tails it’s a draw.”

I also should point out to you how much easier it is for a treating doctor to accept what his patient tells him as true than it is to argue with the patient. If a disagreement arises, the patient is likely to seek care elsewhere.:

I also should point out to you how much easier it is for a treating doctor to accept what his patient tells him as true than it is to argue with the patient. If a disagreement arises, the patient is likely to seek care elsewhere.

What are some tip-offs that might help you suspect that you’re dealing with such a situation?:

What are some tip-offs that might help you suspect that you’re dealing with such a situation?

Dr. Sall’s suggests that Unexplainable symptoms, an understandable goal and the search for further monetary compensation are important clues.:

Dr. Sall’s suggests that Unexplainable symptoms, an understandable goal and the search for further monetary compensation are important clues.

What are clues for unexplainable symptoms? Overacting. Complaints that are disproportionate relative to the results of the physical examination.:

What are clues for unexplainable symptoms? Overacting. Complaints that are disproportionate relative to the results of the physical examination.

The typical cause and effect relationship between a medical event and subsequent symptomatology is grossly exaggerated.:

The typical cause and effect relationship between a medical event and subsequent symptomatology is grossly exaggerated.

The story about how the injury took place becomes altered and the description of symptomatology varies dramatically over the course of time.:

The story about how the injury took place becomes altered and the description of symptomatology varies dramatically over the course of time.

Determining whether someone is doing something intentionally or not can be very tricky because even the best mental health professionals truly do not get inside of the heads of the patients or clients that they see.:

Determining whether someone is doing something intentionally or not can be very tricky because even the best mental health professionals truly do not get inside of the heads of the patients or clients that they see.

When a patient argues vociferously in favor of cause of his/her symptoms while displaying resistance to or actually rejecting obvious potential medical solutions to resolve those symptoms is also very suggestive.:

When a patient argues vociferously in favor of cause of his/her symptoms while displaying resistance to or actually rejecting obvious potential medical solutions to resolve those symptoms is also very suggestive.

When you find several of these components occurring together, the likelihood that you are dealing with malingering issues is enhanced.:

When you find several of these components occurring together, the likelihood that you are dealing with malingering issues is enhanced.

When the practitioner continues to pursue a list of symptoms like the fox chasing the quail who is flopping away from her nest, you should consider the possibility that the person with the symptoms is behaving like the quail.:

When the practitioner continues to pursue a list of symptoms like the fox chasing the quail who is flopping away from her nest, you should consider the possibility that the person with the symptoms is behaving like the quail.

Dr. Sall also points out the difference between illness and disease. Disease has pathology at its root. Illness is the perception of feeling sick.:

Dr. Sall also points out the difference between illness and disease. Disease has pathology at its root. Illness is the perception of feeling sick.

Sometimes people are sick and do not know it. These are the cases that suddenly manifest a cancer and then die quickly.:

Sometimes people are sick and do not know it. These are the cases that suddenly manifest a cancer and then die quickly.

People may have sustained illness without any disease. The CDC has recently named that group of disorders as chronic multi-symptom illness.:

People may have sustained illness without any disease. The CDC has recently named that group of disorders as chronic multi-symptom illness.

Most of you are probably familiar with fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome and possibly multiple chemical sensitivities. These are examples of illness without disease.:

Most of you are probably familiar with fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome and possibly multiple chemical sensitivities. These are examples of illness without disease.

There are also a variety of other illnesses/disorders that lend themselves to exaggeration. Postconcussion syndrome, TMJ disorder and disorders associated with Chronic Pain are common ones.:

There are also a variety of other illnesses/disorders that lend themselves to exaggeration. Postconcussion syndrome , TMJ disorder and disorders associated with Chronic Pain are common ones.

In a way, psychiatric symptoms are quite similar to multisymptom illness. Psychiatric patients do report having many symptoms, but there are no objective tests to confirm an underlying disease in most cases.:

In a way, psychiatric symptoms are quite similar to multisymptom illness. Psychiatric patients do report having many symptoms, but there are no objective tests to confirm an underlying disease in most cases.

An important issue, and one of the most important things that I would like to discuss with you is how psychiatric diagnoses are made.:

An important issue, and one of the most important things that I would like to discuss with you is how psychiatric diagnoses are made.

Remember “Grass”?:

Remember “Grass”?

How many of you know about “Survivor Guilt?” :

How many of you know about “Survivor Guilt?”

The Disabled American Veterans published a newsletter about PTSD. They made a typographical error. They indicated that among other symptoms SURVIVOR QUILT was one of the characteristic symptoms that veterans with PTSD experienced. :

The Disabled American Veterans published a newsletter about PTSD. They made a typographical error. They indicated that among other symptoms SURVIVOR QUILT was one of the characteristic symptoms that veterans with PTSD experienced.

Would you believe that within the next several months, there were a number of Veterans who came to apply for benefits claiming, among other things, that they had SURVIVOR QUILT. When asked what that was, they responded with, “I don’t know, but I’ve got it!” :

Would you believe that within the next several months, there were a number of Veterans who came to apply for benefits claiming, among other things, that they had SURVIVOR QUILT. When asked what that was, they responded with, “I don’t know, but I’ve got it!”

“What’s the point of that story, you might ask?” :

“What’s the point of that story, you might ask?”

In the Mental Health Area, there are no x-rays, MRI’s, CAT Scans, EMG’s, or Laboratory studies [so far], or their equivalent. All there is is the history offered to the mental health professional. :

In the Mental Health Area, there are no x-rays, MRI’s, CAT Scans, EMG’s, or Laboratory studies [so far], or their equivalent. All there is is the history offered to the mental health professional.

“Why is that relevant, you might ask?” :

“Why is that relevant, you might ask?”

Without laboratory tests or other means to confirm or exclude diagnostic considerations, mental health professionals are dependent on the history offered.:

Without laboratory tests or other means to confirm or exclude diagnostic considerations, mental health professionals are dependent on the history offered.

GULLIBILITY doctors versus lawyers:

GULLIBILITY doctors versus lawyers

Now do you remember “Grass”?:

Now do you remember “Grass”?

The DEPRESSION SCALE as a screening instrument was a recently published paper.:

The DEPRESSION SCALE as a screening instrument was a recently published paper. It proposed that 10 statements that could be rated as follows None at all [ 0 ] A little [ 1 ] Quite a lot [ 2 ]; and Extremely [ 3 ] Would allow someone to diagnose depression reliably.

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The questions applied to the past month and began with a statement, “I have…” Suffered from insomnia Felt blue Felt everything was an effort Felt low in energy or slowed down Felt lonely

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Felt hopeless about the future Not got any fun out of life Had feelings of worthlessness Felt all pleasure and joy has gone from life. Felt that I cannot shake off the blues even with help from family and friends

A total score of 18 or more suggests the presence of a significant degree of depression according to the author. How many of you think you could fill it out so as to appear to have a severe depression?:

A total score of 18 or more suggests the presence of a significant degree of depression according to the author. How many of you think you could fill it out so as to appear to have a severe depression?

The most common symptoms of mental illnesses are well known. Even if they were not, they are readily available on Web MD, Reader’s Digest, Good Housekeeping and many other places, they are easy to guess at on most of the commonly used instruments for assessing how a patient is progressing. :

The most common symptoms of mental illnesses are well known. Even if they were not, they are readily available on Web MD, Reader’s Digest, Good Housekeeping and many other places, they are easy to guess at on most of the commonly used instruments for assessing how a patient is progressing.

Those of you who are confronted with deciding how to handle claims know that sometimes surveillance tapes help establish whether a given person is or is not as impaired s/he claims to be.:

Those of you who are confronted with deciding how to handle claims know that sometimes surveillance tapes help establish whether a given person is or is not as impaired s/he claims to be.

Fortunately, there are some things that can be done to help separate the people who really are troubled from those who merely represent that they are troubled. Or from those who are somewhat troubled, but claim they are much more troubled than they are.:

Fortunately, there are some things that can be done to help separate the people who really are troubled from those who merely represent that they are troubled. Or from those who are somewhat troubled, but claim they are much more troubled than they are.

One of my favorite tests is called the Rey test. The person taking the test is told that s/he will be shown a card containing 15 items for 10 seconds. The task is to remember as many as s/he can.:

One of my favorite tests is called the Rey test. The person taking the test is told that s/he will be shown a card containing 15 items for 10 seconds. The task is to remember as many as s/he can.

How many of you believe that you can remember 5 or more? 8 or more? 10 or more? 12 or more? Nearly all 15? I would like a show of hands.:

How many of you believe that you can remember 5 or more? 8 or more? 10 or more? 12 or more? Nearly all 15? I would like a show of hands.

So now we know what this group of highly motivated smart people think they can do on this test.:

So now we know what this group of highly motivated smart people think they can do on this test.

What if you were hoping to convince me that you had a Major Depressive Disorder? How should you plan to perform on this test?:

What if you were hoping to convince me that you had a Major Depressive Disorder? How should you plan to perform on this test?

A B C   1 2 3   a b c        I II III   :

A B C 1 2 3 a b c    I II III

If you have a preconceived notion about what is the proper number, you may limit your effort to that level of performance. If you are making a maximal effort, you will probably be able to re-produce the entire chart, because it consists of only a few concepts. These are very familiar and easy to remember.:

If you have a preconceived notion about what is the proper number, you may limit your effort to that level of performance. If you are making a maximal effort, you will probably be able to re-produce the entire chart, because it consists of only a few concepts. These are very familiar and easy to remember.

If you doubt that, I challenge each of you to take a few seconds and write down or mentally rehearse the task and see how many you actually do recall. You saw the slide for less than 10 seconds. I’m guessing that each of you who are still awake remember 12 or more. How many of you recalled all 15?:

If you doubt that, I challenge each of you to take a few seconds and write down or mentally rehearse the task and see how many you actually do recall. You saw the slide for less than 10 seconds. I’m guessing that each of you who are still awake remember 12 or more. How many of you recalled all 15?

Tests designed to measure effort, attitude and motivational factors are often called symptom validity tests.:

Tests designed to measure effort, attitude and motivational factors are often called symptom validity tests.

I recommend that whenever you ask for an IME from a mental health professional you make sure that his/her evaluation will contain at least several symptom validity tests.:

I recommend that whenever you ask for an IME from a mental health professional you make sure that his/her evaluation will contain at least several symptom validity tests.

A thorough review of the available records is also an important undertaking.:

A thorough review of the available records is also an important undertaking.

The most common symptom validity tests are called “forced choice” tests. If you have an interest in more details about them, I will remain after the talk to tell you about them. :

The most common symptom validity tests are called “forced choice” tests. If you have an interest in more details about them, I will remain after the talk to tell you about them.

Several names to keep in mind are: CARB WMT VSVT SIMS :

Several names to keep in mind are: CARB WMT VSVT SIMS

You might ask,”What about tests with internal validity scales like the MMPI-2 and the PAI?”:

You might ask,”What about tests with internal validity scales like the MMPI-2 and the PAI ?”

Yes. Those tests are much better than tests without such scales, but it has been established that those scales alone are insufficient, at least in some cases to detect symptom exaggeration or frank malingering. :

Yes. Those tests are much better than tests without such scales, but it has been established that those scales alone are insufficient, at least in some cases to detect symptom exaggeration or frank malingering.

There are some other test that also contain internal validity scales. These include the DAPS for looking at PTSD, the ADI for looking at depression and the M-Fast for looking at psychosis.:

There are some other test that also contain internal validity scales. These include the DAPS for looking at PTSD, the ADI for looking at depression and the M-Fast for looking at psychosis.

Let’s return to fibromyalgia, chronic fatigue syndrome and chronic fatigue/immunodeficiency syndrome for just a moment.:

Let’s return to fibromyalgia, chronic fatigue syndrome and chronic fatigue/immunodeficiency syndrome for just a moment.

How many of you will recognize what the next slide is supposed to describe?:

How many of you will recognize what the next slide is supposed to describe?

The CDC’s Definition Fibromyalgia: Also known as myofascial pain syndrome and fibromyositis. A group of common rheumatoid disorders (not involving the joints) characterized by achy pain, tenderness, and stiffness of muscles. :

The CDC’s Definition F ibromyalgia: Also known as myofascial pain syndrome and fibromyositis. A group of common rheumatoid disorders (not involving the joints) characterized by achy pain, tenderness, and stiffness of muscles.

I brought with me some pictures of a person’s back. She claimed that she had fibromyalgia. Most of you are probably aware that fibromyalgia typically is associated with the finding of at least 11 of 18 possible tender points. :

I brought with me some pictures of a person’s back. She claimed that she had fibromyalgia. Most of you are probably aware that fibromyalgia typically is associated with the finding of at least 11 of 18 possible tender points.

The first time that I went over her back, I marked every place that she reported to be tender with a red X. I then went over her back a second time and marked each tender point with a blue X. :

The first time that I went over her back, I marked every place that she reported to be tender with a red X. I then went over her back a second time and marked each tender point with a blue X.

One of the things that goes wrong in the physical examination of such patients is the willingness to simply look for the places that are tender. It is certainly easy to find a large number of them. Grass?:

One of the things that goes wrong in the physical examination of such patients is the willingness to simply look for the places that are tender. It is certainly easy to find a large number of them. Grass?

There are healthcare providers who believe that they can identify these tender points. They argue that this is an objective sign. These issues are unsettled, but I hope the picture that you have seen will leave you suitably skeptical.:

There are healthcare providers who believe that they can identify these tender points. They argue that this is an objective sign. These issues are unsettled, but I hope the picture that you have seen will leave you suitably skeptical.

In a study assessing patients with fibromyalgia on disability versus fibromyalgia still working and compared to a small number of rheumatoid arthritis patients, the following was found::

In a study assessing patients with fibromyalgia on disability versus fibromyalgia still working and compared to a small number of rheumatoid arthritis patients, the following was found:

RECALL Failure rates Group Number CARB WMT CARB-WMT RA 16 0 0 0 FM [s] 50 0 4 4 FM [alldis] 46 24 30 35 FM [dis] 30 20 23 30 FM [seek] 16 31 44 44 :

RECALL Failure rates Group Number CARB WMT CARB - WMT RA 16 0 0 0 FM [s] 50 0 4 4 FM [alldis] 46 24 30 35 FM [dis] 30 20 23 30 FM [seek] 16 31 44 44

“RA” = rheumatoid arthr FMs = FMG not seeking disab benefits FM (all) = total FMG group FM (dis) = FMG already on disability FM (seek) = FMG seeing disability benefits :

“RA” = rheumatoid arthr FMs = FMG not seeking disab benefits FM (all) = total FMG group FM (dis) = FMG already on disability FM (seek) = FMG seeing disability benefits

One of the critical issues in assessing patients for a psychiatric disability is the ease with which the claimed condition can be simulated. In other words, in psychiatry there are no objective tests to confirm or to exclude the reported symptomatology.:

One of the critical issues in assessing patients for a psychiatric disability is the ease with which the claimed condition can be simulated. In other words, in psychiatry there are no objective tests to confirm or to exclude the reported symptomatology.

I have been one of the participants in the development of the chapter on mental health for the sixth edition of the Guides to the Evaluation of Permanent Impairments to be published by the AMA.:

I have been one of the participants in the development of the chapter on mental health for the sixth edition of the Guides to the Evaluation of Permanent Impairments to be published by the AMA.

A great concern of many of the panel members has been how to deliver benefits to people who are entitled to them, and how to avoid delivering those same benefits to people who are not.:

A great concern of many of the panel members has been how to deliver benefits to people who are entitled to them, and how to avoid delivering those same benefits to people who are not.

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For those of you who are active in the Workers’ Compensation area, you’ll be pleased to learn that in edition VI, real percentage impairment assessments will be possible. Three scales will be used, each one tending to offer a specific value. The middle value is currently planned to become the actual value, but some of us would prefer to see an average of the 3 values used.

In a recent set of predictions, Dr. Kessler estimated by the year 2020 more than 50% of the United States population would have a serious mental illness.:

In a recent set of predictions, Dr. Kessler estimated by the year 2020 more than 50% of the United States population would have a serious mental illness.

In an article published recently dealing with the incidence and prevalence of psychiatric disorders in Iceland, Dr. Thorlacius indicated that 40% of males receiving Social Security disability benefits and 30% of females receiving them got them because of psychiatric illnesses.:

In an article published recently dealing with the incidence and prevalence of psychiatric disorders in Iceland, Dr. Thorlacius indicated that 40% of males receiving Social Security disability benefits and 30% of females receiving them got them because of psychiatric illnesses.

Results of 2005 NDSD Mental Health Screening* :

Results of 2005 NDSD Mental Health Screening* Nearly 300,000 screenings were completed at 8,000 sites and through SMH's** year-round, online screening offered by hospitals, community groups, colleges, workplaces, and health care companies. * National Depression Screening Day ** Screening for Mental Health

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Scored positive on the depression screening: 33% for the in-person event and 76% online Scored positive on the bipolar disorder screening: 13% in-person and 29% online

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Scored positive on the generalized anxiety disorder screening: 26% in-person and 82% online Scored positive on the PTSD screening: 17% in-person and 65% online *Due to the self-referred nature of the online screenings, historically, we tend to see a larger percentage of positive scores than for the in-person events where screenings are offered to the public at large, not just those who come out of concern for themselves.

SUMMARY AND CONCLUSIONS 1. Mental health and health professionals are gullible. It is not of benefit to argue with your patients about their symptoms. 2. The symptoms necessary to lead to a psychiatric diagnosis are readily available in many places. 3. There are some procedures that help separate those who merely claim they are disturbed from those who really are.:

SUMMARY AND CONCLUSIONS 1. Mental health and health professionals are gullible. It is not of benefit to argue with your patients about their symptoms. 2. The symptoms necessary to lead to a psychiatric diagnosis are readily available in many places. 3. There are some procedures that help separate those who merely claim they are disturbed from those who really are.

4. There is a group of other conditions, like fibromyalgia that are like psychiatric conditions in that there are no objective tests, just subjective symptoms. Some of these cases also show abnormal symptom validity responses.:

4. There is a group of other conditions, like fibromyalgia that are like psychiatric conditions in that there are no objective tests, just subjective symptoms. Some of these cases also show abnormal symptom validity responses.

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5. Mental health disorders including drug and alcohol abuse are important issues in evaluating social security claims, workers’ compensation injuries and health care costs in general. 6. Psychiatry has no truly objective tests to help identify what problems or conditions a given person has…. This opens us all to the possibility of fraudulent claims. 7. Grass is green, but grass doesn’t have wheels!

The END Joel S. Steinberg:

The END Joel S. Steinberg

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