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Forensic Psychiatric, Psychological and Neuropsychological Evaluations

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Brain Damage & Malingering

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The Forest Hills IPA Inc. (FHIPA) has been arranging forensic level independent psychiatric, psychological, and neuropsychological evaluations for litigated cases since 1987. Our clients include both individuals litigants and major disability, workers compensation, no-fault, and liability insurance carriers.

More than an IME Company
FHIPA is much more than an IME company. Our professional expertise in the mental health arena uniquely qualifies us to assist attorneys and insurers in arranging comprehensive forensic evaluations of the highest professional caliber. Our knowledge and familiarity with a wide variety of psychological and neuropsychological test batteries is particularly useful to our clients. We are also familiar with testing strategies employed to assess malingering tendencies, and with difficult to document conditions such as CFS, somatiform disorders, and fictitious disorders. What's more, all incoming referrals are handled by a licensed psychologist, so clients always have ready access to professional advice and assistance -- a valuable service you can't get from a regular IME company.

Evaluation Criteria
Mandatory components in all evaluations and subsequent written reports include: an extended face-to-face interview; a detailed and complete listing of all medical records reviewed; a detailed description of the examinee and his/her presentation on the day of the examination; diagnoses where applicable in all five DSM-IV axes categories; a detailed clinical history; a detailed summary of the subjective complaints and symptoms reported by the examinee; an assessment of how and at what (pre-morbid) levels the examinee was functioning at before becoming disabled or injured (disability cases); if testing is administered, a complete list of tests administered along with scores and details on objective and subjective findings; a statement of findings regarding the presence and extent of a psychiatric disability (language formulation may vary depending on the policy and questions asked by the referral source) or if no fault or liability, a statement of causal relationship; if applicable, a prognosis regarding recovery prospects; if applicable, an assessment of current treatment efficacy and appropriateness and present and/or future need for treatment and required frequency; detailed responses to any specific referral questions.

Finding an Examiner
Based on a careful analysis of case requirements, FHIPA identifies an appropriate forensic examiner from among our 2,500 member nationwide network of pre-screened mental health professionals and submits their CV to the referral source for approval. Once approved, we will schedule the evaluation and handle all records and payment arrangements through our central office in Sunnyside, New York.

All our providers are rigorously pre-screened before IMEs are assigned. Each must be in clinical practice in their specialty for at least ten years and must provide proof of licensing and adequate malpractice insurance, have prior forensic IME experience, furnish copies of CVs and sample forensic reports, and must sign a statement that they are not currently charged with a misdemeanor or felony, and have not at any time been subject to\or notified of any pending disciplinary actions or ethics code violations.

Sincerely,
Dr. Leonard Grossman Signature
Leonard Grossman Ph.D.,
President, The Forest Hills IPA Inc.
Diplomate, The American Board of Forensic Examiners

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Nationwide Forensic Services

Forensic Peer Reviews & Consulting

Includes full forensic level documentation of all records reviewed and detailed professional reporting on diagnostic validity, treatment efficacy and appropriateness, apparent degree of disability, severity of reported symptoms, back-to-work prognosis, and recovery potential.

Depending on the reported diagnosis, reviews are conducted by a licensed forensic level psychiatrist, psychologist, or neuropsychologist. FHIPA consultants are also available to discuss review findings.

Available for disability, no-fault, workers compensation (including New York), liability, and fitness for duty cases.

Forensic Psychiatric, Psychological & Neuropsychological IMEs

Performed by a forensic level professional and includes a comprehensive record review and a full listing of all records reviewed, extended interview time when authorized, administration of psychological and/or neuropsychological testing when requested and indicated, detailed responses to all referral issues and questions, and peer review of a draft report before submission.

Available for disability, no-fault, workers compensation (including New York), liability, and fitness for duty cases.

Forensic Malingering Assessments

Available for all types of mental and nervous cases. Evaluations are performed by a foresnsic level clinical psychologist or neuropsychologist. We will advise clients regarding the type of testing required and its estimated scope. Includes record review and a full listing of all records reviewed, extended interview time when authorized, administration of psychological and/or neuropsychological testing when requested and indicated, detailed responses to all referral issues and questions, and peer review of a draft report before submission.

Available for disability, no-fault, workers compensation (including New York), liability, and fitness for duty cases.

A Partial List of Clients

Cigna Group Insurance, CNA Insurance Company, Kemper National Services, Marathon Ashland Petroleum, Medical Life Insurance, The Hartford Insurance Co., and Wausau Insurance Co.

The Forest Hills IPA Inc.

Leonard Grossman, Ph.D., President

Internet Address: fhipa.com

Email: lengrossman@fhipa.com

Voice ( 718 ) 786 - 1328 Fax ( 718 ) 937 - 6529

What is Neuropsychological Testing?

By Michael Castellano

Neuropsychological testing is a standardized, clinically-established procedure developed to assess an individual's cognitive level of functioning and, when deficits are present, to quantify the severity and scope of existing cognitive impairment. Testing is administered by a licensed psychologist (also referred to as a neuropsychologist) who specializes in neuropsychology.

What is Neuropsychology?
Neuropsychology is a highly specialized discipline within the field of psychology. The science of neuropsychology focuses on cognition, i.e., the ability of the mind and brain to think, reason, remember, learn, comprehend, etc. Clinical neuropsychology is practiced by a licensed psychologist specializing in neuropsychology. This specialty field has developed a variety of clinically standardized tests and procedures to evaluate the cognitive and functional effects of brain injury, brain damage, and organic brain disease. A clinical neuropsychologist:

may enter private practice and offer various forms of psychotherapy and cognitive rehabilitation to individuals, families, or groups.
can administer standardized psychological and neuropsychological tests to patients in office and hospital settings, and interpret and report on their results.
may furnish legally-recognized clinical and diagnostic opinions and conduct diagnostic interviews regarding the presence, scope, and treatment of cognitive/neuropsychological disorders, behavioral disorders, and mental illness.

Frequent Causes of Impairment
One of the most frequent causes of cognitive (neuropsychological) impairment is brain damage. Damage to brain functioning can be precipitated by head injuries, stroke, chemical and toxic exposures, organic brain disease, substance abuse, and medical malpractice. Cognitive deficits can also have non-organic, transient roots, and may be associated with depressive conditions, anxiety disorders, and severe psychological trauma.

Neuropsychological tests have been standardized over the years in much the same way as psychological tests. SNTs are validated in a clinical trial setting according to established professional procedures such as using a randomly selected control group, adjusting for age and educational background, etc.

SNTs also have clinically-validated "base-line" norms; the amount of deviation from established norms helps determine the severity and scope of cognitive impairment and dysfunction present in the individual.

SNTs are administered in oral, written, auditory, and visual formats, and are also quantifiable. Quantifiable tests present results in a percentile/percentages format. When the percentile or percentage recorded in a particular area deviates from established base-line norms, it suggests the presence of a particular cognitive impairment or deficit.

Screenings and Batteries
Lower-cost neuropsychological screening tests are administered to obtain preliminary information on a patient's cognitive status. While not intended as a formal (stand-alone) clinical diagnosis, neuropsychological screening tests are useful in evaluating patients with mild cognitive impairments, and patients thought to be at risk of having or developing cognitive impairments and disorders (workers and children exposed to lead or other toxins, patients who faint or suffer lapses in consciousness, etc.).

Neuropsychological batteries are usually administered to high- risk/seriously deficient patients who exhibit obvious symptoms of cognitive dysfunction and impairment. A typical battery may consist of a dozen or more SNTs, and provides quantifiable diagnostic information on cognition which is highly detailed and specific.

The attending professional selects the specific SNTs included in the battery based on patient history and current symptoms. (Battery testing by a forensic specialist is strongly recommended in legally-contested disability and liability cases.)

Standardized neuropsychological tests (both screenings and batteries) are typically administered by a licensed psychologist specializing in neuropsychology, and also include a neuropsychological IME component (i.e., the attending professional conducts an interview portion of the examination, and includes in the report observational data and reactions/responses to relevant psychological and neuropsychological questions).

Versus Medical and Neurological Tests
The five minute "mental status" test (Who is president? What is your mother's maiden name?, etc.) frequently submitted to insurance companies by neurologist M.D.s provides preliminary, non-quantified information on gross (serious) manifestations of cognitive impairment.

On the other hand, neuropsychological testing can take many hours to complete, and may encompass more than a dozen specialized tests. It provides standardized, clinically-validated hard data on cognitive impairment which is quantified and qualitatively more detailed, and a great deal more relevant in contentious disability and legal cases.

Quantifiable neuropsychological test data gives the clearest picture possible on cognitive status and functioning, and eliminates the need for informed speculation and subjective medical opinions regarding the cognitive effects of brain damage. (Important Reminder: CAT scans, MRIs, PETs, and other neuro-imaging procedures report on the structural and physiological scope of brain injury, but do not provide any information of cognitive and intellectual functioning.)

Differences between Neuropsychology and Neurology
Neurology is a field encompassing the science and study of the human brain and nervous system and its diseases. Clinical neurology is a specialty field of medicine; a clinical neurologist is an M.D. who is board certified in neurology. The function and practice of a clinical neurologist differs substantially from that of a neuropsychologist. Since there is great confusion between the two, it is important to carefully note the differences:

The neurologist M.D. deals with the structural and physiological consequences of brain injury and organic brain disease, while the neuropsychologist Ph.D. investigates the cognitive and behavioral impact of such conditions. For example, an individual suffers serious brain damage in a car accident. The neurologist will run tests and make determinations as to the physical impact of injuries: Can the patient ambulate, move limbs and muscles, and maintain hand/eye coordination?; Is an EEG needed? How severe is soft tissue damage?; Is surgery in order?; etc. The neuropsychologist, on the other hand, will examine and test the patient's powers of cognition: Can the patient think and reason clearly?; Is long and short-term memory impaired?; Have reading, learning, and comprehension been compromised?; etc.

It should further be noted that in disability determinations and related procedures, the neurologist is not "more important or qualified" in medical or legal terms than the neuropsychologist. The neurologist M.D. is qualified and licensed to make a clinical assessment regarding a patient's physical disability status as a result of brain damage; the neuropsychologist Ph.D. is qualified and licensed to make a clinical assessment of the patient's cognitive disability status. Both have important, but different, functions in examining and treating individuals suffering from head injuries and brain damage.

Neuropsychological Testing,
Brain Damage, and Malingering

By Leonard Grossman, Ph.D.

Whether from accident, chemical exposure, or medical malpractice, the most devastating consequences of brain injury are often those which effect cognition (i.e., the ability to think, reason, access short and long-term memory, speak and comprehend, make decisions, etc.).

Experienced attorneys on both sides of the legal fence know that in litigations where brain damage is alleged, presenting proof of physical injury is not enough: quantifiable evidence must be produced which also documents the functional degree of cognitive impairment currently present.

Objective, Clinically-Validated Hard Data
Neuropsychological testing provides attorneys with clinically validated hard data on the severity and scope of cognitive impairment. Such information is qualitatively more detailed, and a great deal more relevant, than subjective data gleaned from rudimentary "mental status tests" performed by neurologists and psychiatrists.

And while modern neuro-imaging techniques (CAT scans, MRIs, PETs, etc.) and neurological procedures provide important data on the structural and physiological scope of brain injury, they reveal little or nothing in the way of hard evidence about its cognitive and behavior consequences.

CARB and WMT Testing for Symptom Exaggeration and Malingering
The cognitive impact of head injuries and brain trauma is inherently unpredictable: an apparently severe head injury with an accompanying skull fracture may leave no lasting cognitive impairment, while a relatively "minor" injury can leave lasting deficits. With huge cash settlements often in the wings, the temptation to fein or exaggerate symptoms is enormous.

Fortunately, neuropsychological testing affords us the opportunity to objectify the actual degree of cognitive impairment present, and to identify cases of suspected symptom exaggeration or malingering. This can be accomplished through a "dissimulation strategy" that tests the samearea of cognitive functioning in ways which appear unrelated to the examinee. Individuals who exaggerate or fake symptoms tend to perform inconsistently on such tests, with a clear pattern of deception often emerging.

In addition, recently developed tests such as the CARB (Computerized Assessment of Response Bias) and the WMT (Word Memory Test) are now available which more specifically address issues of motivation and effort, and tendencies to exaggerate or fein symptoms. CARB has been extensively normed (validated) and can be self-administered on almost any IBM-compatible in less than a half hour. The CARB is also available in a Spanish version.

The WMT is a dual-purposed test which assesses both malingering and memory using a single, paired associates word list. The WMT has been validated in 218 compensation cases and can be administered orally or by computer in about 15 minutes. The WMT measures both effort and performance. The CARB and WMT can be employed along with other neuropsychological and psychological tests to maximize the potential for detecting and corroborating symptom exaggeration and/or malingering.

Protecting Individual Rights
Less we forget, by its very nature a "dissimulation" testing strategy can also corroborate the accuracy of patient self-reporting, and help validate the severity and scope of existing cognitive impairment. Thus, it would indeed be erroneous to assume that testing of this type is "anti-claimant" or antagonistic to the interests of victims of accidents or medical malpractice. Reliable and verifiable testing methods can only serve to protect the interests of all concerned parties.

For more information on forensic neuropsychological testing, please feel free to contact us at (888) 779 - 2524. We are always available for "same-day" over-the-phone professional consulting for cases which require immediate attention.

Sincerely,
Dr. Leonard Grossman Signature
Leonard Grossman Ph.D.,
President, The Forest Hills IPA Inc.
Diplomate, The American Board of Forensic Examiners

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