April 2006 Newsletter
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What Type of IME Examiner
Should You Use?
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April 2006 Newsletter
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Documenting
Malingering Cases What Type of IME Examiner Should You Use? |
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The following is a recently updated web version of a newsletter initially distributed to claims examiners and disability specialists in April 2006. It was authored by Leonard Grossman, Ph.D., a psychologist and diplomate of The American Board of Forensic Examiners.
 You suspect malingering, but you aren't sure which type of IME examiner to employ. You've just learned that a claimant out on a psychiatric disability with a diagnosis of agoraphobia (a debilitating fear of open spaces, crowded places, traveling, leaving one's home, etc.) has left for Europe on an extended vacation.
While you're no doctor, you immediately suspect malingering. You're about to pick up the phone to arrange an IME when you recall how bad the report turned out the last time you had a case like this.
The truth is, suspecting a claimant may be malingering and documenting it clinically are entirely different matters. With huge benefit reserves often at stake, and with it the very real threat of litigation, you can't afford to arrange a hit-or-miss (some would say "Russian Roulette") IME.
 Employ an experienced neuropsychologist as your IME examiner, and make sure a professional consultant drafts your referral questions. Why employ a neuropsychologist, and why not use a plain vanilla psychologist or psychiatrist? Because in the majority of cases, to credibly document malingering you need objective data on both psychological and cognitive functional abilities and limitations. A neuropsychologist is a special breed of psychologist, one who is qualified to administer a full range of both psychological and cognitive testing procedures.
Without such tests, the examiner is forced to rely exclusively on a one-to-one diagnostic interview. Under such circumstances, there is no way to be sure if the claimant's presentation represents a true picture of psychiatric and cognitive functioning. Even if the examiner makes a diagnosis of malingering, there is no hard evidence to back such findings.
Lacking objective test data, your case may boil down to the opinion of one or more treating doctors versus an IME examiner who spent a mere hour and a half or less talking to the claimant—which is hardly the type of case you'd like to wind up defending in a litigation.
How Dissimulation Testing Documents Malingering
The key to symptom validation, and to confirming or ruling out malingering, is to administer a variety of tests which appear unrelated to the examinee, but which in fact are designed to assess the same area of cognitive or psychological functioning.
When tested repeatedly in the same area, a process sometimes referred to as dissimulation testing, an individual who is feigning or exaggerating symptoms tends to perform inconsistently, and inconsistent performance is a hallmark characteristic in cases of malingering.
For example, an individual complains of problems with recent memory. On one very difficult short-term memory test he scores in the average range with no apparent impairment. However, on another, and much easier, short-term memory test his scores are in the severely impaired range. The same pattern is repeated when long-term memory is assessed, and the examiner eventually concludes that test data does not support the alleged memory deficits.
At the same time, it would be a serious mistake to view dissimulation testing as inherently antagonistic to claimant interests. The process can just as easily validate symptom manifestation and corroborate levels of impairment or disability. An individual with genuine difficulties who is truthful in his or her presentation, and makes an honest effort on the tests administered, need not be concerned about the results.
Who Should Prepare your IME Referral Questions?
In point of fact, the majority of form letters I've encountered were actually written with "straight medical IMEs" in mind, and have no specific language dealing with mental health issues.
In a psychiatric disability case where malingering is a possibility, it is absolutely essential that your questions be prepared by an experienced professional mental health consultant who understands the psychiatric dynamics of the case as well as the testing process itself.
Carefully crafted questions can translate insurance-related concerns into professional issues the examiner can more fully and effectively address. Tight, targeted questions also helps to avoid reports with unrequested or inappropriate speculation in areas outside the examiner's specialty.
For More Information on Malingering
Sincerely,
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