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Abstract
If a patient reports not having back pain before lifting an object at work but having chronic disabling pain thereafter, an examiner may conclude without further questioning that an injury took place when the object was lifted and therefore is work related. This article reviews relevant scientific findings and provides recommendations for making disability determinations in a manner that is more credible than basing conclusions on an examinee's reports. The author specifically recommends that future editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) should emphasize that clinical and forensic conclusions cannot be based on reports from an examinee and instead must be based on more credible sources of information. Research has shown that, among individuals who believe that a specific event (eg, an accident) caused the current complaints, the individual is likely to underreport their health history for the time preceding that event and to overstate the extent of their problems following the event. Other researchers found that claimants systematically underreported every preclaim health issue that might have provided a non–injury-related explanation for their complaints. Any basis for a conclusion of injury should be based on objective and scientifically credible findings that would have indicated that an injury had occurred even in the absence of any information having been reported by the patient.
- Abstract
- Lack of Credibility of Examinee Reports Even Outside of a Claims Context
- Pronounced Unreliability of Histories Reported by Examinees Making a Medical-Legal Claim
- Additional Findings Indicating the Severe Extent of the Problem
- Recommendations for Clinicians
- Recommendations for Claims Administrators
- Recommendations for Future Editions of the Guides
- References
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1
Barsky AJ. Forgetting, fabricating, and telescoping: the instability of the medical history. Arch Intern Med. 2002;162(9):981-984.
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2
Lees-Haley PR, Williams CW, English LT. Response bias in self-reported history of plaintiffs compared with non-litigating patients. Psychol Rep. 1996;79(3 pt 1):811-818.
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3
Lees-Haley PR, Williams CW, Zasler ND, Marguilies S, English LT, Stevens KB. Response bias in plaintiffs' histories. Brain Injury. 1997;11(11):791-799.
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4
Carragee EJ. Validity of self-reported history in patients with acute back or neck pain after motor vehicle accidents. Spine J. 2008;8(2):311-319.
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5
Don AS, Carragee EJ. Is the self-reported history accurate in patients with persistent axial pain after a motor vehicle accident? Spine J. 2009;9(1):4-12.
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Harris I, Mulford, J, Solomon M, van Gelder JM, Young J. Association between compensation status and outcome after surgery: a meta-analysis. JAMA. 2005;293(13):1644-1652.
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7
Melhorn JM, Ackerman WE. Guides to the Evaluation of Disease and Injury Causation. Chicago, IL: American Medical Association Press; 2008.
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8
Australasian Faculty of Occupational Medicine and Royal Australasian College of Physicians, Health Policy Unit. Compensable Injuries and Health Outcomes. Sydney, Australia: Royal Australasian College of Physicians; 2001.
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