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 AMAGuides 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.

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