From a recent report by Social Security's Office of Inspector General (OIG)
We received a letter, dated August 1, 2009, from a former CE [Consultative Examination] provider who served as an independent medical source while performing psychological evaluations for the IN-DDB. [Indiana Disability Determination Bureau?] The CE provider raised questions about SSA’s [Social Security Administration's] CE process and claimed the Chicago Regional Office (RO) and IN-DDB discouraged the use of certain language as well as the term “malingering” when stating a medical opinion in a CE report.6 Malingering is a term used to describe individuals who intentionally pretend to have, or grossly exaggerate, physical or psychological symptoms for their own gain. ...
RESULTS OF REVIEW
SSA Headquarters and the Chicago RO [Regional Office] have not issued guidelines on suitable language for CE medical opinions and use of certain terms, such as malingering, in CE reports. Although the Chicago RO has preferences regarding suitable language in CE medical opinions, its expectations have not been formalized. Further, while SSA Headquarters does not encourage DDSs to purchase tests for malingering and the Chicago RO would like to cease procurement of these tests, the IN-DDB is still obtaining such tests at the request of administrative law judges (ALJ). ...
While SSA Headquarters’ guidance encourages the identification of malingering, it does not encourage the purchase of malingering tests for mental and psychological impairments. Under “CE Best Practices,” SSA Headquarters’ guidance states, “Do not purchase CEs that include tests for malingering.” The guidance also states, “. . . there is no test, when passed or failed, which conclusively determines the presence of an inaccurate patient self-report.” Related guidance states it is “. . . the observation and assessment of the claimant when challenged with various tasks, and using multiple records and observations from multiple sources, that allows the clinician to make meaningful inferences about a claimant, and the likelihood of malingering.” ...
We believe the IN-DDB’s process of allowing tests for malingering for ODAR, while discouraging the same tests for initial and redetermination cases, sends an inconsistent message to CE providers about SSA’s position on the appropriateness and usefulness of tests for malingering for mental and psychological impairments.
I think it is inappropriate to even talk about "tests for malingering" since there is no accepted "test for malingering." If there were, Social Security would have long since been using it. Supposed "tests for malingering" are sometimes used to try to defeat workers compensation or personal injury claims but they have not been validated and are not generally accepted in the medical community.
My experience is that there are a hell of a lot of Social Security disability claimants with undiagnosed somatoform disorders but not many who exhibit malingering.
My experience is that there are a hell of a lot of Social Security disability claimants with undiagnosed somatoform disorders but not many who exhibit malingering.
Agree, Mr. Hall. I had a psychologist CE testify that use of the term malingering does not always mean the person is not sick. There are lots of reasons that people exaggerate their condition, and often the "secondary gain" they obtain is not financial, but social or psychological.
ReplyDeleteIt would be very entertaining to see the original complaint sent by the "doctor." Apparently the "doctor" was upset that he was using terms like malingerer, and other "non-objective language" in his CE reports and he was angry that SSA told him to stop using that sort of language.
ReplyDeleteWhile "malingering" may be the medical term, in a public benefit claim the words "fraudulant claim" and "perjury" might be more appropriate, ultimately. There are a lot of reasons that a person may carry a cane to show their not being able to work _status_, with a slidding scale of sometimes may need it covering the broad gray middle who CE doctors devine do not need the cane -- based on walking across the exam room.
ReplyDeleteI would rather have the CE come straight out and say what they feel, rather than shade what should be objective findings.
We have one rather notorious psychologist used routinely by the Indiana DDB who routinely administers the TOMM and declares nearly every claimant a malingerer. This test was not ordered by the DDB, nor is it accepted. However, he refers to it and judges will use his reports to destroy credibility. My assumption that the CE doc mentioned in the report is one and the same. We do not ever let a client go to a psych CE with this guy. Never. Perhaps he was feeling the financial pinch.
ReplyDeleteI concede that somatoform disorders are grossly undiagnosed but malingering is out there.
ReplyDeleteMaybe its 2% of cases. 2% isn't many but that works out to a lot of cases on this volume.