Comp Clues


Psychological Evaluations

By Gregory T Hale, Ph.D.
| Date: 02/01/2003

The role and purpose of psychological evaluations in understanding behavioral problems is more clearly understood and accepted for providing clarification in medical and psychological disorders.  In the case of a worker’s compensation claim, any type of complicated medical and psychological disorder is affected by how the diversity of human behavior affects the reactions of the injured worker. The disparity and recovery time required following a work related injury populations it even more difficult to predict who is going to respond positively to the medical and psychological interventions employed to aid recovery.  The psychological and medical literature documents the variable recovery rates for Worker’s Compensation patients compared with those from a noncompensation population.  In addition, psychological evaluations for those being considered for implantable devices and surgical intervention indicate psychological and behavioral factors are critical to the decision making process and success rate of such procedures.

Various types of stressors contribute to the difficulties often experienced by med/psych patients.  The associated problems of physical illness, injury, increased somatic symptoms and sleep disturbance contribute to increased psychological stress and interference with occupational capability and the basic ability to manage the environmental changes.  This causes an increased number of risk factors that contribute to the behavioral and psychological response of medical patients and influence their recovery.  It may even interfere with their ability to overcome some of the difficulties being experienced.  Multiple surgical procedures, repeated experiences in physical therapy and rehabilitation provide both a source of comfort and add to the stress experienced by many medical patients. How a person responds to these various stressors in the course of their treatment can significantly impact their recovery.  For this reason, understanding who was injured is often as important as understanding the injury.

There seems to be great variability, however, in how psychological information is gathered. Clarifying the behavioral aspects of the med/psych case and determining which medical and behavioral interventions are likely to be successful is critical to designing the behaviorally meaningful psychological examination.  More importantly, who conducts the examination based on their expertise and understanding Worker’s Compensation claimants is also critical.  Unfortunately, mental health professionals receive limited training in legal issues, and no training in understanding worker’s compensation.  In addition, external motivating factors in a Worker’s Compensation case often negatively impacts the recovery process.  Thus, the assessment of dissimulation or response bias is needed.   Once again, mental health professionals are rarely trained to assess dissimulation or to question the role of secondary gain.

What is the role of a psychological evaluation in a Worker’s Compensation claim?   First, to establish what psychological factors and psychological disorders, if any, impact the patient’s behavior.  This is determined by conducting a psychological examination and identifying psychological disorders with the assistance of the DSM-IV-TR.  Secondly, are the medical professionals confronting and trying to manage subjective or objective symptoms?  That is, do psychological and behavioral factors impact symptom perception as well as the behavioral presentation of the patient?  A final aspect of the psychological examination is to determine if the legally relevant event caused the psychological disorder.  In addition, some events aggravate underlying psychological disorders.  Thus, psychological evaluations help to clarify those disorders which are pre-existing and existed co-morbidly with the psychological disorder which is causally related to the work event.

The structure of the psychological evaluation is based on conducting a complete diagnostic interview.  The diagnostic interview is an integral aspect of getting to understand the alleged psychological and physical complaints.  The results of the psychological evaluation should not be based solely on self-report.  That is, the determination of causation and other issues critical and appropriate to understanding a Worker’s Compensation claim should not be based simply on a diagnostic interview or limited to the self-report of the claimant.  Psychological testing should be administered which is designed to assess the current complaints.  These tests should be normatively based psychometric measures that provide clarification of the complaints and behaviors reported.  Reviewing medical and psychological records pertinent to the claim aids in understanding the behavioral patterns of the claimant.  Being able to compare data from multiple sources aids in determining the consistency of the symptoms and helping to clarify the credibility of the symptom report.  Without such information it is nearly impossible to determine a cause and effect relationship.  Moreover, concurrent psychological stressors can be identified.   Most importantly, comparing the consistency and inconsistency of the data is achieved.

By utilizing multiple data sources clinical judgment is then based on multiple sources of information and not simply on clinical judgment.   Clinical judgments are often lacking in accuracy when clinicians base their opinions simply on clinical experience or the self-report of the patient.  These clinicians are prone to making significant errors in judgment and overlooking meaningful pieces of clinical information.  Thus, an appropriate psychological examination encompasses an interview, psychological testing, record review, mental status observation, and comparison of data from multiple sources before determining an outcome.

The ultimate value to claims examiners and physicians in requesting a psychological examination is that it helps those who are involved in treating the patient to better understand the effects of the work-related event and psychological disorder.  The life of the claimant, prognosis for recovery, and treatment needs can also be facilitated.  This helps to determine what is necessary to regain useful function, thus reducing the possibility of permanent impairment.  In the medical context, the information gained from a psychological evaluation helps physicians sort out additional information that will enhance their ability to determine which patients have a better and more reasonable prognosis for benefiting from the medical treatment recommended and provided.  The key is to make the information relevant and useful to the recovery of the injured worker.