What is malingering?

What is “malingering” and how can it affect your workers' comp case?

Malingering comes up often in the context of workers' compensation. Malingering is a term used to describe the action of exaggerating or falsifying one's illness or injury to gain some benefit (such as workers' comp payments).

Workers' compensation program administrators and officials of the employing company often accuse employees who receive workers' comp payments of “malingering” as a way to extend benefits. These accusations, which happen on a fairly regular basis, are unfair to dedicated employees who continue to suffer effects from injuries or illness contracted on the job. Such workers are rightfully owed benefits.

A Medical Definition of Malingering:

WebMD defines malingering as:

“‌. . . pretending to have an illness in order to get a benefit. The feigned illness can be mental or physical. Malingering is also when someone exaggerates symptoms of an illness for the same purpose. Malingering is an act, not a condition.”

Adding insult to injury: When you're accused of malingering after making a workers' comp claim

False accusations, especially when a victim of illness or injury is pressured to return to work when they are truly unable to do so, are detrimental to the healing process. Accusing employees of malingering, rather than finding ways to adjust their job tasks so they can return to work promptly, hampers the healing process, contributes to continued suffering.

An ill or injured worker, unfairly accused of dishonesty, may understandably become even more stressed. His or her condition, rather than improving, may deteriorate.

Insurance company representatives and corporate leaders are paid to keep their organizations profitable. They can't be blamed for looking out for their bottom lines. But sometimes they apply a bit too much pressure to injured or ill individuals when evidence of malingering is lacking.

The defense in a workers' compensation case will go to great lengths to make an injured worker seem undeserving of benefits. A common tactic is to label the worker a “malingerer”. Workers' comp lawyers are prepared to defend the right to benefits of injured workers who are innocent of these charges of malingering.

Workers' Compensation Lawyers Address Frequently Asked Questions about Workers' Comp and Malingering

What conditions trigger suspicions of malingering?

These 3 red flags are among the conditions that may result in a charge of malingering, whether or not the charge is valid.

• The nature and severity of your symptoms, as you report them, do not correlate with the typical symptoms of most people experiencing the condition with which you were diagnosed.
• Medical tests that are objective: like x-rays, CT scans, MRIs, and blood analysis cannot verify the symptoms or conditions you are reporting.
• Your past medical and personal history – does your doctor have reason to doubt the honesty of what you are reporting, based on earlier false or misleading descriptions of symptoms?

Can a workers' compensation lawyer protect me from charges of malingering?

Your best course of action, if you are receiving workers' comp benefits and are under investigation for suspicion of malingering, is to contact a Pennsylvania workers' compensation lawyer. It's not always easy to prove someone is guilty of malingering, but in some cases, it is easier to do so than it was several years ago.

Taking a chance isn't worth the risk. A workers' comp lawyer will understand the best action to take to prove you are experiencing the symptoms you report. If there is no way to provide definitive proof, a lawyer can cast doubt on the motivation behind the insurance company or employer's challenge to your honesty.

Seeking help makes sense. Contact a Munley Law Personal Injury Attorneys workers' comp attorney for a free, no-obligation consultation to determine whether we may be able to assist.

How can I avoid being accused of malingering?

There are some proactive steps you can take, and actions to avoid, to lessen the chance of innocently triggering a charge of malingering.

Everyone does not always heal at the expected rate. Some injuries and illnesses leave lasting effects, prompting a request for continuing treatment. But be careful what you say when speaking with a doctor, especially if you are consulting with one who doesn't know you well.

The most innocent of requests can be misinterpreted by some physicians. If what you are asking doesn't sound like a typical request by someone with your diagnosis, it could evoke suspicion in the minds of some physicians.

Following are four actions to avoid if you want to lessen your chance of being suspected of malingering.

• Try not to request that your doctor prescribe a specific drug to treat your symptoms.

Some doctors take a dim view of those who actively seek certain types of drugs, especially strong medicines intended to manage pain. Though you may legitimately need a drug you have taken previously, one you know works for you, consider carefully how to word your request, especially if the drug you believe you need is a narcotic.

• Don't exaggerate your symptoms. Maybe your doctor isn't as empathetic as you would like. Some physicians fail to realize how much pain their patients experience. They may believe a patient should be improving, whether that's the case or not. Such situations can be frustrating.

Nevertheless, don't tell your doctor your pain is at the top of the 1-10 scale unless you recently experienced an acute injury, and the pain truly is currently excruciating.

• Offer your best effort toward mental and physical tests.

Scoring significantly lower on mental or physical health tests than expected can trigger alarm bells – suspicion of malingering. It will destroy your doctor's trust in you, not to mention that of workers' comp or other benefit program administrators.

• Don't mention your workers' comp or other benefit claims until you discuss your condition.

Focusing first on the claim during a visit to the doctor can make it seem like receiving benefits is your sole intent, rather than the effort to find a way to heal your condition.

Note: If you suffer from lingering symptoms or have a condition like fibromyalgia that cannot be diagnosed via objective tests, and your doctor doesn't seem to believe your reports, seek another physician.

What should I do if I am accused of malingering?

A claim of malingering is often made following an examination of an injured or ill worker by a workers' compensation insurance company doctor.

In such a case, a written statement from the worker's primary care physician, especially if the worker has been treated by that physician for several years, can be very convincing. Objective medical evidence is, of course, the best way to put malingering charges to rest.

Past medical records may be helpful also. If the worker was rarely ill or injured in the past, or, if so, recovered normally, the workers' claim of still experiencing symptoms is probably legitimate.

But a charge of malingering is a serious action. Countering it immediately is essential. A skilled and experienced workers' comp attorney can help an injured worker by obtaining independent medical reports that prove the worker's condition is genuine.

In cases where a person's doctor has accused him or her of exaggerating symptoms, the ill or injured person is in a much more difficult position. But even in such a case, statements of friends, family, co-workers, and a good lawyer can help,

Hiring a Pennsylvania Work Injury Lawyer to Address a Charge of Malingering

Some workers represent themselves. But self-representation is usually unwise. Most people do not have the training to understand the best manner of addressing an accusation of malingering. Those who fail to obtain a lawyer may be forced to return to work before they have recovered sufficiently. Additionally, they often accept an inferior settlement offer.

Various issues must be addressed if an injured or ill worker is to receive proper compensation for on-the-job injuries. Munley Law Personal Injury Attorneys is an award-winning legal firm whose goal is to provide superior legal services for those who have suffered an injury or have been denied workers' compensation benefits. With offices in eight cities across Pennsylvania, we have the knowledge and experience to offer you legal services for workers' comp cases, free of charge until you receive benefits.  Call 24/7 for a free consultation.