Disability Insurance Policies

Disability insurance companies often seek out medical and forensic psychiatry consultation, when policyholders assert they cannot work and file claims for longer term benefits. Such forensic evaluations are heavily focused on an examinee’s diagnosis and prognosis.

A more complicated variant arises in evaluations of those who carry “own-occupation” insurance policies. The forensic psychiatrist must determine only if that person is unable to function in the duties of the specific position covered. A surgeon, for example, is fully covered if he is no longer able to perform surgery but still able to practice medicine. Insurance companies, who do not consider occupational burnout a disability, engage forensic mental health professionals to gauge the extent of illness vs. loss of enthusiasm.

In disability cases, it is particularly important to involve standardized malingering testing to determine whether symptoms are exaggerated, and to what degree. The claims process promotes an examinee maintaining a disabled state as long as possible – and amplifying symptoms and complaints to the examining physician. However, exaggeration does not negate the possibility of genuine and severe illness. The Forensic Panel combines standardized testing with careful history gathering to appraise the possibility of malingering – while remembering to examine for the infirmity and conditions that legitimately persist.

Applying forensic methodology to these cases, The Forensic Panel feels the interview is well-suited for the examinee’s home environment. Such proximity to the examinee’s home turf minimizes a distorted picture that might present in the doctor’s office, by observing the trappings of an examinee’s day-to-day function. Conversely, latent dysfunction may be uncovered, particularly if pride or poor communication skill hinders an examinee from revealing just how limited he or she is.

In our extensive experience at The Forensic Panel, we find that examinees often have medical records which are poorly documented, reflect half-hearted care that perpetuates disability, or under-represents the disabling aspects of an illness. For this reason, we use The Forensic Panel’s peer review to inventory areas that we further explore with treating clinicians, incorporating their familiarity with the patient, before embarking on careful review of collateral sources and a careful examination to flesh out how a person is disabled by their reported condition. The Forensic Panel, through peer review, ensures that the clinical sophistication of our expert forensic psychiatrist gains from the oversight of colleagues who promote objectivity and a thorough, realistic forensic inquiry into a person’s function, potential, and treatment needs.