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Making the Right Choice when a Disability Claim Involves a Painful Somatoform Disorder

Jan 15, 2019

Disability claims that include a somatoform disorder (somatic symptom disorder) can be difficult for a claims adjuster to deal with.

The essential problem with these claims is that it’s impossible to objectively verify the pain, as if the pain does exist, it’s not caused by a physical medical problem. The person could be genuinely suffering and unable to perform work or other activities — but without further investigation, could appear indistinguishable from somebody simply malingering or pursuing other illegitimate gain.

Want to learn more about Somatoform Disorders and employment issues?

How do Somatoform Disorders Work?

Somatoform Disorders can be quite diverse. They’re disorders where a person experiences physical symptoms suggestive of injury or illness ­­– but that can’t be explained by a specific objective medical condition, substance abuse, or a separate mental disorder. It’s not an easy thing to diagnose or treat — especially as the person could also be suffering for other medical conditions on top of a Somatoform Disorder — but as with everything, whether a claim should be approved or denied is often going to take a close look at the person, their symptoms, and their behavior.

How are Somatoform Disorders Treated?

When somebody genuinely suffers from this type of disorder, you should look for how they’re receiving treatment. Cognitive behavioral therapy (CBT) is frequently enlisted to help people understand how to handle their symptoms and their stress.

This will help improve the person’s quality of life — and ultimately assist with a return to work and resumption of ordinary social activities.

How Should a Claims Adjuster Make Their Decision?

Use your usual discretion when faced with a somatoform disorder.

  • Doctor shopping may be a sign that the person is searching for a specific diagnosis
  • The claim may be unclear about how much the disorder restricts their activities
  • If the person hasn’t seen a medical professional recently, the diagnosis could have been made based on outdated information
  • There should be some documented evidence of the condition having been present for some time
  • The person may be seeking inappropriate treatment and be on the way to becoming medicalized

When a Somatoform Disorder is present, it’s often present for a long time — sometimes indefinitely. Make sure you get all the information you can.

Seek A Functional Capacity Exam or an Independent Medical Examination

Often, the best way to get a reliable opinion on a disability matter is to engage with a relevant medical expert. Getting an experienced specialist to examine the claimant can help define the issue. You’ll be able to reduce potential bias or lack of knowledge from a family doctor or a general practitioner and get the opinion of someone who regularly deals with these specific issues.

Usually the plan is to rule out physical disease with a rheumatology IME, followed by a psychiatric IME to understand the psycho-social issues that are frequently present and potentially ultimately responsible for the condition in ways that current medical science cannot explain.

When a person’s job description is relevant, and the question of how much of their job they’re able to perform is key, a Functional Capacity Exam specifically can provide answers on exactly how suited they are for work.

Video Surveillance Can Shed Additional Light

If you’re not confident in the details of a claim, you may want to try surveillance. Getting a recording of the person when they’re not undergoing direct medical observation can help to verify the issue or alternatively suggest the possibility of some form of secondary gain.

Look for inconsistencies in behavior between the footage and medical testing. You will want expert medical help in your interpretation — Western Medical Assessments’ new VISAR service, VIdeo Surveillance Analysis Report, can do just this. You’ll be able to get an objective interpretation that can answer questions of the demonstrated endurance, ability to lift, walk, and other work-relevant abilities.

Contact Western Medical Assessments If Ever You Need a Hand

Never hesitate to reach out to qualified medical help to obtain clarity around a tough disability claim. We have access to a vast network of working experts able to provide reliable opinions and reports. And our Medical Director Dr. Roger Hodkinson is always available for a no obligation quick chat!

Reach out here. Or, if you’d like to learn more about how we can help disability insurance adjusters, you’ll want to continue learning here.

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