Claims examiners are understandably a skeptical group. They tend to assume that any claimant who overstates his actual level of emotional harm or neuropsychological impairment is malingering. While that is often correct, it is important to recognize that not all exaggeration, or even intentional failure, on a neuropsychological test is necessarily malingering. This article considers other explanations for nonproximally caused emotional symptoms, and methods for detecting feigned neuropsychological impairments.

Malingering Emotional Harm
Malingering is the intentional production or reporting of symptoms to obtain an external reward (e.g., money) or escape undesirable consequences (e.g., work, jail, etc.). The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is the key reference work in the fields of psychiatry and psychology. It recommends that malingering strongly be considered during evaluations performed in a legal context if one of three factors is present—a marked discrepancy between the claimed disability and objective findings, poor cooperation with the evaluation process, or the presence of Antisocial Personality Disorder.

Examiners must be careful, however, to consider reasons other than malingering that can cause claimants to exaggerate their conditions or even intentionally harm themselves. Factitious Disorder is the intentional production of mental or physical symptoms of illness to assume the role of an ill person and thereby receive compassionate care.

Claimants with Factitious Disorder intentionally induce sickness or injury, or subject themselves to multiple, invasive, and even dangerous medical procedures without a genuine medical need. The claimant then derives gratification from the attention and care received as a “patient.” Although a claimant with Factitious Disorder is intentionally producing his or her symptoms, the desire to derive compassionate care is driven by a mental illness rather than malingering.

These claimants will deny intentionally harming themselves and flee healthcare facilities, medical providers, and adjusters when confronted with the intentional aspects of their self-injurious behaviors, only to repeat their pattern at another facility on another date. The cause of Factitious Disorder is not known, but certainly is not caused by insured events like motor vehicle accidents.