Psychosomatic Injuries – An Adjuster’s Challenge

The doctor treating the injured employee notes the physical symptoms improve, but the employee still complains of pain, stiffness, numbness, tingling, and burning.  When a physical exam does not explain away the employee’s symptoms, the doctor requests additional diagnostic testing. When this occurs, the workers comp adjuster should pay close attention to the test results. If an MRI or CT scan or other diagnostic tests reveal no physical problem(s), then the adjuster is facing a significant challenge with the claim and must consider the possibility of a psychosomatic injury.

The treating physician may suspect the employee’s medical issue has psychosomatic features, but few physicians voice an opinion. Instead, the physician often refers the employee to a pain management doctor. Unfortunately, pain management clinics are not designed to treat psychosomatic injuries.

Employers and adjusters often suspect the employee is faking, committing fraud, or malingering. It is almost impossible to distinguish between a psychosomatic injury and an employee exaggerating a claim for secondary motives. Sometimes an employee who fakes physical symptoms to seek out narcotics or avoid going back to work begins to believe the symptoms. So a case of what was malingering is now a psychosomatic injury.

The example of the long haul truck driver illustrates another psychosomatic scenario. A truck driver exits the tractor, when a foot slips causing the driver to fall. The driver uses his hands to break the fall, and this prevents head injury but in turn causes compound fractures in both wrists. A surgeon operates and inserts a plate and screws in both wrists. The driver is now unable to drive and support his family, and temporary disability benefits are not enough for the family to live on. The financial situation worries the truck driver and depression begins to develop. Despite this situation, there are positives for the driver. The family the driver rarely sees is now suddenly attentive. The driver’s family life and marriage even improve. As weeks pass, the trucker feels better and family life returns to normal. The driver does not consciously use pain to get attention, but psychologically realizes life is better when complaining about pain. A psychosomatic condition is born.

According to Wikipedia, there are three common mechanisms for the psychological exacerbation of symptoms in which a normally functioning human mind increases pain and pain related disability.

1.     Depression and anxiety make pain seem worse. Chronic pain leads to a cycle of increasing depression.

2.     When a person worries about a particular body part, the brain can actually signal to the spinal cord via outgoing neurons that it should be more apt to interpret nerve impulses from that body part as pain. For instance, the brain learns to automatically trigger pain when an injured limb is moved.

3.     A belief that something is seriously wrong that does not lessen with normal medical test results and reassurance from the medical provider. Heightened concern and anxiety over the injury is commonly seen in psychosomatic injuries.

The employer and the adjuster can recognize what may be a psychosomatic condition in two ways.

1.     The injured employee may have developed a psychosomatic injury, especially if the symptoms move around the body (the trucker discussed above developed severe pain in his elbow and shoulder after all physical symptoms of the fractured wrist had ended).

2.     When an objective test addresses a specific set of physical symptoms and verifies there is not a physical cause, the injured employee replaces those symptoms with a new set of symptoms.

The psychosomatic injury is a very difficult claim to resolve as the injured employee rejects that the symptoms are not physical. The reluctant medical providers understand it is psychosomatic but avoid officially stating it fearing the patient may replace them. The adjuster or the nurse case manager must be willing to incur the employees anger and urge the employees medical providers to also address the psychological aspects of the injury claim.

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