The definition of malingering as defined by most disability insurance companies is: “the deliberate exaggeration of psychological and/or physical complaints for purposes of tangible secondary gain.” (i.e. monetary rewards, etc.) According to the organizations who review medical claims including disability, the use of the health care system and its resources are severely impacted by patients who malinger. Access to clinicians by patients with valid concerns can be obstructed as well as costs escalated by needless tests for falsified symptoms.”
There are four major types of “malingering.
Pure Malingering—This situation exists when an individual claimant falsifies all symptoms.
Partial Malingering—The individual has legitimate symptoms, but exaggerates the impact they have upon daily functioning.
Symptom Emulation—This person acts out the symptoms of disability but denies the existence of problems which would account for the symptoms (i.e. drug or substance abuse, divorce or family stress etc.)
False Imputation—Situations in which the individual has valid symptoms, but is dishonest as to the source of problems, attributing them , for example, to an automobile accident when the cause was, in fact, an injury occurring in the home.
Again, according to insurance companies, “the malingering individual is seeking tangible gains such as time-off from work and/or financial gain. Underlying motivations may differ among such patients. Indeed, there may be individuals who falsify their symptoms because they believe that it is inevitable that such symptoms will arise later.”
I’ve mentioned malingering here because at least, in part, the purpose of an IME is to obtain written documentation from an outside medical resource stating you are malingering or exaggerating your impairment. Often the MMPI-II is interpreted to indicate whether or not the insured is engaging in “symptom magnification.”
This consultant is of the opinion that if any individual is physically or mentally able to work, they should work. Furthermore, to deliberately misrepresent symptoms or exaggerate a disability in order to gain financially is fraud, and you may be prosecuted under any number of laws existing in the individual states. Your disability policy may have several provisions describing the actions an insurance company will take against you if it is discovered you have given false or misleading information to them.
Having said that, however, it is also my opinion individuals who have a legitimate disability preventing them from working should not be falsely accused of “malingering” when they are not. I recommend to all insureds that they respond and act in a truthful and honest manner in all of their dealings with a disability insurer.
