Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Early Administrative Closure

Clearly, this would seem not to be a clinical matter, merely a financial one. But I suspect that early settlements occur because an insurer or employer has found case management to be burdensome, unrewarding, unending and often punitive.

Many insurers and employers perceive that ultimately the patient and his/her family solely want a monetary conclusion.

While this may be true in some cases, my clinical experience is that insurers/employers (including adjustors/nurses) are not able to discern the patient_s goals and try to find a dollar amount that allows closure since the underlying goal appears elusive.

Many patients want the unachievable: they _just want things back the way they were_ (pre-injury status)_ _want my life and my family back_ _ _want to go back to the work I did._

These often unattainable goals are often unrecognized and, therefore, never addressed. The patient languishes, all become frustrated, and the money which precedes closures is misperceived as the true goal. In reality, the money is often just resignation.

A much more effective approach would be to determine, from the patient and the patient_s spouse, what goals are not being verbalized and whether the patient can be assisted to discover which can, and ultimately, which cannot be achieved.

This is the answer to people who ask _what is the role of psychotherapy with these patients?_

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