It is far easier to authorize on more series of epidurals, one more referral to pain management, one more MRI, and two more courses of physical therapy than to find out what is wrong with this patient.
I had a patient referred this week solely because after two years, he was claiming depression. However, it was a very illuminating referral. He refused to answer any questions about his life_even claimed to be somewhat uncertain of his age. He would not reveal health problems, education, work history, size of family, whether he was married, etc.
He said _you can only ask me about my pain._
This was one of the most revealing referrals in recent memory. In less than 10 minutes, this refusal/noncompliance was more informative than all of the other studies, exams, tests, and procedures to date.
I am certain that he is attempting to shield a life that is replete with a criminal history, multiple past disability claims and spotty-at-best work history.
Adjusters are overworked and under-rewarded. They want to believe that if they provide the legally mandated care that the case will resolve. This is frequently not the case. Often they need exposure to a psychological report before they realize that they benefit from authorizing (if not initiating) a psychological referral.