My experince has been that at the time of settlement, there is an increase in complaints of depression and pain. My belief is that these are simply manipulations to encourage a larger settlement._
If the patient is referred early for psychological care, we have a clearer timeframe of the onset, intensity and course of resolution of pain, anxiety and depression.
When the referral comes closer to settlement, it can be difficult to determine if the purported increase in symptoms is part of the normal waxing and waning of complaints or if it is, instead, part of a conscious manipulation.
Patients consistently tell me that their requests for psychological care were made six-nine-twelve months ago…and more than once.
However, patient’s mental status at the time of proposed settlement is undeniably a problem area. There is no question that this can be an opportunity for the patient to appear dysfunctional for three reasons:
a. The patient is fearful of release and independence from the workers’ compensation system even though they have decried the unfairness of the system. Simply, they have become hostile-dependent
b. The patient is concerned that within months of release, he/she will encounter obstacles that again trigger the psychological symptoms, or that they may be unable to find work
c. The patient (and/or counsel) is attempting to increase the value of his/her case
Thus, it is always better to refer for the psychological complaints as soon as they are detected by the nurse case manager or primary physician.