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April 19, 2016
Case Management Update
This Week's Topic: “Collateral Damages“
Question: Are his personality or legal problems our responsibility?
Dr. Adams replies: Personality disorders cannot be the target of injury-related care, and personality disorders do not arise as a result of injury.
But clinical conditions such as recurrent mood disorders can be potentiated or exacerbated by injury.
A patient assaulted at work may suddenly have to appear for legal proceedings against his/her assailant. While the assault itself is no longer a cause of psychological dysfunction, the court appearance is anxiety-provoking and can be a new source of impairment.
An injury may also involve legal culpability (for example, an MVA in which another individual, even a coworker, is injured or killed). While the patient's physical complaints and psychological symptoms may have subsided, the legal arraignment and charges produce great agitation to patient and family.
Since care is only authorized for those psychological complaints that arise naturally and unavoidably from injury, a more complex issue occurs when the patient individual is authorized for psychological care, but now this work-related accident involves legal, family and interpersonal aftermath.
In this case, we have variability in what the insurer is willing to address/fund. Clearly, a patient facing arraignment on criminal charges may be too agitated/worried/preoccupied to function effectively in the workplace, especially when the work could involve risk to other workers. Depressed and anxious workers are distractible, inattentive and forgetful. Judgment and reasoning may be impaired.
Therefore, we have a patient that could return to work as far as the work-related injury, but the patient feels s/he cannot return to work in the face of new legal burdens. This must be taken into consideration when seeking MMI release of a patient facing potential civil and criminal charges.