In the world of insurance claims, medical assessments, and disability cases, malingering is a very important factor to consider. Being able to identify malingering is a critically important skill, especially for a Special Investigations Unit (SIU).
Understanding the Terminology
“Malingering” is a term that refers to making up or exaggerating symptoms beyond reasonable and expected processing time to gain a secondary goal. In the world of fraud investigation, this “secondary goal” is almost always a financial one, but malingering can also be tied to avoidance of work, school, or military service, to obtain drugs, or even just for sympathy or attention.
A claim may start as a legitimate loss. During the normal course of the claim/treatment process, circumstances may change:
- Financial changes
- Medical/Chemical dependency
- They become accustomed to the claims process
- They become more knowledgeable about how to “work” the system.
- As this develops, the opportunity to manipulate the loss manifests into what is considered malingering.
Common Signs to Help Detection
When looking for an instance of malingering, there needs to be close attention to how the subject is behaving and when the behavior changes. This includes when there is an audience and when they believe that they are unobserved. Below are some of the top signs to be looking out for to detect malingering:
- Complaints in gross excess of clinical findings
- Strange or inconsistent symptoms
- A change of symptoms in relation to a change of incentives
- Marked differences in capability for work vs. recreation
- Avoidance or noncompliance with evaluation or treatment
- Compliance with only passive treatment
- Unwillingness to undergo invasive testing, regardless of potential benefit
- Excess of self-limiting behaviors
- Premature or excessive demand for compensation
Consistency is Key
Those who are genuinely disabled due to an injury can be noted by the consistency of their symptoms, behaviors, and stories. On the other side of the picture, those who are fabricating symptoms will have a harder time remaining consistent with them.
Often times, more closely observed tasks will be treated as harder, while routine or typical tasks are done with ease. For example, exiting and entering a vehicle, talking on a cell phone, bending over to pick up a newspaper or walking a dog might be done quickly, but signing a document or demonstrating range of motion might be more exaggerated. In cases where you are looking for signs of malingering, pay attention to the consistency levels in a wide variety of behaviors. People are creatures of habit.
To learn more about fraud investigations and the detection of malingering, contact Brumell Group. We have been responsible for conducting countless investigations into these types of cases and have helped bring fraudulent claimants to justice. Our dedication to unbiased and responsible investigation techniques continues to set us apart and make us an invaluable resource for a wide variety of organizations.