Abstract
Psychologists serving as Qualified Medical Examiners (QMEs) in settings where mental and emotional damage claims (i.e., psychological disability stemming from psychological injury) are involved typically must comment not only upon the impact of the injury on the individual’s functioning and quality of life, but also on the causality of the psychological disability. This is a highly specialized endeavor for which little guidance exists. The disparate conceptualizations of causality in the fields of psychology and law and the unavoidable complexities associated with determining causality, especially the apportionment of causality across industrial and non-industrial factors, are discussed. The questions at the core of the present paper are: 1) What are the ethical challenges facing psychologists working as QMEs who are tasked with determining causality of psychological disability in the ways currently required by the law, and 2) What considerations should guide ethically-minded psychologists in such settings? The authors argue that, although some level of subjectivity is unavoidable, psychologists working within the legal system can take the lead in bringing an evidence-based approach and greater scientific rigor to the high-stakes causal evaluations required as a basis for determining compensation for injured workers.
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Notes
Although there are distinctions among different types of evaluative experts and different names used (e.g., Agreed Medical Examiners, Independent Medical Examiners, evaluator, expert, treating physician) depending on the various selection processes used to identify the expert, for the purposes of the present analysis, the term QME will be throughout. Further, while psychologists and psychiatrists can serve as QMEs for psychological injury cases, the focus of the present paper is on the role of psychologists in such settings.
The terms “psychiatric injury” and “psychological injury” are often used interchangeably in the academic literature and in the law; however, to be consistent with the terminology used in this journal and other prominent works on the topic, the authors will refer to psychological injury and disability.
Note that in cases involving violent acts, the phrasing is modified to read, “actual events of employment were a substantial cause of the injury.” Substantial cause is defined as, “at least 35 to 40 % of the causation from all sources combined (see CAL. LAB. CODE § 3208.3).
The Supreme Court has defined substantial, as that, “which, if true, has probative force on the issues. It is more than a mere scintilla, and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. It must be reasonable in nature, credible, and of solid value.” Braewood Convalescent Hospital v. Workers’ Comp. Appeals Bd. (1983) 34 Cal.3d 159, 164.
Despite being removed from the DSM-5, the GAF is still used to rate disability of psychological injury in workers’ compensation settings.
Note that the QME would also consider dates of injury and apportion based on date of injury pursuant to the decision Benson vs. WCAB (2009) 170 Cal. App.4th 1535, 74 Cal. Comp. Cases 113; Benson vs. The Permanente Medical Group (2007) 72 Cal. Comp Cases 1620 (WCAB en banc decision).
Although, of note, the law simply requires that psychologists evaluate the individual to assess the presence of a “mental disorder which causes disability or need for medical treatment…diagnosed using the terminology and criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, or the terminology and diagnostic criteria of other psychiatric diagnostic manuals generally approved and accepted nationally by practitioners in the field of psychiatric medicine.” See CAL. LAB. CODE § 3208.3—thus, given the different diagnostic thresholds in different diagnostic manuals, there may be also be cause for concern in terms of heterogeneity of diagnosis.
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The authors would like to thank Sarah Mills, M.S., M.P.H., and three additional reviewers for their valuable comments and suggestions that contributed to improving the final version of this manuscript.
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Gholizadeh, S., Malcarne, V.L. Professional and Ethical Challenges in Determinations of Causality of Psychological Disability. Psychol. Inj. and Law 8, 334–347 (2015). https://doi.org/10.1007/s12207-015-9237-z
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DOI: https://doi.org/10.1007/s12207-015-9237-z