Psychological Testing SSDI Benefits

Malingering, Disability Benefits and Standardized Psychological Testing – Some Thoughts

Apart from a complete medical record review, standardized psychological testing may become mandatory in SSDI determination

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Medical evidence that is considered for a detailed medical record review in a social security disability (SSI) case includes physician examination and treatment notes, mental health records, imaging study reports and blood work panels. To get a speedy determination on a disability claim, timely, accurate and adequate medical evidence is vital. In disability determinations, benefits may also depend on the results of a PCE or psychological consultative examination. A recent News Medical article highlighted a report from the Institute of Medicine (IOM) that called for broader use of standardized psychological testing for applicants applying for SSDI to the United States Social Security Administration. This is to help improve the accuracy and consistency of disability determinations. Some medical experts say that the number of people who fake or exaggerate illness is increasing. It is suggested that there are people who enter the benefits rolls through malingering or exaggerating illness and mandatory psychological testing for SSA disability applicants may reduce the number of beneficiaries receiving undue benefits.

The Curse of “Malingering�

Malingering is defined as the purposeful production of false or grossly exaggerated symptoms of some illness, largely motivated by the hope of external gain. A 2002 study in this regard published in the Journal of Clinical and Experimental Neuropsychology examined approximately 10,000 neuropsychological assessments that involved patients who applied for or received compensation benefits or were involved in personal injury litigation. The study found that 29% of personal injury and 30% of disability claims involved probable malingering and symptom exaggeration. A 2007 book Assessment of Malingered Neuropsychological Deficits by a neuropsychologist also points out that half of people involved in medical-legal claims exaggerate their illnesses. Apart from the desire to secure workers’ compensation and disability benefits, people are motivated to malinger in order to stay out of legal trouble, avoid working, obtaining medications or receiving allowances such as extra time for an academic exam.

Researchers in this area say that the bad economy was the main cause that led to an increasing number of people pretending illness to gain financial benefits. There have been

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many cases such as retirees being arrested for disability pension fraud, and others falsely claiming to have some fatal illness or other and raising thousands of dollars in donations. A 2009 survey by the Association of Certified Fraud Examiners point out that 55% of 500 fraud examiners said that occupational fraud had risen mostly as a result of intense financial pressure.

If people are obtaining benefits through faking illness, it will obviously bring huge costs to the government and must therefore be avoided.

Argument for Mandatory Psychological Testing Under the SSA, state agencies determine disability of an applicant on the basis of medical and other evidence that may include standardized psychological tests. They may use validity tests along with these standardized tests to evaluate whether the claimant is exerting sufficient effort to perform well in the test, or providing a correct report of his/her symptoms or replying to the best of his/her ability. As per the IOM study mentioned at the outset, 

Under specified conditions, the SSA should ask for standardized, non-cognitive psychological testing for all applicants whose claim of non-cognitive functional impairment relates to a mental disorder that is not accompanied by cognitive complaints; or to a disorder that is accompanied by physical symptoms that are inconsistent with the medical findings.

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Testing should be required when the claim is primarily based on the applicant’s own reporting of the symptoms, which is not validated by objective medical evidence or medical records adequate to arrive at a disability determination.

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Standardized cognitive testing should be included in the case record for all claimants whose allegation of cognitive impairment is not accompanied by objective medical proof.

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A statement of evidence emphasizing the soundness of results should be included in all cognitive and non-cognitive psychological testing.

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Validity assessment will help the claim evaluator to interpret the accuracy of a claimant’s non-cognitive and cognitive test results. Validity tests alone do not provide information about whether a person is disabled. Moreover, if the validity testing was not proved valid, that alone cannot be used to deny a disability claim. In such cases, the SSA should obtain additional evidence to determine disability.

What exactly is the advantage of mandatory psychological testing, especially validity testing? It may help the SSA disability programs generate significant cost savings. This cost savings would vary on the basis of the assumptions about the groups to whom the testing is applied and how many false claims are detected and rejected. The SSA will have to collect additional information both before and after the implementation of the mandatory psychological testing before a complete cost-benefit analysis of psychological testing can be derived.

What about Genuine Applicants?

Genuine applicants for disability benefits who unfortunately find their claim denied for lack of evidence can benefit from the service of a social security disability attorney. If you consider the disability application process in detail, you will find that the SSA does not easily approve a benefits request. More than half of all applicants may face denial initially without regard to the applicant’s level of disability. Often, it is after an appeal process and a hearing before an ALJ (Administrative Law Judge) that an application is approved. SSD attorneys with the support of medical record review services clearly evaluate the claimant’s case for merit. They assist clients throughout the disability claim application process. Sometimes, after the hearing before an administrative law judge, an applicant may find that he/she has been denied benefits even with sufficient evidence. In such cases, disability attorneys may be able to convince a court to order the SSA to give claimants the due benefits.

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