The Forensic Examiner Articles

Causal Attributions of Occupational Disability

Attribution theory seeks to understand how individuals interpret events and how explanatory thinking and behavior tends to correlate with human motivation. Attribution theory considers how people make sense of their worlds and what causeand-effect inferences they make about the behaviors of themselves and others. For years the potential role of attribution theory in the cause-and-effect beliefs that people create and maintain when they acquire vocational disability has been explored. It has been postulated that healthcare providers, specifically physicians, trained in assessing impairment are generally ill equipped to determine the cause of disability in others. The authors of this article have hypothesized that vocational disability tends to be temporary or become fixed depending on an individual’s attributional style. This article will again review the difference between medical impairment and vocational disability and discuss the multitude of issues surrounding causal attribution of occupational disability.

Medical Impairment v. Occupational Disability. Medical impairment, an alteration of an individual’s health status, is what is wrong with a body part or organ system and its functioning (American Medical Association, 1990). Permanent impairment should be determined only at the end of the normally accepted healing period or when maximum medical improvement has occurred. Impairment does not determine the impact on the person’s capacity to meet social or occupational demands; disability defines the impact of impairment on occupational functioning. Medical impairment is evaluated and treated by healthcare personnel. Disability is assessed by non-medical means, generally by vocational experts and disability evaluators. What causes occupational disability is often more complex than simply a decrease in physical or mental functioning secondary to a particular impairment.

Occupational disability is often caused by pre-existing medical problems, social dynamics, psychological issues, the lack of work skills that might be utilized in alternative or perhaps less demanding work, and/or economic factors such as the availability of appropriate employment given a medically impaired individual’s residual employability. Nonetheless, how people explain acquired disability is very much a function of the attributions they create.

Attribution Theory. Attribution theory, what Weiner (1986) called naïve psychology—the cause-and-effect analysis of behavior made by the person-in-thestreet—attempts to explain the mechanisms by which people construe the causes of behavior and arrive at their beliefs about success and failure. Attribution theory has been linked with achievement-related behavior, such as learning and working, and mental health concepts (e.g., optimism, pessimism, anxiety, and depression). Attribution theory helps explain not only how individuals perceive their own successes and failures, but also how they causally ascribe the achievement of others.

The authors of this article postulate that individuals who have medical impairments can attribute occupational disability to an accident or injury for no other reason than a temporal connection—that is, the person became unemployed after a trauma. Since the injury allegedly resulting in impairment came at the time of or after an accident, it is implied that the accident caused the disability. It can be argued that a timebased explanation in the determination of what causes occupational disability is often inadequate in explaining disability given the multitude of other factors, including pre-existing medical conditions, that can cause unemployment subsequent to, but not necessarily as a consequence of, the indexed traumatic event.

For example, a 38-year-old female who sustained a whiplash injury in an automobile accident stopped working as an outside sales representative 5 months after the accident and claims that her chronic regional pain syndrome, diagnosed after the accident, was the cause of her occupational disability. Careful investigation, however, revealed that she was previously treated for rheumatoid arthritis and fibromyalgia. Her theory as to why she was unemployed with a loss of economic power was that her occupational disability was directly and causally related to the whiplash injury. A physician treating her declared that her chronic pain complaints were directly linked to the whiplash injury that had become the basis for the patient’s personal injury lawsuit. In reality, her chronic complaints of pain and concomitant allegations that she could not work were multifactorial at least. Further investigation revealed that this sales representative was being disciplined at work for low production. Additionally, the company for which she worked was being purchased by another entity, and rumors were circulating that layoffs of sales representatives would occur as a result of the acquisition.

Causal attributions of occupational disability are best made by trained observers or evaluators who fully appreciate the psychosocial context in which causal attributions of acquired disability are made. Occupational disability has been studied from numerous social and psychological perspectives. Important constructs have been offered to help better understand and explain the non-medical antecedents and consequences of vocational disability. The concepts of disability without disease and the disability process, learned helplessness (and laziness), co-malingering, locus of control, loss of self esteem, disability induction, disability proneness, illness behavior, and the meaning of work help us understand some of the underlying principles of disability causation.

To be continued.