The Forensic Examiner Articles

Disability Induction

Occupational disability and lost productivity can often be explained by understanding that acquired disability can be encouraged, prompted, influenced, and solicited. That is, vocational disability can be induced. At least four separate methods of disability induction have been identified: iatrogensis, beaurogenesis, litogenesis, and psychogenesis.

Iatrogenic. Iatrogenic disability occurs more frequently than the casual observer might suppose. Low-back surgery, for example, is well known to resolve less often in the injured-worker population. Indeed, for many years, a successful neurosurgeonin Philadelphia would not treat compensable back injuries surgically because of the dramatically different “success” rates in the occupationally injured versus non-occupationally impaired populations.

Iatrogenic disability need not be the result only of surgical intervention. Physician induction of disability can often result from mere suggestion. The susceptible, or all-too-vulnerable patient can hear, or think he or she heard, the physician say that the patient is “unable to work.” Physicians unknowingly underestimate or consciously abuse the power invested in them by the generally naïve health care recipient.

Disability induction through iatrogenic means is sometimes a function of the employer not insisting that its health care providers stay within their disciplines and avoid making vocational decisions. Employers and employees make vocational decisions; physicians diagnose and treat disease.

Beaurogenic. Work disability is often caused by the bureaucracy that surrounds occupational injury and non-occupational disease. Organizational policies and personnel decisions often ignore the consequences of shortsighted and antiquated return-to-work practices. From “you cannot return to work until you are 100%” to “light duty for workers’ compensation recipients only,” light duty programs seldom serve both employee and employer. Although the rising costs of workplace disability and the Americans with Disabilities Act led to some reevaluation of these return-to-work standards in the 1990s, the beaurogenic induction of disability remains a significant problem for most work organizations and our country at large.

Some self-insurers of both workers’ compensation and long-term disability have failed to realize that, as work organizations, they create disincentives for employees to return to work following the onset of injury or illness. With employees able to receive nearly 70% of their income in wage-replacement benefits, the employer has introduced secondary gain as a factor that the injured or ill worker would find difficult to overcome despite a strong work ethic. The Social Security Administration has recognized that most recipients of Social Security Disability Insurance are of working age, yet few take advantage of the trial work period available to them. The widespread use of managed care organizations in the treatment and rehabilitation of injured workers raises a legitimate question regarding the possibility that managed care adds a layer of bureaucracy to the already complex social and political systems that induce disability in the workplace. Bureaucracies can foster disincentives to get well and return to work.

To be continued.