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Abstract
The purpose of this study was to determine if there is a dose-response relationship between potential monetary compensation and failure on psychological indicators of malingering in traumatic brain injury. 332 traumatic brain injury patients were divided into three groups based on incentive to perform poorly on neuropsychological testing: no incentive; limited incentive as provided by State law; high incentive as provided by Federal law. The rate of failure on five well-validated malingering indicators across these groups was examined. Cases handled under Federal workers compensation laws showed considerably higher rates of failure and diagnosable malingering than cases handled under State law. The findings indicate that monetary compensation associated with workers compensation claims is a major motive for exaggeration and malingering of problems attributed to work-related brain injuries. The clinician's index of suspicion regarding exaggeration and malingering of symptoms and deficits should be much higher in the context of Federal workers compensation claims, particularly in patients who have suffered only mild traumatic brain injury.
ACKNOWLEDGMENTS
The authors would like to thank Adrianne Brennan, Jeff Love, and Bridget Doane for their assistance with data collection. We would also like to thank Joseph Guilbeau for his guidance regarding the details of workers compensation law. Some data reported in this manuscript were originally presented at the 23rd annual meeting of the National Academy of Neuropsychology, Dallas, TX.
Notes
Note. All skull fractures in mild TBI patients (n = 4) were nondisplaced skull fractures.
1Odds ratios cannot be calculated when the control group (No Incentive) frequency is 0. Therefore, the odds ratios for TOMM are based on an assumed 5% base-rate in the No Incentive sample. Because the baserate is really 0, the odds ratios are underestimates.
1Odds ratios cannot be calculated when the control group (No Incentive) frequency is 0. Therefore, the odds ratios for “Meets both Slick B2 and C5” are based on an assumed 5% base-rate in the No Incentive sample. Values in parentheses are 95% confidence intervals for the odds ratio.