Personal Injury Evaluation

The ultimate task of a forensic mental health clinician during a personal injury evaluation is an analysis of causation. As noted previously, the forensic mental health clinician must first determine the plaintiff’s pre-injury psychological functioning. Next, current psychological impairment is assessed though a detailed clinical interview, psychological testing, a review of recent records, an analysis of malingering, and collateral interviews. If current psychological impairment exists which represents a decline from pre-injury psychological functioning, the forensic psychologist must then determine the cause of this psychological deterioration.  The central question of a personal injury evaluation is not the extent of current psychiatric impairment that exists, but the degree to which the plaintiff’s psychological functioning prior to an alleged trauma has worsened as a result of the traumatic event. When conducting personal injury evaluations, Embrace Therapists establishes pre-injury psychological functioning through a careful review of records, interviews with individuals in the plaintiff’s life, and a detailed clinical interview investigating significant life events or mental conditions that occurred prior to the alleged trauma. Next, assessment is done of present psychological impairment utilizing objective psychological testing, including malingering measures. Finally, in a causation analysis, Determination is made whether any changes in psychological functioning were proximately caused by the alleged trauma. Such a causation analysis includes consideration of the base rates of relevant symptoms and disorders, an analysis of whether the plaintiff’s change in psychological functioning occurred temporally close to the alleged trauma, and a consideration of co-occurring stressors, including the psychological impact of litigation. In cases in which a plaintiff is alleging psychological damages from a minor trauma, It is carefully distinguished between an “eggshell plaintiff” (e.g. a plaintiff whose limited pre-injury coping capacities left him vulnerable to the impact of a trauma) and a “crumbling skull plaintiff” (e.g. a plaintiff whose psychological functioning would have deteriorated regardless of whether he was exposed to an alleged trauma.)  The forensic mental health clinician must establish a clear picture of the plaintiff’s pre-injury psychological functioning through a review of pre-injury records and collateral interviews with medical and non-medical individuals who can provide insight into the plaintiff’s functioning before and after the alleged traumatic event. The most useful individuals to interview are those who have had significant contact with the plaintiff, before and after the alleged traumatic event, but have no personal stake in the outcome of the plaintiff’s legal proceedings. It is highly useful for the forensic psychologist to create a timeline of major life events and stressors prior to the alleged trauma.

Assessment of Malingering:

Malingering, the intentional production or fabrication of symptoms for an external gain, should be assessed in all personal injury evaluations. Indeed, plaintiff-retained experts who do not comprehensively assess malingering face significant vulnerability during cross-examination.

There are several features of malingering that warrant mentioning. First, malingering is not a static condition, but a behavior which will be performed in certain contexts for specific purposes. For instance, an individual in a personal injury proceeding may malinger in attempt to maximize his award yet respond honestly in a co-occurring custody evaluation during which he wants to be perceived as psychologically healthy. Thus, malingering needs to be assessed in all evaluations, and a plaintiff’s history of malingering does not necessitate that he will malinger again in the future. Second, malingering does not preclude genuine disorders, and indeed a subset of individuals with genuine psychological impairment will malinger symptoms due to a variety of factors, including a fear that their distress will not be taken seriously.