A Better Way To Handle The Malingering Problem

Here are my current thoughts on what I see as a much better way to at least handle the malingering problem. I wish I could say I think it could solve it entirely, but that’s probably not realistic. People are people, and some people seem utterly incorrigible. But even if the following cannot totally solve the malingering problem, the basic gist strikes me as quite promising, and at the very least I think that pondering this sort of approach out in the open could be productive and eventually lead to whatever the best solution(s) may be. Anyway, here’s what I’m thinking:

  1. Insurance companies should not be allowed to make any of their own claim payment decisions. That is just asking for trouble. Their job is just to design and sell policies, collect claims, etc.
  2. The decision to pay or deny claims should be made by a neutral party, whose job it is to collect the relevant information and make the decision.
  3. Doctors should have the right to prescribe a medical leave, and given such a prescription, the initial, default decision should be to pay the fucking claim. This is totally consistent with the core principle of our Justice system to assume innocence and demand proof of guilt. It is also consistent with the way FMLA claims are processed, where’s it is primarily the doctor who decides.
  4. The doctors should be held accountable for their decisions with random audits, and if the auditors discover evidence of fraud on the part of either the doctor or the patient, that evidence should be brought to the appropriate investigative authorities.
  5. If insurance companies and investors don’t like the profits they can make under this system, they should go into a different line of business. This will motivate the establishment and development of suitable non-profit alternatives.

Aside from putting a lot more power in the hands of doctors to provide the kind of care their patients need, it will also reduce the risk of “fox” bias in the decisions regarding which “chickens to eat”. It will also lower the risk of accidentally punishing an honestly but “invisibly” disabled person for being punished for the fraudulent behavior of others.

I’m sure that a lot more could be said about the above, but I think that’s a good place to start.

How To Malinger: Lesson From An Expert

“…I always wondered how the “fakers” did it. Like maybe they could give me some helpful hints on how to get the care I needed.”

— King Ben’s Grandma, posted in the comments section of Autism, body awareness, and ‘malingering’ by Laina Eartharcher.

Killdeer bird faking a broken wing

A killdeer faking a broken wing in order lure a predator away from its nest. For more, see the short video after the post. Image found here.

The exercise of writing Towards a Mythology of Malingering helped me parse out from the bloom and the buzz of the disturbing chaos described in part 2 of that post a number of additional minor but potentially useful insights regarding the general problem of malingering. I plan to document each of these in the near future, beginning with the one I’ll just plunk down here for starters, before explaining how I witnessed it in actual use:

A great way to hide your own malingering is to accuse your victims of malingering.

Now, I should probably warn you that what follows might become very confusing for you. You see, I’m about to accuse a billion-dollar, global multinational insurance company (BDGMNIC) of malingering. Also, if you are on the right side of the fence on this issue, there’s an excellent chance that you will find my accusation quite convincing. And if you think too much about that (or even if I just point it out to you), you might start to feel thoroughly confused about which of us — me or this BDGMNIC is the true malingerer.

Now, I actually think such confusion is probably healthy. Yes, absolutely, I think a little skeptical confusion on your part regarding which of us is the real culprit would actually be a good thing. In fact, I would take such confusion as indicating that you really understand the core insight presented in part 1, which I’d like to paraphrase here as follows:

In the absence of actual evidence to settle the issue, and whenever confronted by any given accusation of malingering, an objective, rational observer ought to feel quite skeptical about whether the accusation is really truthful.

See, this skeptical confusion you might begin to feel in a moment (if it hasn’t already started) is like a hunger. The way I see it, this kind of skeptical confusion is basically your brain’s own hunger for a very specific and highly nutritious kind of brain food which usually goes by the name of evidence. It’s like your brain just woke up from a nap, looked around, noticed in the first place that something just happened; noticed next that whatever it was that just happened seems to be important; and then finally formulated the question, “wait a minute, what the heck just happened?!?!

And in that kind of situation actual evidence is really the only kind of brain food that can satisfy that hunger.

And as much as I happen to believe that insurance companies in general are capable of malingering; that they do in fact malinger, and chronically so; that the specific insurance company referred to in Towards a Mythology of Malingering truly did malinger in my own case; and that I definitely did not malinger; the only reason that I truly believe all of that is because I have personally scrutinized the actual evidence.

But you have not. At the moment, all you may have done is read my own narrative about what actually happened — a highly subjective, likely quite biased and self-serving account of the events in question. But that’s not really evidence; or at least, it’s not evidence that is especially strong, or evidence that should be taken at face value. And as much as I feel genuinely grateful for the sympathy you may have felt for me and my family for what we all endured in the clutches of that evil Insurance dragon, in the interest of full disclosure I feel I should point out to you that the elicitation and exploitation of such sympathy is exactly the goal of true malingerers. In part 1 of my narrative I used the phrase sympathy vampire, which I think is an excellent way to conceptualize the animal in question. And if what I’m about to tell you causes you to feel a little disoriented and to start squinting at the possibility that I might actually be such a parasite, I encourage you to value and nurture that sense of dizziness, because to my view there is far too little of it in the world, and not just as regards the problem of malingering. I think it is generally true and also generally quite dangerous that so relatively few of us seem willing to stew for a while in our own skeptical confusion, so quick to cling to whatever soothing dogma happens to be floating near us in the deep-water lake of Life. That skeptical confusion is a kind of resource — easily converted into Curiosity rocket-fuel, a powerful urge to learn. And I think that’s a good thing, for the most part.

But vampires are mythological creatures, which is to say that whatever their basis in reality, they are for the most part fictional beings. Like a large and beautiful pearl that has formed around a much smaller and quite ordinary looking granule of sand, the pearl part, whatever its attributes, actually has very little in common with the quartz granule. Yes, there really are animals and insects that eat blood — bats, mosquitoes, fleas, etc. But none of these is actually immortal; none is actually without reflection before a mirror. And I think that a sympathy vampire, a true malingerer, is a lot like that — which is to say, much of a myth.

Yes, yes, of course human beings can and do cheat. I’m certainly not suggesting that actual malingering is impossible or even infrequent. On the contrary in fact, I’m quite sure that there is a rather good deal of malingering that happens. But if anybody is so afraid of a mosquitoes that he goes around shooting at them with a shotgun; blasting away at them left, right and center with no concern for the legs, arms and ears of the creatures (human or otherwise) upon which these tiny bloodsuckers happen to be feeding at the moment, then such an individual has mythologized mosquitoes in a dangerous way, and that mythology needs to be debunked. And I believe that this aptly characterizes the general problem of malingering. Yes, malingering is a real phenomenon, a genuine problem, and one we would do well to try and solve, but I for one am wholly unimpressed with the current standard ways of solving it — especially with the ways that insurance companies try to solve it, which seem to me not at all unlike the solution implemented by our shotgun-happy skeeterphobe from a few sentences ago.

The fact is that some solutions are worse than the problems they are meant to solve, and some problems make tolerable solutions where the alternatives simply cannot be tolerated. This dour but fundamental fact about the way things really work seems to be a moldy crust of bread for many, no matter how hungry they are. But a fact it is, and a refusal to face it is occasionally disastrous, which I think is an apt comment to make about the general problem of malingering.

In any case, in order to illustrate this sneaky, dastardly way to camouflage one’s own malingering , we need to return to my own narrative and examine one additional piece of the story, which is the explanation given to me by the BDGMNIC for why they rejected my short-term disability claim, both initially and following the appeal review. Let me start by quoting the very last sentence in the appeal review report, prepared by the company’s Senior Psychiatric Medical Director, a man with both an MD and a JD (he’s both a doctor and a lawyer):

The file does not contain incapacitating clinical observations, abnormal mental status exam findings, or other explicit evidence of psychiatric symptoms that are more reliably associated with impairment, such as psychomotor abnormalities, mood lability, difficulties with reality testing, etc. to support functional impairments due to the psychiatric conditions for the period of review.

In other words, the good doctor looked in my file and simply did not see any reliable evidence of impairment. How else might we say that? We could say that he looked for it in the file, but didn’t find it there. We might also say that he listened for it, but didn’t hear it. Or maybe he sniffed and groped around for it, but neither smelt nor felt it. More generally, the good doctor detected no such evidence. But really, I think the most common way to put it is that he did not see it in the file.

And why not? Well, I know for a fact that it was there. My doctor and I were completely transparent with the company, shared with them my entire medical file, including all of my doctor’s session notes. And I know for a fact that my own doctor looked at the exact same evidence, and did see it, which is exactly why he prescribed the medical leave for me in the first place. So, if this lawyer-doctor didn’t see it, then it can only be because the poor man is suffering from a kind of blindness. In the same way that some people can’t see certain colors, this man is simply unable to see certain kinds of evidence — coincidentally that particular kind of evidence that might justify paying out short-term disability claims. We might call this kind of visual impairment evidence-blindness, which under most circumstances is surely a disability that causes serious problems for anyone who suffers from it, not to mention anybody else whose well-being might depend on certain evidence being seen.

But in this case, the doctor-lawyer has been able to turn his weakness into a strength. He has figured out a way to convert his evidence-blindness into real personal asset, what I can only imagine must be a very lucrative kind of super-ability. I bet he’s a real hero around the office, defending his employer — this poor, defenseless billion-dollar, global multinational insurance company — from having to pay all those pesky disability claims. Good for him.

Ok, ok, I’m sure you get it. Yes, I’m an autistic person who understands and knows how to use sarcasm. And FYI, I’m not the only one either, so how about we all let go of that particular stereotype, shall we?

No, this man is not really “evidence-blind”. And here’s the point of all of this: Make no mistake: this doctor is malingering, and I mean that quite literally. This is not a metaphor. He is literally faking this so-called “evidence-blindness”, this inability to see exactly the kind of evidence that would justify a claim payment. That is textbook malingering. Furthermore, the only reason an insurance company hired him is because he’s really, really good at it — a highly skilled malingering expert, who knows exactly what he’s doing, and one of the things he’s doing is accusing his victims of malingering. And he’s doing it precisely because he knows its a wonderful way to hide his own malingering.

I hope that’s useful in some way. And if you are feeling that skeptical confusion I mentioned earlier, if you are perhaps squinting at both me and that doctor and trying to figure out which one of us is the real malingerer, which of us is the “expert” referred to in the title, here’s what I suggest:

Although it really does matter to me personally that you eventually come to believe that I am really not a malingerer, but rather a survivor of the doctor’s malingering (and by extension, the malingering of the BDGMNIC), I’m more than happy to wait while you carefully review the actual evidence for yourself — to the extent that such evidence is or eventually becomes available to you — and make up your own mind, if ever you are even able to accomplish that. And as far as the basic “lesson” of this post is concerned, to my view it really does not matter one whit which way you are leaning on this issue for now. As far as the above insight is concerned, please feel free to just pick one of us as the culprit, and then move on to pondering how you might find some use for this idea that a great way to hide your own malingering is to accuse your victims of malingering. Of course, I hope you won’t actually try to exploit this insight in order to malinger, but I am hoping it may come in handy if you ever need to protect yourself from the malingering of somebody else.

Please share your success stories below (or any other comments you wish to share).

Oh, and check out this short YouTube video of a killdeer faking a broken wing in order to lure a predator away from its nest. Now that’s a true expert malingerer!