Evaluating the Veracity of Claims

Employers and employees may decide to falsify injuries for their own financial gain. Alternatively, attorneys, government agencies, and insurance carriers may have doubts that an injury actually occurred. The treating physician is in a unique position to answer the question of causation by making a work site visit.

Determining how an injury occurred involves asking open-ended questions to elicit more detailed responses in the form of thoughts, observations, and history. The physician should keep in mind the principle of multiple causal factors and should avoid drawing conclusions until after conflicting or incomplete information is resolved as best as possible. However, because much farm work involves lone workers, the specific cause may be difficult to ascertain, especially with deceased or memory-blocked victims. Ascertaining the cause of an agricultural injury depends on finding one of several possibilities summarized in Table 11.2 (9).

To determine the veracity of a claim, the physician may best serve the patient by going to the workplace and actually seeing the circumstances of the accident. Sometimes the injury can be reenacted to see if the history related by the patient is plausible (11,12).

Table 11.2. Factors to consider when determining causation of a work-related injury.

A cause-and-effect relationship

Consistency of the mechanism and agents of injury with the description of the injury itself

(see Chapter 25) Internal consistency of the employee's history External consistency with the history as related by coworkers

Consistency with what is medically known about the offending substance, machine, animal, infectious agent, or job task

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