Forensic psychiatric evaluation of workers' compensation claims in a managed-care context.

Among the staples of forensic psychiatric evaluation are independent medical evaluations (IMEs) for work-related psychiatric and neuropsychiatric claims, ranging from post-traumatic stress disorder to chronic pain syndromes accompanying and compounding impairment due to other medical conditions. To provide a comprehensive evaluation and an objective opinion, forensic psychiatrists must know how the social organization of medical care can limit the claimant’s prior access to psychiatric evaluation and care. Today, psychiatric referral and treatment are increasingly restricted by managed health care. In this context, the scope of forensic psychiatric analysis and opinion formulation can include an evaluation of whether and how such restrictions have played a role in or substantially influenced the prior treatment history and current presentation and impairment of the claimant. The case vignettes below are composites based on the forensic psychiatric practice experience of the authors and members of the Harvard Medical School Program in Psychiatry and the Law at the Massachusetts Mental Health Center. They are composed to illustrate how a psychiatric workers’ compensation evaluation can be helpful when the forensic evaluator has an awareness of the social context of primary medical and mental health care in today’s managedcare-dominated health care environment.