Further Readings
Dattilio, F. M. (2002). Board certification in psychology: Is it
really necessary?Professional Psychology: Research and
Practice, 33,54–57.
Dattilio, F. M., & Sadoff, R. L. (2003). Mental health
experts: Roles and qualifications.Mechanicsburg, PA:
Pennsylvania Bar Institute.
Dattilio, F. M., Sadoff, R. L., & Gutheil, T. G. (2003). Board
certification in forensic psychiatry and psychology:
Separating the chaff from the wheat. Journal of
Psychiatry and Law, 31,5–19.
Drogin, E. Y. (in press). Expert qualifications and credibility.
In D. Faust & M. Ziskin (Eds.),Coping with psychiatric
and psychological testimony(6th ed.). Los Angeles: Law
& Psychology Press.
Parry, J. W., & Drogin, E. Y. (2007). Mental disability law,
evidence, and testimony: A comprehensive reference
manual for lawyers, judges, and mental disability
professionals.Washington, DC: American Bar
Association.DISABILITY ANDWORKERS’
COMPENSATIONCLAIMS,
ASSESSMENT OF
Disability insurance and workers’ compensation both
concern illness or injury in the context of work. These
terms are sometimes (erroneously) used interchange-
ably, but in actuality they refer to very different con-
cepts. Disability insurance provides benefits to an
eligible claimant whose ability to work is compro-
mised by injury or illness. The cause of the injury or
illness need not be related directly or indirectly to the
work setting. In contrast, workers’ compensation is
designed to provide financial relief to an employee
who is injured or becomes ill as a direct result of
work-related factors. Thus, the key issue in disability
evaluations is functional capacity, while the key issue
in workers’ compensation evaluations is causality.
When assessing disability or workers’ compensa-
tion claimants, it is critical for the evaluator to use a
variety of data sources. Psychological and/or neu-
ropsychological tests are usually considered an inte-
gral component of the evaluation, and test selection
should be determined by the specific referral ques-
tions and the nature of the claimed impairment.
Owing to the possibility of secondary gain on the partof the claimant, all disability and workers’ compensa-
tion evaluations should include an assessment of
symptom validity to rule out exaggeration or other
forms of dissimulation. Conclusions expressed by the
evaluator should focus on the specific referral ques-
tions, and statements regarding ultimate issue deter-
minations should be avoided.Disability Claims
Disability, used in the context of disability claims, is a
legal rather than a psychological or medical term. Its
definition is determined by the terms of the policy, con-
tract, or entitlement program under which the claimant
has applied for benefits. Sources of disability benefits
include private disability insurance policies, public and
private sector employee benefits, and federal entitle-
ment programs (Social Security Disability). Each of
these sources of benefits is subject to different federal,
state, and local laws. For example, Social Security
Disability and private sector employee benefits are reg-
ulated by federal law (the Social Security Act and the
Employee Retirement Income Security Act of 1974,
ERISA). Private disability policies are usually gov-
erned by the laws of the state in which the policyholder
resides. State and local government employee benefits
are exempt from ERISA regulation and are defined by
state statutes, local ordinances, and (when applicable)
collective-bargaining agreements.
Although policies and entitlement programs vary,
there are some concepts common among all disability
sources. Disability refers to functional capacity, not
diagnosis. To be eligible for benefits, the claimant must
meet the specific definition of disability determined by
the policy or program under which benefits are sought.
Regardless of the source, most definitions of disability
include two prongs: (1) The claimant must have sus-
tained an injury or illness that (2) renders him or her
unable to perform the substantial and material duties of
his or her occupation (or, in some cases, to be able to
perform any work at all). Thus, a valid disability claim
requires both the substantiation of the presence of a con-
dition as well as proof that this condition creates impair-
ment in the claimant’s functional abilities to perform his
or her occupation. It also must be established that the
absence from work is, in fact, due to the illness or injury
and not to circumstantial factors (e.g., being laid off) or
choice (e.g., job dissatisfaction, the desire to relocate).
When a policyholder files a claim for disability ben-
efits, the insurance company initiates an evaluation of222 ———Disability and Workers’ Compensation Claims, Assessment ofD-Cutler (Encyc)-45463.qxd 11/18/2007 12:42 PM Page 222