Of all the comorbid and complex issues that come to the attention of clinical psychiatry, few equal the complexity of workers' compensation issues. Essentially, assessing the injured worker for disability involves legally administrative processes that deal with conflict resolution. The clarification proposed by Dr Becker and his colleagues in this issue of Psychiatric Annals is an unraveling of the medical validation of the allegedly industrially caused disability. The goal is to contrive a nonsubjective, empirically grounded estimate of the qualitative and quantitative aspects of the iunctional impairment that is said to be the consequence of a workers' injury. Their individual articles address the requirements of the carefully analyzed components of a differential diagnosis in a sequentially linked assessment. In essence, this procedure seeks objective data to validate claims without reference to subjective prejudicial bias. It relies on the collective expertise of individuals who are wellversed in the inductive processes of their respective disciplines. The consequence is the production of an ordered body of empirically based evidence.
Dr Becker's article introduces the examining psychiatrist to the problem of an interlocked process that constitutes an overview of a standardized procedure of a clinical examination. This assessment is based on a detailed study of an impairment affecting the worker's ability to function efficiently. The assessment consists of a rigorously defined step-wise series of empirically standardized, weighted assessments that have been objectively adduced. This network of algorithms is duly noted in a work impairment form. This deliberately exercised caution precludes the contamination of subjective bias. The procedure is further buttressed by the use of standardized psychological tests of demonstrated reliability. The form uses descriptors that specify a quantitative measure of ability of performance in every modality of the individual's cognitive and behavioral capacities. It is important to note that symptoms are not to be equated with impairment as such; instead, they are used as dimensions of severity. The result is a structured, meticulously defined measurement of the putative impairment.
Dr Enelow's article describes eight functions of this procedure currently used in California. It is a commendable effort to equitably settle the legal controversies that characterize injuries sustained in an industrial economy. The process is an administrative judgment of a worker's disability, a standardized effort to redress a worker's disability attributed to occupational employment in our society. Inherent in the adversarial machinations is the competition and conflict found in every sector of our culture. In our collective efforts to enjoy the vouchsafed rights of our Constitution, such techniques of conflict resolution have developed.
In addition, there is recourse to a pyramid of appellate courts assuring both worker and management of an even-handed resolution of the conflict. Modern times have evolved a formal collaboration of social scientists, medical experts, and forensic specialists to assist in the resolution of this controversy. Its effort is to render medicolegal opinion to dispassionately settle the contended claims. Latterly, occupational medicine has combined its effort with the subspecialty of forensic neuropsychology. Thereby, a standardized approach to equitably resolve the burgeoning issue of industrial disputes evolved.
The result is a gradual crystallization of a sound methodological procedure. It serves multiple needs by connecting a database of case material for future clinical as well as legal judgments. Thus, it is important that the clinical psychiatrist have this overview so that when confronted with a patient's disability, said to be the consequence of his or her employment, the psychiatrist is informed in general about the details of workers' compensation.
We are grateful to Dr Becker and his colleagues for their lucid description of the procedure and the process involved in resolving workers' compensation conflicts.