UNMASKING MALINGERERS.

Dominion, Volume 7, Issue 1870, 2 October 1913, Page 5

UNMASKING MALINGERERS.

HOW THEY ARE TRAPPED. NATIONAL INSURANCE TROUBLES. A series of interesting papers arising out- of the National Insurance Actam! the Workmen's Compensation Act wore read before tho Forensic Medicine section of ' tho International Medical Congress (says the London "Daily Telegraph "). Some amusing cases of malingering and the tactics adopted by medical men to get at the truth were given.

Sir John Collie, discussing tho question of "malingering," said that the quostion of feigniiig or exaggerating illness had of lato attracted considerable attention in this country, but it was a mistako to suppose that the condition was of recent origin. -Those who had to adviso insurance companies knew that exaggerated and fraudulent claims were, at any rate, as old as tho accident laws. The reason for the prominence the matter had now attained was that many of t'lie approved societies under the National Insurance Act had taken fright, and become obsessed with tlie idea that excessive sickness from this cause must inevitably lead to sericus financial embarrassment. On tho other hand, there were those who emphatically denied any tendency on the part- of the working classes to'exaggerate or feign disease.

.However, it might bo safely assumed, judging from tho experience of the Workmen's Compensation and Employers' Liability Acts, that it would bo necessary te take special precautions for tho prevention of malingering when dealing with 13,000,000-of , insured people, nearly half of whom, prior to tho passing Of the National Insuranco Act, had not- in any way been insured against sickness. • ■ BATTLE OF WITS. To most medical men the simulation of disease presented a difficult, almost insoluble, puzzle, for in ordinary medical practice, such cases seldom occurred, but those who had tho 'administration of the Insurance Act must- ever keep an open eye for tho possibilities of Jraud or nunsi-fraud.

A malingerer had been defined as "one who feignsj sickness, or who (deliberately, knowingly, ana wilfully) induced or protracted an illness with the object of avoiding duty, claiming money compensation, exciting sympathy, or from any other reason." Now, the out-and-out malingerer who filled this definition was as rare as lie was interesting, and his unmasking should not be difficult. The procoss of accumulating data to expose fraudulent' cases often resolved itself into a battlo of wits between the medical examiner and tile so-called patient. Fortunately, in most cases, it was a contest between knowledge and ignorance, such matters the ignorant wero very heavily handicapped. Examinations in these cases, apart from tho routine investigation of tho various systems, could follow no set rules; the matter of meeting tho various difficulties as they aroso were only learned by long and sometimes bitter experience; difficulties were met at almost every turn, for which academic training gave little preparation. A WOMAN WHO FORGOT. "Effective assistance can," added Sil John, "frequently be obtained by simple means, such as the ' following case illustrates

"A woman was condemned by a liouso surgeon to. wear for many weeks a back splint for an alleged stiff right kneo. i removed tho splint, and directed her to sit . down ' and take off her right boot. Meanwhile, 1 eagerly pliod tier with questions as to what exactly happened at tho moment of tho accident —whether tho company's servants had been becomingly polite, what she said, what tlioy said, and ho forth —all of which' was 110 business of mine. It was intensely interesting to her, however. She forgot tho present, and lived in the past, removing her boot in the usual way as' she spoke'—i.e., she crossed her legs and bent her knee!"

Straws showed how the wind blew. On two separate occasions, after examining plaintiffs with the mcdical assessors," before the judge in his private room after a trials ho had given tho necessary turn in favour, of tho defendant by pointing out that, whilst the man . declared ho had a limp, tho soles of his shoes were equally woi'iil HOODWINKED EMPLOYER. . Dealing with another case, Sir John said; — "A workman bruised his log, for which lie received prompt treatment. His employer's doctor nine .months later, and on several subsequent occasions, certified that there were no objeetivo signs of injury to his leg,'and that ho . involuntarily kept his thumb stiff. The man continued to receive compensation for seven and a quarter years, at the end'of which period I say him. Ho complained of stiffness and continuous pain in his leg, and brought with him his son, whom he insisted should valet him as if ho were helpless.

"Prolonged and exhaustive examination revealed no reason for incapacity, lie made many attempts to frustrate my examination, keeping his leg stiff, and describing the necessary manipulation as 'inhuman.' Although lie complained of intense and continuous pain on attempting to move his thumb, there was no muscular wasting such as would have occurred had his complaint been genuine. X-ray photographs confirmed mv diagnosis that he was a rank impester. His employer having learned that ho frequented certain swimming baths, had him watched, with .tho result that he . was seen swimming and diving, and dressing and undressing himself. .

"On my adtico the employer stopped payment, tlie case was taken into Court, and the Judge, who was assisted by a medical refereo, made an award terminating the weekly payments from the (late ot my examination. From the date of the accident to the time of the decision lie had received sick pay amounting to some £290. 1 may remark that it was the aggressive and ostentatious way in which this man asserted his complete inability to un- . dress and dress himself that first aroused my suspicions."