Some of our least favourite people contributed to a book entitled Malingering and Illness Deception in 2003, that seems to provide much of the ammunition used by the current government to demonise claimants of disability and incapacity benefits.
One of the relevant chapters is ‘Malingering, insurance medicine and medicalization of fraud’ by John LoCascio of the criminal American insurance giant Unum, that has been heavily involved in British social security work since the 1990s.
The other is ‘Origins, practice and limitations of Disability Assessment Medicine’ by Mansel Aylward, the Unum puppet who was formerly chief medical officer at the Department for Work and Pensions.
These are the two charmers who put forward a perversion of Professor George Engels’ biopsychosocial theory that calls an individual’s illness into question, rather than treating it, to the then-Department of Social Security back in the 1990s.
The assertion that it was a tool to reduce claimant numbers can be proved by the fact that Mr Aylward was asked to change the test used to determine whether a claimant deserved benefit, in order to reduce the flow of claimants with mental health problems. When politicians ask for specific results, you know impartiality has gone out the window!
Look at the title of the book: It labels incapacity and disability claimants as “malingerers”, defined in the book’s first chapter as those who engage in “the intentional production of false or exaggerated symptoms motivated by external incentives” – in this case, the desire to receive state benefits.
This fits with what we know of the Unum-influenced benefit system already – that claimants are to be treated as if they are trying to cheat the system, unless they can prove to a state-provided official (not necessarily medically-trained) – who has been briefed to find ways to prevent them receiving the benefit – that they are unwell. Their own doctor’s reports are ignored.
Let’s look at LoCascio’s chapter. He starts by suggesting that “disability-related programmes in both the public and private sectors are faced with increasing numbers of disability claims despite improved health care and job design (the disability paradox).”
Already we are in the realm of fantasy as he fails to mention the logical reasons for these increases, which include poor implementation of health and safety measures in the workplace under ‘light touch’ regulation, and the discovery of new medical conditions whose causes are unknown and which require protracted study before they are understood – all made possible by the “improved health care” to which Mr LoCascio refers.
Amusingly, LoCascio also claims that the commercial insurance industry “is neither medically nor legally driven. It is driven by societal imperatives”. What a whopper! Commercial insurance is driven by the desire for money. That is why his company has a criminal conviction to its name – it changed its medical procedures to make it almost impossible for anyone to claim successfully that their Unum health insurance policy had matured.
Much of the remainder of his chapter attempts to convince the reader that the lack of data available – to support claims that a medical patient is “malingering” – should not be used as evidence that they really are ill. He asks the reader to believe that three questions should be asked: Did the patient understand the medical issues? Are the patient’s reported and actual behaviours consistent through time and across observers? And are the functional capacities in question (the patient’s abilities) well-defined?
What a cheat.
It seems perfectly likely that any patient will understand the medical issues informing their condition. However, in a Work Capability Assessment it is common for the assessor to have a completely different opinion of what those issues are. This discrepancy allows the assessor to find fault with the benefit claim.
The second question supports evidence of those who have read assessment reports claiming that patients did not display the behaviours expected of a person with their condition – one famous example was that the patient was not “rocking back and forth”. The simple reason for this was that their condition did not display in that manner but the assessor – who was not an expert in this field of medicine – did not know that because the only advice available was a biased screed from the Unum-influenced DWP.
The final question – are the functional capacities in question well-defined? – can be defeated with a simple, two-word counter-question: By whom?
Also of interest is the concept of ‘Functional Capacity’ (FC). LoCascio argues that a person should not be expected to be incapable of any type of work, just because they are incapable of one. His example is that a person limited to typing for 20 minutes due to forearm pain may be able to play piano for an hour. This is entirely possible but contradicts one of the quotations Mr LoCascio uses four pages previously: “The question of disease—that and nothing more—is the one for the physician to determine” (Drewy 1896). It is not the assessor’s job to dream up functions a claimant might be able to carry out and then discount a claim for benefits on the basis of that possibility. That is not evidence; it is fantasy.
All of the above questions are also rendered pointless by the simple fact that a claimant’s condition may be variable. LoCascio acknowledges this! However, he then goes right off the rails: “I favour a series of three questions: ‘Please describe a bad day. Please describe a good day. Please tell me how many good days and bad days you have in an average week.’ Armed with this knowledge about any particular symptom and the corresponding reduction in an FC, the medical resource can proceed to analyse the consistency of the history against the medical or observational data.”
That is an inaccurate assumption. When you are ill with (for example) fibromyalgia, there can be a huge range of difference between days. Sometimes Mrs Mike has seemed able to function almost normally (she can never walk far without suffering a huge amount of pain in the following days, as an example of why she only seems more able); other times she has been confined to the sofa for days on end in terrible pain for which medical science currently has no alleviation. At other times her condition may be anywhere between those extremes. Asking for a description of a good or bad day, or how many of these take place in an average week, is not only pointless – it hinders understanding of the condition.
“In conclusion,” LoCascio writes, “the most important product of the medical consultant is clear, credible, and defensible
documentation.” It seems strange, then, that the most clear, credible and defensible documents – those written by the patient’s doctor – are the first to be ignored in any Work Capability Assessment.
What we have here is a propaganda screed, riddled with inconsistencies and running against reason, that has been used to support the government’s position on sickness and disability benefits. As an argument in favour of current policy, it is worse than useless. In fact, it should be a tool for campaigners to use against that policy.
It tells us why a claimant who lives in agony every day should be outraged when assessors use LoCascio’s nonsense to explain away their pain.
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