THE MEDICAL DETECTION OF SIMULATED OCCUPATIONAL INJURIES - A HISTORICAL AND SOCIAL ANALYSIS

Occupational malingering is often thought to involve the deliberate fe igning of disease by workers seeking undeserved financial gain. Concer n about this form of malingering grew in the late 19th century as a re sult of the emergence of the new industrial economy and the institutio n of workers' compensation insurance. Medical judgments about the simu lation of work injuries have placed physicians in a crossfire between the interests of employers and workers in numerous medicolegal debates . Because of uncertainty about the true cause of many occupational dis orders and the highly charged social environment in which medical opin ions are rendered, physicians' views about malingering are often swaye d by cultural, political, and economic forces. The historical record s hows that a medical diagnosis of occupational malingering can reflect deep-seated cultural and social biases toward women, Jews, immigrants, and other groups representing a potential threat to the privileged so cial class. Current efforts to eliminate fraudulent workers' compensat ion claims must be sensitive to the inherent ambiguities in the medica l determination of work-relatedness and the potential for judgments ab out simulated work injuries to conceal deep-seated social biases and c lass prejudices.