[Errors in medical records as the cause of negative expert decisions regarding disability pensions]

Abstract

Psychiatric disorders frequently make the patient unable to perform their work. It is estimated that psychiatric disorders are the third most frequent reason for an expert's decision concerning long-term inability to work justifying the granting of a disability pension. Unfortunately, not all patients are certified positively, i.e. are granted disability pension or receive disability benefits in the expected amount; usually, they are lower than those they applied for. The paper discusses the premises applied by the Social Insurance Institution (ZUS) physicians and court appointed experts in their examination of patients applying for disability benefits. Some patients are positively certified already at the time of the initial contact. Their mode of behavior, functioning and patterns of speech leave no doubt as to the significant exacerbation of their mental disturbances. Another group of patients manifests situational "exacerbation" connected with the stressful nature of a meeting with an expert physician. In such cases, the patient's medical records are of great importance. Evaluation of medical records takes into account regular and systematic character of treatment, as well as the kind of pharmacotherapy applied in the treatment. The patient's discontinuation of treatment just after having been granted disability benefits and restarting it a short time before check-up examination is regarded rather critically. Rare appointments taking place once or twice a year are not recognized as corresponding with the existence of intense and debilitating mental disorders. Duration of treatment before applying for disability pension is also evaluated. The author discusses particular cases in the context of ethical and deontological principles.