The medical detection of simulated occupational injuries: a historical and social analysis

Occupational malingering is often thought to involve the deliberate feigning of disease by workers seeking undeserved financial gain. Concern about this form of malingering grew in the late 19th century as a result of the emergence of the new industrial economy and the institution of workers' compensation insurance. Medical judgments about the simulation 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 disorders and the highly charged social environment in which medical opinions are rendered, physicians' views about malingering are often swayed by cultural, political, and economic forces. The historical record shows 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 social class. Current efforts to eliminate fraudulent workers' compensation claims must be sensitive to the inherent ambiguities in the medical determination of work-relatedness and the potential for judgments about simulated work injuries to conceal deep-seated social biases and class prejudices.