Many people with mild head injury get caught up in a predicament - particularly when compensation is involved that biases them to attribute everyday cognitive shortcomings to their trauma, explains neuropsychologist Michael Williams. The influence of this process extends far beyond the initial determination of compensation. Thus, a financial incentive is created for the injured person to appear as impaired as possible during the initial disability determination and at any evaluation point thereafter. The person's family and the lawyers connected to the case are subject to the same incentive. Since compensation amounts can be quite large, the person may feel considerable pressure to report problems following the trauma and demonstrate the lowest possible scores on cognitive tests.
People affected by such pressures and expectations react in different ways.
Some obviously malinger and deliberately exaggerate or manufacture post-concussive symptoms. Others exaggerate symptoms unconsciously. Many people, however, do neither, and their test results provide a valid indication of their abilities. These include dependency relationships within families, and psychological disorders such as depression. But financial incentives, probably more than any other factor, can impede rehabilitation efforts and contribute to the continued disability status of a patient, particularly one with mild injury.