Medical Legal/Worker’s Comp

  • Differentiating between physiologic and aphysiologic symptoms is a significant medical-legal problem because complaints of dizziness and unsteadiness are frequent sequela in accidental and job related injuries (mild head injury, neurotoxic chemical and drug exposure).1
  • For the neurotologist as an expert witness, the main areas of concern are hearing, and balance.2
  • Dizziness is of particular concern in medicolegal neurotology because the incidence is high, the etiology may be multifactorial, and a patient’s symptoms may have other concurrent, unrelated causes.2
  • In addition to organic disorders of the balance system, nonorganic etiologies, including anxiety, fear of falling, deconditioning, and malingering are frequently seen.3, 7
  • For those patients who may be exaggerating symptoms, the inconsistencies of symptoms, function, and vestibular testing may be inadequate to clearly determine nonorganicity.5
  • Low back pain is a leading cause of lost work days, worker’s compensation claims, and visits to physical therapy. Patients with low back pain may have impairments to the afferent and/or efferent physiologic mechanisms which control balance.6
  • Dizziness is frequently reported by litigants who have had accidental or job-related injuries. Worker’s compensation claims, disability claims, and lawsuits are filed because of this symptom.8
  • The difficulty in objective evaluation of dizziness and the potential for monetary compensation can lead to exaggeration of the severity of symptoms.8

References:

    1. Goebel JA, et al (1997). Posturographic evidence of nonorganic sway patterns in normal subjects, patients and suspected malingerers. Otolaryngol Head Neck Surg; 117:293-301.
    2. Hart CW and Rubin AG (1996). Medicolegal Aspects of Neurotology. Otolaryngology Clinics of North America. 29(3):503-517.
    3. Coogler CE (1996). Using Computerized Dynamic Posturography to accurately identify nonorganic response patterns for postural control. Neurology Report. 20(3):12-21.
    4. Chester JB (1991). Whiplash, Postural Control and the Inner Ear. Spine 16(7):716-720
    5. Cevette MJ, et al (1995). Aphysiologic performance on dynamic posturography. Otolaryngol Head Neck Surg 112:676-688.
    6. Alexander KM and Kinney LaPier TL (1998) Differences in Static Balance and Weight Distribution Between Normal Subjects and Subjects With Chronic Unilateral Low Back Pain. JOSPT 28(6):378-383
    7. Krempl GA and Dobie RA (1998). Evaluation of Posturography in the Detection of Malingering Subjects. American J Otology 19:619-627.
    8. Gianoli G, et al (2000). Posturographic performance in patients with the potential for secondary gain. Otolaryngol Head Neck Surg 122(1):11-18.