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Physicians & Medical Treatment 2/29/2008 3:54:04 PM EST Claude S. Munday, Ph.D., on Issues in Apportionment in Psychiatric Cases and California Workers' Compensation Board of Directors of the Brain Injury Association of California California workers' compensation professionals are dealing with the changes mandated by SB899 that have been further modified or clarified (to a degree) by the Escobedo decision [Escobedo v. Marshalls, CNA Insurance Co., 70 Cal. Comp. Cases 604, WCAB en banc, April 19, 2005]. This expert commentary, written by Claude S. Munday, Ph.D., focuses on the key tenets of the Escobedo decision, and how they may apply to psychiatric or Amental@ cases. (Note: This article originally appeared in The Bulletin, published by the California Society of Industrial Medicine & Surgery, September-October 2005, Vol. 26, No. 5.) Dr. Munday attempts to apply not only medical/psychological wisdom but also a dose of common sense to this ever-changing landscape. According to Dr. Munday, there are three general situations regarding pain and somatoform disorders: (1) An overreaction to relatively minor trauma with a diagnosis of a somatoform disorder: This situation may call for apportionment. (2) Depression or other psychiatric disorder as a reaction to or secondary to chronic pain or physical disability: This would not usually call for apportionment absent the documentation of pre-existing psychopathology. (3) Pain that is reasonably related to the actual physical pathology: This will usually be handled without bringing in mental health issues. Dr. Munday concludes that the workers' compensation system in California has instituted new rules pertaining to apportionment, and everyone in the system from claims people to judges to doctors is struggling with the new criteria. Future legal rulings will likely provide further guidance. For now, a thoughtful and reasonable approach based on Asubstantial evidence@ as well as long-standing tenets of psychology and psychiatry is his recommended approach.
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