Plaintiffs in medical malpractice actions sometimes will claim psychological injuries resulting from the alleged malpractice or negligence. Because no national standards exist for the psychological, psychiatric and/or neuropsychological examination and evaluation of such claimants, plaintiffs' attorneys have no basis for gauging whether they have a meritorious claim and defendants have no way of assessing the case against them and gathering the necessary expertise to create a defense. The problem has become increasingly important for defendants, given the enormous costs to the insurance industry and self-insured corporations each year.

Now, in an unusual collaboration, Continental Insurance Co. has joined with the Georgetown University School of Medicine's Department of Psychiatry to research and develop standards for the evaluation of psychological-injury claims and the examination of such claimants. "The lack of standards creates a windfall for some, while others who are legitimately hurt don't get anything. Objective standards will help everyone," says Adrian M. Tocklin, senior vice president - claims at Continental Insurance.

This project was introduced at a National Conference on Psychological Injury Claims Nov. 6 in Washington, D.C. It will include forensic research that will be presented in a series of symposia in 1992, 1993 and 1994. Selected papers will be published in psychiatric, psychological, insurance and law journals throughout the United States and Canada. The project will provide continuing medical and professional education, culminating in the publication of forensic standards.

It is hoped that research, education and the development of national standards will bring order and fairness to the process. "Evaluations are very erratic now. They're so varied and idiosyncratic, " said Dr. Robert 1. Simon of Georgetown. "It's hard to tell what is a spurious claim and what is a valid one. Plaintiffs' attorneys don't want to bring claims that won't go anywhere, and the diversity in psychological evaluation makes it difficult for insurers to evaluate what to do with those cases."

Even when a plaintiff-patient is found to have legitimate depression, post-traumatic stress disorder (PTSD) or other psychological injury, it may be that the injury was not caused by the malpractice or negligence that is the subject of litigation. It is important to know the plaintiff's pre-injury social, medical and educational history. Proper discovery is therefore imperative. School records may reveal similar problems or patterns of behavior; medical history may reveal physical diseases or disorders that can cause psychological disorders, such as hyperthyroidism.

Even in cases of PTSD, proper evaluation requires knowledge of the plaintiff's pre-incident psychiatric history. True cases of PTSD are incident-specific, generally with no prior psychological history. In addition to the incident that is alleged to have caused the psychological injury, it is important to discover the plaintiff's other life stressors.

Psychological symptoms may also be the result of over medication by the physicians treating the patient's other injuries. The mental impairments observed may actually be the side effects of drugs or the result of drug withdrawal. Psychological symptoms can also be a result of lifelong personality disorders, which must be understood for the proper evaluation and defense of psychological-injury claims.

The new Georgetown-Continental Insurance collaboration should result in objective guidelines and standards for screening psychological-injury claims so the meritorious ones can be discerned from the spurious ones and litigation will proceed on a basis that is fair to all parties involved.