Neuropsychological testing and ACC

June 29th, 2012 at 10:00 am by David Farrar

Vernon Small at Stuff reports:

’s methods are again under the spotlight after it confirmed using “neuropsychological and psychological assessments” to help decide if claimants were being straightforward.

That came to light yesterday after claims it uses “lie detector tests” to see if claimants are telling the truth.

Claimant Margaret Read told Radio New Zealand that ACC would not believe her statements of brain and spinal injuries, nor evidence from specialists, and applied a lie detector test.

An ACC spokeswoman declined to comment on an individual case, but said the no-fault insurer did not use lie detector tests.

Asked if any of its processes could be interpreted as a lie detector test, she said that was subjective. “What seems to be being referred to is the use of measures in neuropsychological and psychological assessments to provide some indication as to whether the client is presenting in a straightforward manner; that is, not under- or over-reporting their symptoms,” she said.

“Neuropsychological assessments administer tests which look at the client’s cognitive functioning (thinking functions such as language, attention, speed of thinking, memory, flexibility in thinking and problem solving skills).”

They were used to help indicate whether “clients are either minimising or exaggerating their emotional symptoms such as anxiety and depressive symptoms”. This was also to determine whether the assessment results truly reflected a client’s current emotional functioning.

When a client displayed evidence of a lack of effort, under-reporting or exaggeration of symptoms, ACC would try to determine why “and then provide the appropriate help the client needs to progress in their rehabilitation”.

Labour ACC spokesman Andrew Little said he was “gob-smacked” by the practice, which was evidence of the distrust ACC had for claimants. “It sounds like lie-detecting to me.”

I’m sorry but this is getting rather hysterical. This happens to be an area I know a wee bit about as I am related to a neuropsychologist. Neuropsychological assessments of head injured ACC clients has been happening since at least the 1980s. This is nothing new or unusual.

The assessments are not lie detector tests. They test damage and capacity of cognitive ability.

Of course the tests are designed to measure actual ability and damage, and can detect if people are exaggerating damage. That is why you get expert medical assessments. But that is not the primary purpose of the test, which is to assess capacity. It is like saying seeing a general practitioner is a lie detector test about your back pain.

Again these tests have been done for several decades, as far as I know.

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18 Responses to “Neuropsychological testing and ACC”

  1. Bevan (3,965 comments) says:

    So let me get this straight, are Labour and the Herald saying that a patient who has had a serious brain injury should not get a Neuropsychological test to assess the damage? Would they rather the patient be referred to a gynecologist instead?

    I think this is more of a case of under-educated politicians and reporters getting confused by big words then making assumptions about their meaning.

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  2. BeaB (2,081 comments) says:

    This is where people like Little are so dangerous. With no scruples at all he will knowingly undermine established and valid medical practices through scaremongering and misrepresentation.
    Can you imagine him as a leader when he will stoop to anything in the pursuit of publicity? The man seems to have no principles at all.

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  3. Bevan (3,965 comments) says:

    Sorry, make that Stuff – not the Herald.

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  4. ironswan (14 comments) says:

    Can confirm this is the case as I had a head injury and was on ACC in 2008. In fact, I had to arrange further scans/visit to the neurologist (which ACC then paid on the back of my own initiative) to show that I was ready to go back to work, so if anything ACC arent doing enough

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  5. wynkie (86 comments) says:

    David,

    As you well know TOMM and MMPI are widely used tests used to determine if someone is suspected of malingering. These are perfectly valid to determine ‘effort’ – that is, are symptoms are ‘put on’ / fake or real.

    Whether you want to call it a test for malingering or lie detection is merely a question of semantics.

    The fact is they are used every time with head injured ACC claimants when conducting neuro psycholoogical testing, as they suspect everyone of malingering, unless proven otherwise.

    Yet even when proven NOT to be a malingerer ACC frequently still will not accept the validity of those results.

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  6. OTGO (523 comments) says:

    And furthermore ACC are operating covert operatives in the field wearing dark glasses and mikes up their sleeves carrying long lenses fitted to expensive SLR cameras and or video with directional microphones to record every move of the suspect claimant.
    Honestly what goes on in the brains of people like Little is really quite disturbing.

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  7. KH (694 comments) says:

    Yep. the whole thing is getting hysterical. Claimants are getting quite bizarrre about how they see it works.
    And ACC is stuck with having to do the job they are given, and meeting the demands of the worthy and the non worthy as well. An impossible task.
    As for ‘leading the world’ and the ‘Woodhouse report’ etc.
    Maybe it was always going to be a crock, given the demands on it by all sorts of stakeholders, which can’t be balanced.
    The benign govern run service, which solves all problems, is just a lefty dream.
    ACC was always going to end up this way. And it’s not the corporations fault.
    Time to go back to fault based insurance.

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  8. Mark (1,429 comments) says:

    “An ACC spokeswoman declined to comment on an individual case, but said the no-fault insurer did not use lie detector tests.

    Asked if any of its processes could be interpreted as a lie detector test, she said that was subjective. “What seems to be being referred to is the use of measures in neuropsychological and psychological assessments to provide some indication as to whether the client is presenting in a straightforward manner; that is, not under- or over-reporting their symptoms,” she said.”

    David you don’t think that this comment from the ACC spokesperson is not fuelling the misunderstanding of what the tests are properly utilised for. Once again an own goal for the ACC because they constantly appear to have spokespeople who are incapable of straight talking. All they needed to say is that they used the tests to assess head injury victims in the normal course of their diagnosis. Fuck me how hard is that.

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  9. toad (3,672 comments) says:

    It is something I know a little bit about too, DPF, having worked as an ACC claimant advocate for a good number of years in the past.

    A neuropsychological assessment is a perfectly legitimate diagnostic tool for ACC to be using in circumstances where there are symptoms of mental injury consequent on physical injury, such as cognitive difficulties consequent upon a traumatic brain injury or a chronic pain syndrome consequent upon a serious physical injury. Indeed, if ACC were not referring claimants for neuropsychological assessments in those circumstances they would be being negligent in their provision of rehabilitation.

    However, I have also seen cases where such assessments have been used by ACC to disentitle claimants on the basis that “the pain is all in the claimant’s head” and therefore their condition is deemed to be wholly or substantially caused by something other than the injury. Such assessments are often accompanied by a misdirection of the assessing health professional and ACC itself as to the law, as a way to exit long term claimants perceived malingerers from weekly compensation.

    There’s not enough information in the article to determine which category this particular case falls under.

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  10. wf (398 comments) says:

    Why don’t ACC hire someone who can state what their obligations are under the act, and how they are implemented?
    Preferably in simple terms, for those of us who can’t read Acts of Parliament without getting a headache -

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  11. ross69 (3,652 comments) says:

    No, hysterical would be ACC calling in the armed offenders squad because a wheelchair-bound beneficiary had the temerity to want to show them a document.

    http://www.stuff.co.nz/dominion-post/news/7175232/Armed-cops-pounce-after-misunderstanding

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  12. Viking2 (11,263 comments) says:

    Well after observing the results fo quite a few managers and CEO’s that have undergone this process with “employment consultants” one concludes that it doesn’t wok even with unimpaired brains.
    The worst managers are those clever enough to fool the system and physco testing is just that a system which clever people can figure out.

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  13. KH (694 comments) says:

    Ross69 at 11.40.
    There has been a death at the counter. Where an ACC staff member was murdered by a claimant. ACC staff have rights to a safe workplace.
    I deal with ACC from time to time. And sometimes the outcome is outrageous. But ACC still have a right to personal safety.

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  14. mikenmild (11,246 comments) says:

    That’s right KH, better safe than sorry. How was the case manager suppposed to know that guy was wheelchair bound and had a speech impediment? Read his file or something?

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  15. toad (3,672 comments) says:

    Interesting “core competencies” from the ACC Case Manager job description:

    • Not fearful of acting with a minimum of planning.
    • Can decide and act without having the total picture.
    • Isn’t upset when things are up in the air.
    • Doesn’t have to finish things before moving on.

    Seriously! Take a look: https://careers.acc.co.nz/jobdetails?jobmc=35912NZGJO

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  16. john.bt (170 comments) says:

    Please note that this ‘story’ comes from Vernon Small who is effectively a Labour party press secretary paid by Fairfax. Probably the most leftie biased journo in the country (and that is saying something).

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  17. ross69 (3,652 comments) says:

    > ACC staff have rights to a safe workplace.

    As opposed to the rest of us who don’t? Every worker in NZ deserves to have a safe workplace. The point I was making is that ACC called the armed offenders squad and felt threatened by an invalid in a wheelchair waving a document.

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  18. BeaB (2,081 comments) says:

    One of the problems is the number of claimants who tell lies. Like the problems with insurance in Christchurch where the dishonest claims for the latest big TV etc hold up legitimate claims while the fraudsters are investigated.
    How many people do you know who have exploited ACC? Even among the honest there can be a bit of padding.
    Every system would work perfectly if administered by perfect human beings for totally honest human beings.
    Perhaps none of it should be completely free. If we had to pay even a small portion of the cost it may deter the liars and mean a smoother process for genuine claimants.

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