As an attorney, it is important to understand all of the factors that may have contributed to your client’s unemployment or underemployment after brain injury so you can prepare your case. A now well-cited article discusses likelihood of unemployment after TBI and the factors that influence this. It is important to understand that there is not a 1:1 relationship between TBI and unemployment in some cases. Alternative explanations should be discussed and ruled in or ruled out by the forensic neuropsychology expert you have employed. Otherwise you can be challenged on this claim.
One frequently cited article published in 2005 speaks to this (Doctor et al., 2005; Journal of the International Neuropsychological Society, 11(6), 747-752). In the sample under study, 42% of cases were unemployed. Individuals more likely to be unemployed were male, those with higher education, those with more severe injuries, and those with more impaired early neuropsychological or functional status. Please note that there were other variables at play than severity of injury. This article also illustrates the importance of identification of early neuropsychological and functional status. It is often forensic neuropsychology experts (neuropsychologists) who can best comment on neuropsychological and functional status within the post acute to chronic phase of symptoms, through interview and objective neuropsychological testing. In my practice I have found that I become more useful when symptoms do not resolve as expected (for concussion) within the first days to weeks post-injury. Often it is other medical professionals such as an emergency department physician and/or neurologist who will see the patient immediately post-injury (i.e., within the acute phase).
It is also important to be aware of the numerous research studies supporting the role of involvement with workers compensation, litigation, and motivational factors in symptom sustenance and production. The forensic neuropsychology expert’s testing can be helpful in this, especially given that effort testing has become commonplace within forensic contexts. The forensic neuropsychology expert is also adept in identifying any preexisting (pre-injury) contributions to current employment status. Likewise, neuropsychologists can assess for work readiness. The forensic neuropsychology expert’s opinions is generally admissible in the court setting and have proven helpful time and time again in resolving some legal claims, especially those related to TBI.
One purpose of this blog is to promote the interdisciplinary dialogue between attorneys and neuropsychologists (forensic neuropsychology experts), and to enhance understanding of what neuropsychologists can provide for the legal system, within the bounds of our expertise. Contributing to the understanding of functional outcomes such as unemployment is just one specialty area for the neuropsychologist, who is accustomed to commenting on prognosis and predicting functional status.