Most accidentally injured subjects do not exaggerate their loss, (27) and malingering is an unlikely explanation of most cases of chronic disturbance after accidents. Neither is a monetary settlement followed by a significant change in the clinical situation in most cases. Factitious disorder is very rare.
In a few cases, there is disagreement between the insurance company and the injured party about the extent and consequences of the accident and the injury. Studies of personal injury plaintiffs indicate that a significant number report pre-injury functioning superior to that of controls and some exaggerate their symptoms. Untrained subjects have been shown to endorse symptoms on checklists to meet DSM-IIIR criteria for diagnoses of major depression, PTSD, and generalized disorder. These findings, which correspond to clinical experience, suggest the need for caution in assessing litigants. The physician should always try to obtain independent information from reliable sources (e.g. medical records, general practitioners) before coming to conclusions about the health status of the patient before the accident.
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