If Job depended on Managed Care

For those of you who remember the story of Job from the Old Testament in the Bible. Of course, there is a psychiatric twist to the story.

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Disability Determination

Claimant: Job (no surname)
Date of Injury: September 26, 2507 B.C.E.
Date of Evaluation: 11/28/2001

The claimant appeared for an independent Medical Evaluation based on his assertion that he has a disability because he has become so depressed that he cannot continue in his usual occupation as a farmer.

Mr. Job notes that on the morning of September 26, 2507 B.C.E, he was feeling fatigued, and had been resting from working in his fields, when a cloud of locusts appeared and began devouring his crops. He ran to the house to get help in flailing away the insects. However on his way to the house, he discovered his cattle all lying on the ground dead. He arrived at his house, only to find it in flames. His wife and seven children were all inside, burned up.

Mr. Job states that he then fell to his knees and prayed to God, only to discover that his entire body was covered with boils. Since then, his neighbors have shunned him.

It is Mr. Job's claim that he has been so upset by these events that after vainly trying to chase the locusts away, he simply let them eat his crops. He said that he has not been able to return to work since that time.

Assessment: It is clear from his account that the claimant has a history of feeling fatigued in connection with farming work. He admitted that the work-related fatigue began prior to his applying for the disability insurance. It seems quite evident that his so-called depression is an offshoot of this...a psychologically motivated effort to avoid gainful employment. He did show signs of open sores, but these are likely to be self-induced. In my opinion, Mr. Job has a form of Munchhausen Syndrome where he is driven to excoriate his skin, fueled by a covert psychotic disorder. I infer the psychosis from his mutterings about God and the Devil being behind his problems.

In conclusion, I see no basis for compensating this man for an obviously pre-existing condition.



Lou Siffer, M.D.
Psychiatric Consultant
IWIF