What is Functional Overlay?

At the risk of making a hasty generalisation, ‘functional overlay’ is a term beloved of (and ripe for misuse by) medical professionals with little awareness of chronic pain, its causes and diagnoses. The terms ‘psychosomatic’ and ‘psychogenic’ are also used interchangeably with ‘functional overlay’.

A search online reveals that ‘functional overlay is interpreted as “the emotional response to physical illness.”

Sceptical

The term is found frequently in medical reports and medical records where often sceptical clinicians apply the term when they believe a patient’s symptoms are medically unexplained, ie when they can see no, or no obvious, organic reason for an individual’s continued symptoms. In other words, they believe those symptoms are largely or entirely a result of psychological factors.

Unfortunately, but possibly understandably, this is usually interpreted:

by the claimant as “he doesn’t believe me”;
by a large proportion of the legal profession as “another high maintenance client”; and
by the whole of the insurance industry as “fraudulent claimant”!

Interestingly, in my experience, when a medical expert in a claim is questioned in conference about their use of the term, the vast majority are quick to confirm that they don’t doubt the claimant’s veracity; it is simply that they cannot fathom why they still have symptoms, why the nature of those symptoms has changed or why the claimant reports that their symptoms are getting worse. The issue is therefore simply one of lack of awareness by the clinician and a failure to recommend onward referral to more appropriate specialisms (usually pain medicine, rheumatology and psychiatry).

Medical Expert

Accordingly, whenever a solicitor sees that or a similar term used in a medical report, before the report is disclosed, it is fundamental that the medical expert must be encouraged to:

better define their use of the term;
confirm their opinion on the veracity of the claimant; and
recommend the input of other medical specialism(s) whose opinion(s) may assist the Court.