title: Medically unexplained illness in short- and long-term disability applicants: prevalence and cost of salary reimbursement.
abstract: OBJECTIVE
  Compared to patients with explained illness, patients with medically unexplained illness (MUI) may be at elevated risk of applying for disability. Accordingly, patients with MUI may account for a disproportionate number of disability claims and for a disproportionate percentage of salary reimbursement costs. The study was conducted to determine: (a) The prevalence of MUI among disability insurance claimants; (b) the cost of salary reimbursement; and (c) the impact of psychiatric comorbidity on length and cost of disability.
  
  
  METHODS
  An insurance database of 26,451 short-term disability (STD) recipients with long-term disability (LTD) coverage was analyzed to determine the prevalence and salary reimbursement costs of MUI. Applicants with medically explained and psychiatric illness were included for comparison.
  
  
  RESULTS
  The prevalence of MUI among STD recipients was lower than clinical and community rates. Rates of application and receipt of LTD benefits for MUI were similar to explained illness. When LTD payments were projected to retirement age, costs associated with unexplained back pain and fibromyalgia were comparable to those of explained illness. The length of disability and salary reimbursement costs were greater when comorbid psychiatric illness was present.
  
  
  CONCLUSIONS
  Patients with MUI did not account for a disproportionate number of disability claims or amount of the money spent on salary reimbursement. Comorbid psychiatric illness increased the length and cost of disability.
authors.affiliation: Department of Psychiatry, New Jersey Medical School, Newark, New Jersey 07103, USA. chandlhe@umdnj.edu
authors.forename: Helena K
authors.initials: HK
authors.lastname: Chandler
authors.forename: Donald
authors.initials: D
authors.lastname: Ciccone
authors.forename: Robert J
authors.initials: RJ
authors.lastname: MacBride
authors.forename: Benjamin
authors.initials: B
authors.lastname: Natelson
mesh_terms: D005260:Female; D017048:Health Care Costs; D006801:Humans; D007342:Insurance Benefits / Q000191:economics*; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D009515:New Jersey / Q000453:epidemiology; D015995:Prevalence; D011602:Psychophysiologic Disorders / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D018582:Sick Leave