Biopsychosocial interplay of personal injury insurance, legal frameworks, and functional neurological disorder: an emerging perspective on recovery and disability determinants

Functional Neurological Disorder (FND) is a disabling neuropsychiatric condition marked by motor/sensory symptoms not explained by neurological illness. Perceptions of medically unexplained disability, such as FND, are shaped by their social contexts. For example, the introduction of workmen’s compensation legislation (late 19c) prompted labels such as ‘compensation neurosis’. Since the mid 2000s, a biopsychosocial understanding of FND has developed, offering a more nuanced lens through which to examine FND in the personal injury compensation context. This review journeys through historical perceptions of FND in this setting, from its conflation with malingering to its eventual distinction from feigning, before examining how features of compensation environments, such as their legal and administrative structures, are etiologically relevant to FND. We explore how increased understanding of biopsychosocial drivers and prognostic indicators in FND, alongside ‘rule-in’ criteria for early diagnosis, may reduce iatrogenic harm. We also examine whether the biomedical foundations of social insurance programs align with the defining features of the illness. The review highlights the significant contextual relevance of personal injury compensation to recovery outcomes in people who develop FND after physical injury; primarily in an Australian context, but also internationally. Opportunities to more closely align compensation frameworks with the evolved clinical understanding of FND are offered to mitigate against iatrogenic impacts, along with insights to guide future research.