Vous êtes sur la page 1sur 1

The effect of adversarial claims management

on injured persons health and recovery


Nieke

1
Elbers ,

Ian

1
Cameron ,

Alex

2
Collie

Rehabilitation Studies Unit, University of Sydney, Sydney


2 Institute of Safety Compensation Recovery Research, Monash University, Melbourne
Introduction
This research:

Injured claimants do not recover as well as


injured people who do not claim compensation,
both physically and mentally (e.g. Gabbe et al
2007)

It is not clear why this is happening


The WHY question should be investigated in
order to improve health and recovery of
injured people after transport accidents

This research builds on to the theory of


secondary victimisation, investigating
stressful components of claim process
One way of examining this is by comparing
a fault-based scheme with a no-fault
scheme, because fault-based compensation
schemes are hypothesised to be more
stressful than no-fault schemes

Injured people

Health & Recovery

Problem (displayed in Figure 1)

Injured claimants

Why?

Explanatory theories:
Secondary gain
Financial incentive not to get better
Secondary victimisation
Stressful compensation process
Biopsychosocial theory
Multiple factors cause stress
Reverse causality theory
Claimants have pre-injury illness history

Research questions:
Is a fault-based compensation scheme more
adversarial than a no-fault scheme?
Is a fault-based compensation scheme
perceived less fair than a no-fault scheme?
Does a fault-based scheme involve poorer
health & recovery than a no-fault scheme?

Time

Figure 1.
Injured claimants do not recover as well as injured people
who do not claim compensation

Method
Cross-jurisdictional study:

Hypothesis:

A comparison will be made between:


- Fault-based scheme in New South Wales (NSW)
- No-fault scheme in Victoria (VIC)

It is hypothesised that the fault-based scheme in


NSW is more adversarial, perceived as less fair and
involves poorer health and recovery than the nofault scheme in VIC

Phase

Compensation
policies

II

III

Data

Hypothesis

Website MAA, TAC


Claim managers
Adversarial aspects

more
NSW adversarial VIC
than

200 Claimants NSW,


VIC
Procedural justice

Perceived fairness
of claim process

Databases NSW, VIC


SF-12 & return to
work

Claimants
health and recovery

less fair
NSW
than

VIC

poorer health
NSW & recovery VIC
than

Figure 2. Flow chart of cross-jurisdictional study investigating: (I) compensation policies, (II) perceived
fairness of claim process, (III) claimants health and recovery

3 Phases (see Figure 2):


I. Compensation policies
Policies are being collected on the websites of
the Transport Accident Commission (TAC) in VIC
and the Motor Accident Authority (MAA) in NSW
Claim managers in both states will be
interviewed to derive additional information
Adversarial aspects will be scored, such as the
medical assessments, lawyer involvement,
frequency of payments, litigation and duration

II. Perceived fairness of claim process


Telephone interviews will be conducted with 200
claimants, 100 in VIC and 100 in NSW, recruited
via TAC and MAA
The interview will consist of the procedural
justice questionnaire (Colquitt 2001) investigating
fairness of claim process, lawyer involvement,
communication with insurer, medical
assessments

III. Claimants health and recovery


Already collected data from NSW & VIC will be
used
Claimants health (SF12) & recovery (Return to
work) will be analysed

Possible implications
The study could have implications for the following professionals:

Policy makers:

Lawyers:

Currently there is much debate on law reforms

Research has shown that lawyers have a negative


impact on the injured persons health and recovery

Law reforms are based on monetary arguments


e.g. less expensive premiums
However, law reforms may have adversarial
effects such as poorer health & recovery
This research can provide valuable
evidence in order to make better law
reform decisions

However, so far the reason for this is not known


why, it could be caused by unfair treatment
The findings can provide guidelines how to
improve lawyer services

Results are expected in August 2014

Researchers:
Previous compensation & health researchers did
not accurately describe the claim process
The reason is probably a lack of knowledge of the
adversarial aspects of the claim process
The black box is problematic because then the
results of different studies cannot be compared
This study can provide a taxonomy of the
adversarial aspects of the claim
process which can be used to
describe compensation schemes

Nieke Elbers can be contacted at nieke.elbers@sydney.edu.au

Vous aimerez peut-être aussi