Do compensation processes impair mental health? A meta-analysis

Abstract

Being involved in a compensation process is associated with higher mental health complaints but three-quarters of the difference appeared to be already present at baseline. The findings of this study should be interpreted with caution because of the limited quality of evidence. The difference at baseline may be explained by a selection bias or more anger and blame about the accident in the compensation group. The difference between baseline and follow-up may be explained by secondary gain and secondary victimisation. Future research should involve assessment of exposure to compensation processes, should analyse and correct for baseline differences, and could examine the effect of time, compensation scheme design, and claim settlement on (mental) health.

Associations with duration of compensation following whiplash sustained in a motor vehicle crash

“…Compensation participants, particularly those with a poorer baseline health profile may be more vulnerable to the impact of the system complexities [9][10][11] which have been found to have a negative impact on health and recovery [6]. However, a poor baseline health profile does not wholly account for the poorer psychological and physical health seen post injury [6,11] perhaps suggesting that the causal relationship occurs cyclically, in the manner of a vicious cycle.…”

“…However, a poor baseline health profile does not wholly account for the poorer psychological and physical health seen post injury [6,11] perhaps suggesting that the causal relationship occurs cyclically, in the manner of a vicious cycle. Prolonged exposure to the scheme increases the likelihood of participants coming into contact with system complexities known to be stressful including; numerous assessments [12] and the overall adversarial nature of dealing with compensation players [13].…”

Associations with legal representation in a compensation setting 12 months after injury

“…This notion of secondary victimisation where claimants experience renewed victimisation because of the stressful compensation process has also been described by others [17,26]. A recent review by Elbers et al [27] suggests that there are significant stressors in the compensation process, among them; numerous assessments, situations where claimants are confronted with the traumatic history of the injury event, delayed funds and financial risks. It has been suggested that claimants with lower general health, particularly mental health at baseline may be more vulnerable to the effects of these stressors [14,26].…”

“…It has been suggested that claimants with lower general health, particularly mental health at baseline may be more vulnerable to the effects of these stressors [14,26]. These stressful processes have been associated with increased claim duration [27], increased lawyer involvement [17], and increased health care utilisation [28]. In our study it is possible that this contributes to the ongoing worse health for the group and leads some to seek the assistance of lawyers.…”

“…Previous studies support this assertion, reporting that often the language used in this context is overly technical and held no meaning for the claimant, particularly those whose first language was not that of the communication [25]. Studies have reported that that compensation participants appreciated the 'interaction with lawyers more than the interaction with insurance companies' [27] and they further suggest that 'Insurance companies could try to improve the interaction with claimants by communicating more directly' [34]. Other studies point to the negative impact of multiple file rotations amongst case managers and a lack of clarity around the language used to communicate with the worker [25].…”