The perceptions and experiences of people injured in motor vehicle crashes in a compensation scheme setting: a qualitative study

Abstract

BackgroundThe evidence that compensation related factors are associated with poor recovery is substantial but these measures are generic and do not consider the complexity of scheme design. The objectives of this study were to understand people’s perceptions and experiences of the claims process after sustaining a compensable injury in a motor vehicle crash (including why people seek legal representation); and to explore ways to assist people following a compensable injury and improve their experience with the claims process.MethodsA qualitative study in a Compulsory Third Party (CTP) personal injury scheme covering the state of New South Wales (NSW), Australia. A series of five focus groups, with a total of 32 participants who had sustained mild to moderate injuries in a motor vehicle crash, were conducted from May to June 2011 with four to eight attendees in each group. These were audio-recorded and transcribed. The methodology was based on a grounded theory approach using thematic analysis and constant comparison to generate coding categories for themes. Data saturation was reached. Analyst triangulation was used to ensure credibility of the results.ResultsFive primary themes were identified: complexity of the claims process; requirement of legal representation; injury recovery expectations; importance of timely healthcare decision making; and improvements for injury recovery. Some participants struggled, finding the claims process stressful and subsequently sought legal advice; whilst others reported a straight forward recovery, helpful insurer interactions and no legal representation. Most participants were influenced by injury recovery expectations, and timely healthcare decision making. To assist with injury recovery, access to objective information about the claims process using online technology and social media was considered paramount.ConclusionsParticipants had contrasting injury recovery experiences and their perceptions of the claims process differed and were influenced by injury recovery expectations, and timeliness of healthcare decision making. Improvements to the claims process are required, including: simplification or streamlining (possibly using online technology and/or social media to reduce paperwork); and providing access to objective information. There is a need to trial early interventions and new claims management policies that could improve injury recovery and satisfaction with the claims process.

Psychologists’ Application of Clinical Guidelines and Recommended Protocols and Procedures within State Insurance Regulatory Authority Insurance Frameworks: Outcomes for Injured Patients with Musculoskeletal Injuries

“…However, the findings also suggest that early referral of the CTP cases did not necessarily lead to favourable patient outcomes, and this may have resulted from secondary gain motivations created by CTP lump sum payments. Current research supports that the complexity of the claims process and the requirements of legal representation in the CTP compensation setting contribute to poor injury and mental health recovery, which in turn may pose additional challenges for psychologists (Murgatroyd, Lockwood, Garth, & Cameron, ). However, with the new CTP scheme commencing in December 2017 and reforms including lump sum payments being limited to serious injuries, psychologist's capacity to implement EBP should be increased.…”

Biopsychosocial barriers affecting recovery after a minor transport‐related injury: A qualitative study from Victoria

“…Hence, permanent or temporary disabilities arising from minor injuries pose an on‐going problem for the compensation and health‐care system . It has been acknowledged that this particular group is at risk of being left alone with problems and symptoms that are difficult to understand and often invisible to others …”

“…Other reasons suggested for a poor recovery, or even for permanent disability, include factors other than purely injury‐related ones. Few qualitative studies have identified factors that largely depend on a person's environment and health‐care and compensation systems . Others reported factors such as lack of family support, legal involvement and the compensation claim .…”

Beyond symptom resolution: insurance case manager’s perspective on predicting recovery after motor vehicle crash

“…While their role and competencies may vary in the different countries, CMs relationship with the injured person may often be much longer than the duration of interaction with any health care providerit starts very soon after the event and may continue for years until claim resolution. Though, delayed treatment and payment approvals may hamper that relationship [12], based on their longitudinal familiarity with the hundreds of cases they manage each year, CMs represent a unique source of information on early predictors of recovery outcome. Additionally, their perspective is broader than most health care providers, because they interact with more of the key persons involved in the injuryincluding injured person, various health care providers, attorneys and family.…”