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Injury recovery may be affected by compensation

At a glance:
This study looked at patients admitted to hospital with trauma injuries. Patients who were compensated by the Transport Accident Commission (TAC) did not recover as well as those who were not compensated, especially for mental disability. 12 months after their injury, compensated patients were less likely to have returned to work or study, even when other factors such as severity of injury, age, type of injury, and place of discharge were taken into account.
Perspectives:
Employee
A number of studies have shown people have poorer recovery times and outcomes when they are part of a compensation system. This study was undertaken on road trauma victims.

Many factors are thought to influence this situation, such as decisions about surgery which are often slowed down by the system.

People who have significant financial needs will often work out a way of returning to work. Greater financial needs drive people to find a way to deal with their health problem. When the person is part of a large system, there is often the expectation that someone else will deal with the issues. The insurer may expect the employer to focus on return to work; the employer may expect the insurer to deal with issues about approving surgery or other treatments. You may be waiting, expecting others to suggest or advise, as your sense of personal responsibility is handed over to others who are operating the system.

People who are subject to a compensation system can lose mental flexibility and the sense that they are in control of their destiny.

Many factors influence the situation. You can improve this by taking responsibility for changing your situation, and helping to drive the process. Be a manager of the issues that affect you, rather than a passive recipient.
Employer
This study shows that recovery in compensation circumstances is poorer than recovery in non-compensable situations. These results are consistent with other studies that have assessed outcomes for injuries of similar severity suffered by people in compensable and non-compensable circumstances.

A number of studies have suggested that the relationship between the employee and employer is the driver of a successful return to work outcome. A positive partnership improves the employee, his motivation and focus.

Avoiding bureaucratic delays through regular and timely communication, and helping employees get the best medical care are simple, but effective strategies to improve outcomes.
Treater
Treating practitioners generally believe that people won't do as well in a compensable situation. There is often blame and anger associated with claims which results in reduced outcomes. Some surgeons are wary of operating on people in compensable circumstances.

People in compensable circumstances can find it difficult to resolve issues in a timely fashion. Delays cause frustration and distress
distress
Severe suffering, pain, anxiety or sorrow
 which then leads to more investigations, treatment, and value judgements may be made about people who are not seen as paying for their treatment.

Patients often expect others to make decisions about them. For example, many people say that they continued with ineffective treatment because they thought others would not consider them motivated if they ceased that treatment. Empowering the patient to make decisions, to be an active participant in their recovery, minimises delays and improves outcomes.
Insurer
People in non-compensable circumstances often expect the system will drive the process and they become dependent in situations in which they would normally make their own decisions. Encourage people to understand the system, and how they can best work within it. This may include:

Ensuring they understand their condition and the treatment options
Understanding the expected outcome of their treatment
Making judgements about whether treatment is helping them
Communicating their work capabilities
Voicing concerns about duties within return to work
Following up if they consider there are inappropriate delays.
Original Article, Authors & Publication Details:
B. J. Gabbe1, P. A. Cameron1, O. D. Williamson1, E. R. Edwards2, S. E. Graves3 and M. D. Richardson4 (2007).

The relationship between compensable status and long-term patient outcomes following orthopaedic trauma. Medical Journal of Australia; 187(1):14-17.

1Department of Epidemiology
epidemiology
The study of factors affecting the health and illness of populations. Also refers to the study of management and control of health problems.
 and Preventative Medicine, Monash University, Melbourne, VIC
2Department of Trauma Surgery, National Trauma Research Institute, Alfred Hospital, Melbourne, VIC
3Department of Medicine, University of Melbourne, Melbourne, VIC
4Department of Orthopaedics, Royal Melbourne Hospital, Melbourne, VIC
Background, Study Objectives, How It Was Done:
Previous research has suggested that a patient's "compensation status' affects their recovery. Most of this research has focused on injuries such as whiplash and low back pain, rather than severe trauma.

Injuries to the skeletal system, such as fractures, are the most common trauma causing hospital admission in Australia. In Victoria, 46% of patients with this kind of trauma are covered by the TAC “no fault' compensation scheme, which covers the cost of medical treatment, rehabilitation, lost wages, disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 services and household support.

The aim of this study was to determine the relationship between TAC compensation status and patient recovery in the 12 months after a trauma injury.

Patients admitted to participating hospitals in Victoria for trauma between September 2003 and August 2004, who were either receiving compensation from TAC or not receiving any compensation, were asked to participate in the study. The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) records information about each patient's injury through medical and hospital records and patient interviews during hospital stay. Patients were asked about their health before their injury during the in-hospital interview. 12 months after injury patients were interviewed by phone. From this interview, a patient's level of disability and whether they had returned to work or study was determined.
Study Findings:
707 patients participated in the study (69% of those asked).

Type and severity of injury:

Almost 75% of compensated patients also suffered other types of injuries (as well as the compensated injury), compared to 27% of non-compensated patients.
Compensated patients were more likely than non-compensated patients to have a serious head injury or more severe injury.
14% of non-compensated patients had transport accidents.
More compensated patients (49%) were discharged into rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 centres than non-compensated patients (14%), most of whom were discharged home (82%).

Physical and mental health:

12 months after injury compensated patients had poorer physical and mental health
mental health
Emotional wellbeing. Ability to cope with difficulty and enjoy life. THe absence of a mental health problem.
 than non-compensated patients.
Compensated patients were more likely than non-compensated patients to report moderate to severe disability 12 months after injury.

o More than half (56%) of compensated patients said they had ongoing physical disability compared with 35% of non-compensated patients.
o 57% of compensated patients said they had ongoing mental disability compared with 20% of non-compensated patients.

Return to work/study:

Among patients who were working or studying before their injury:

Compensated patients were less likely than non-compensated patients to have returned to work or study 12 months after their injury, even if other factors such as severity of injury, age, type of injury, and place of discharge were taken into account.
The return to work/study rate for non-compensated patients was 84% and 67% for compensated patients.
Conclusions:
The physical health of trauma patients 12 months after their injury remained lower than before injury. Non-compensated patients had recovered their mental health 12 months after injury, whilst compensated patients had ongoing mental disability. Compensated patients were more likely to report moderate to severe physical and mental disability 12 months after injury, and less likely to have returned to work, than non-compensated patients.

The outcomes were worse for compensated patients than for non-compensated patients. Reasons that have been proposed for compensation causing poorer recovery include:

Severity of injury
Traumatic nature of the injury
Patients experience with the compensation system
Patient behaving ill for financial gain
Psychosocial environment before injury
Psychosocial environment after injury

The mental health of compensated and non-compensated patients didn't differ before injury, but the questionnaire may not have detected the important differences in psychosocial
psychosocial
Refers to psychological and social factors. Examples of psychosocial factors that affect return to work area include: a person's beliefs about how they will cope with their condition, the attitude of the inured worker's family to their condition and return to work, the employer's return to work policy and the influence of the WorkCover system on a person.
 environments.

All compensated patients were injured in a traffic accident, while non-compensated patients were mainly injured in falls. This difference in the nature of the injury may have affected patient outcomes. Compensated patients were more likely to have a severe injury than non-compensated patients, but after correcting for this difference compensated patients still had poorer outcomes.

As financial compensation from the TAC depends on the level of disability a patient experiences, patients may overstate their limitation for secondary gain.
secondary gain
Any indirect gain that occurs as the result of an injury or illness. For example, financial gain (in the form of compensation), not having to work, sympathy or attention.
 

Whether patients' experiences with the compensation system affected their recovery from injury was not assessed in this study.
References:
PubMed Abstract
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