Claimant experiences and outcomes in compensation systems

Transcription

1 Claimant experiences and outcomes in compensation systems Dr Genevieve Grant Collaborators: A/Prof ML O Donnell (Melbourne), Dr MJ Spittal (Melbourne), Prof DM Studdert (Stanford) Funders: Transport Accident Commission, WorkSafe Victoria, Institute for Safety, Compensation and Recovery Research

2 Health and compensation systems Recent surge in interest in the relationship between compensation systems and claimant health Existing evidence is flawed, but influential Compares claimants and non-claimants Fails to account for claim variability Qualitative evidence shows that some claimants have stressful claims experiences 2

3 What did we do? Identified aspects of the claims process that claimants find stressful Investigated the relationship between stressful claims experiences and long-term recovery after injury Explored the role of claimant vulnerability to stressful claims experiences 3

4 How did we do this? By looking at outcomes within a large group of compensation-claiming injury patients Using a sample drawn from the Injury Vulnerability Study (a cohort of injury patients in 3 states) At the 6-year follow up, we asked participants who had made a claim about their claiming experiences 4

5 Study timeline Key outcomes: Disability, quality of life, anxiety and depression 5

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7 Claimant characteristics (n=332) Male (n, %) 235 (71%) Mean age on admission 39 Education (% completed year 12) 48% Working prior to injury 94% Injury characteristics Intensive Care Unit admission 16% Presence of MTBI 45% Hospital stay (median days) 8.5 Claim complete at 6 years 87% Used a lawyer for claim 48% 7

8 Study timeline 8

9 Was this aspect of your claim a source of stress? If yes, how stressful was it? Stressed group (%) 1. Understanding what was required for claim 34% 2. The amount of time taken to deal with claim 30% 3. The number of medical assessments 27% 4. The amount of compensation received 26% 5. Being listened to 22% 6. Being treated with respect and dignity 18% 7. Negative attitudes of health practitioners 8% 8. Negative attitudes of friends, family, colleagues 7% 9

10 Claimant disability at 6 years 10

11 Claimant disability at 6 years 11

12 Claimant disability at 6 years 12

13 Claimant disability at 6 years 13

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15 Summary of findings Stressful claims experiences were prevalent among injury compensation claimants in three Australian states Early interactions are critical in setting the tone There were strong associations between stressful claims experiences and poorer long-term recovery Adjusting for factors that predisposed claimants to stress reduced the strength of the associations, but did not eliminate them 15

16 Implications Our findings point to two main strategies for improving claimant recovery: Redesigning aspects of claims processes that are strongly associated with claimant stress and are modifiable Developing interventions to decrease claimants vulnerability and increase their resilience in the acute post-injury phase or early in the claims process 16

17 Acknowledgements Thank you to our study participants and funders This project was funded by WorkSafe Victoria and the Transport Accident Commission, through the Institute for Safety, Compensation and Recovery Research at Monash University For more information Contact me - genevieve.grant@monash.edu 17

18 Primary outcome models adjusted for: Pre-accident disability, age, gender, income, pre-accident psychiatric history, Injury Severity Score, compensation scheme 18

19 Secondary outcome models adjusted for claimant vulnerability Propensity score included: Claimant pre-injury characteristics: Age, gender, psychiatric history, pre-injury disability, income, marital status, education Injury severity: MTBI, ISS, discharge destination, days in hospital Psychological response to injury: PTSD severity (acute, 3 mths), anxiety and depression (acute) Additional items: Compensation scheme, hospital 19