The relationship between compensable status and long‐term patient outcomes following orthopaedic trauma

Abstract

Objective: To determine the relationship between compensable status in a “no‐fault” compensation scheme and long‐term outcomes after orthopaedic trauma. Design and setting: Prospective cohort study within two adult Level 1 trauma centres in Victoria, Australia. Participants: Blunt trauma patients aged 18–64 years, admitted between September 2003 and August 2004 with orthopaedic injuries and funded by the no‐fault compensation scheme for transport‐related injury, or deemed non‐compensable. Main outcome measures: 12‐item Short Form Health Survey (SF‐12) and return to work or study at 12 months after injury. Results: Of 1033 eligible patients, 707 (68.8%) provided follow‐up data; 450 compensable and 247 non‐compensable patients completed the study. After adjusting for differences across the groups (age, injury severity, head injury status, injury group, and discharge destination) using multivariate analyses, compensable patients were more likely than non‐compensable patients to report moderate to severe disability at follow‐up for the physical (adjusted odds ratio [AOR], 2.0; 95% CI, 1.3–2.9), and mental (AOR, 1.6; 95% CI, 1.1–2.5) summary scores of the SF‐12. Compensable patients were less likely than non‐compensable patients to have returned to work or study, even after adjusting for injury severity, age, head injury status and discharge destination (AOR, 0.6; 95% CI, 0.3–0.9). Conclusions: Patients covered by the no‐fault compensation system for transport‐related injuries in Victoria had worse outcomes than non‐compensable patients.

Understanding the effect of compensation on recovery from severe motor vehicle crash injuries: a qualitative study

“…This is supported by other studies which show higher levels of disability and poor psychological health during the life of a claim 3 8 23…”

“…Many returned to work and other activities out of necessity. This has also been shown in research where there is a non-compensable comparison group 3 8 15…”

“…We found that the injury recovery experience was difficult for all people, but it was particularly stressful for people claiming compensation. These results provide additional insight into why compensation factors affect people's health following injury 3 4 6 7 15…”

Factors predicting work status 3 months after injury: results from the Prospective Outcomes of Injury Study

“…There may be injured New Zealanders, not included in our study, who did not access medical support from a health professional for their injury (a necessary requirement to become registered with ACC), or, who were not referred to ACC by a health professional. There is moderate evidence that the receipt and extent of compensation has a negative effect upon returning to work following injury in healthcare systems where only certain causes of injury receive compensation, such as those caused by a motor vehicle traffic crash or while at work 4 39. However, it is a strength of the study that the universal nature of this scheme allows us to examine predictors of work status in the short-term in a broader population context of injury and work than previously examined.…”

Do outcomes differ between work and non-work-related injury in a universal injury compensation system? Findings from the New Zealand Prospective Outcomes of Injury Study

“…Differences in recovery outcomes for workers injured in work settings are often attributed to secondary financial gain via workers compensation insurance or litigation, as the non-work comparison group is usually generated from a population with vastly different entitlements to compensation [2,3]. Entitlement to compensation is known to be associated with slower recovery from injury [5,6]. For example, processes for establishing entitlement in some schemes can lead to poorer outcomes for those with compensable injuries due to difficulties in accessing financial compensation, treatment, and the resulting psychological distress [7].…”