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 People injured in an accident or at work sometimes
file for monetary compensation, and according to some studies those
who file tend to have worse long-term health than those who do not.
A new survey of Australian accident victims found that claims stress
often comes from confusion about the process, delays and related
medical assessments. Those who were most stressed by filing a claim
tended to have higher levels of disability years later.
Study author David M. Studdert of Stanford University in California
said past studies have compared people who filed for compensation to
people who did not, but those groups might have different types of
injuries to begin with.
Another aspect to consider is that people who file claims have an
incentive to exaggerate their symptoms to receive more compensation
for longer.
"The novelty of this study was to look within a group of claimants
to test whether those who reported experiencing the most stress also
had the slowest recoveries," Studdert said. "They did."
He and his colleagues polled a random selection of more than 1,000
patients hospitalized in Australia for injuries between 2004 and
2006. Six years later, 332 of the patients who had filed for
workers' compensation or another accident claim told the researchers
how stressful the process had been. Claims can take four to five
years to conclude, Studdert noted.
A third of the claimants reported high stress from understanding the
claims process and another third were stressed by delays in that
process. A slightly smaller proportion said repeated medical
evaluations and concern for the amount of money they would receive
were sources of stress.
Negative attitudes from doctors, friends, family or colleagues, on
the other hand, did not seem to be common sources of stress.
People with the most stress tended to score higher on a disability
scale and have higher levels of anxiety and depression and lower
quality of life, the researchers reported in JAMA Psychiatry.
"While it's intuitive that the compensation process is going to be
stressful for some claimants, what is less clear is whether that
stress has a substantial impact on recovery many years after the
injury," Studdert said. "We were surprised by the size of the
compensation effects on outcomes like level of disability and
quality of life — they were fairly strong," he told Reuters Health.
When the researchers took into account that some patients seemed to
be more vulnerable to stress from the start, the link between claims
stress and long-term recovery was similar but not as strong.
"There is much debate at the moment about the role of ‘systems,' in
this case ‘compensation systems' on health outcomes," said Michele
Sterling, who studies injuries and rehabilitation at the University
of Queensland in Herston, Australia. She was not involved with the
current study.
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"If it can be established which parts of the process cause stress
and/or poor outcomes or recovery then the system could look at
targeting these specific areas and improve them," Sterling told
Reuters Health. "Some insurance regulators are already trying to do
this in some areas."
This study deals with severe injuries that require hospitalization,
and her own research focuses on more minor injuries, she noted, but
the relationship between stress and health is likely the same, she
said.
She has found that posttraumatic stress symptoms predict poor
recovery, and that could be worsened by stresses in the claims
system, she said.
It is still worthwhile for patients who have sustained a serious
injury to file a claim, Studdert said.
"Compensation serves an important function, especially for people
who must drop out of the workforce for a period of time," he said.
"The financial support can be critical."
"Our study joins many others that show the rate of mental health
problems among people who are injured is astonishingly high," he
said, adding that medical systems are excellent at treating physical
injuries but not as good at treating mental conditions.
"I think the point that needs to be made is that those managing
these systems, insurers or workers' compensation boards, or no fault
automobile compensation schemes, should realize that they are
undermining their own mission of getting workers back on their feet
if the process is unnecessarily stressful," said Katherine Lippel,
who studies occupational health and safety law at the University of
Ottawa in Ontario, Canada and was not involved in the study.
The authors suggest that compensation schemes could be redesigned to
get the process over with quicker and make it easier for patients to
understand, which could alleviate some sources of stress.
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Source: http://bit.ly/1boZNiZ
JAMA Psychiatry, online Feb. 12, 2014.
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