The association of compensation on longer term health status for people with musculoskeletal injuries following road traffic crashes: emergency department inception cohort study

Abstract

Objective: To compare the health status of people claiming compensation for injuries sustained in road traffic crashes (RTC), with people who do not claim compensation. Design: Prospective cohort study. Setting: Australian Capital Territory, Australia and a fault based common law compensation scheme. Subjects: People presenting to the emergency department with mild to moderate musculoskeletal injury following RTC. Main outcome measures: Physical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure, Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI). These measures are recorded immediately post crash, at 6 and 12 months post crash. Results: 95 people participated in the study and were enrolled a mean of 8.6 (median 8) days following the crash. 86% were followed up to 12 months after injury. Mean age was 37 years, 61% were female and 91% were employed at the time of their injury. 33% ultimately claimed compensation, and 25% engaged a lawyer. There were no major differences in baseline personal characteristics or injury related factors between the groups. As expected, involvement as a passenger and in multiple vehicle crashes, were more frequent in the group claiming compensation. Over the duration of the study claiming compensation was associated with lower SF-36 PCS (-5.5 (95%CI -8.6 to -2.4), p = 0.001), greater HADS-Anxiety (1.7 (95%CI 0.2-3.3), p = 0.048), and worse FRI (11.2 (95%CI 3.9-18.5), p = 0.003). There was a highly significant improvement in health status between baseline and 6 months after injury, but no further significant change between 6 and 12 months after injury. There was no difference in rate of improvement between the groups. Claiming compensation and psychological factors were independent predictors of worse health status at 12 months. Conclusion: In this study the group claiming compensation had overall worse health status following mild to moderate musculoskeletal injuries over the course of the study. There was no difference in rate of improvement between the groups. However, it is not possible to determine whether this negative effect was due to claiming compensation itself or the presence of other unmeasured factors.