Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury

Cassidy, J. David; Carroll, Linda J.; Côté, Pierre; Lemstra, Mark; Berglund, Anita; Nygren, Åke

Affiliations

¹Alberta Centre for Injury Control and Research, Department of Public Health Sciences, University of Alberta, Edmonton, Canada

²Institute for Work and Health and the Department of Public Health Sciences, University of Toronto, Toronto

³Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, Canada

⁴Section of Personal Injury Prevention, Department of Clinical Neurosciences, Karolinska Institute, Stockholm, Sweden

Abstract

Background and Methods: The incidence and prognosis of whiplash injury from motor vehicle collisions may be related to eligibility for compensation for pain and suffering. On January 1, 1995, the tort-compensation system for traffic injuries, which included payments for pain and suffering, in Saskatchewan, Canada, was changed to a no-fault system, which did not include such payments. To determine whether this change was associated with a decrease in claims and improved recovery after whiplash injury, we studied a population-based cohort of persons who filed insurance claims for traffic injuries between July 1, 1994, and December 31, 1995.

Results: Of 9006 potentially eligible claimants, 7462 (83 percent) met our criteria for whiplash injury. The six-month cumulative incidence of claims was 417 per 100,000 persons in the last six months of the tort system, as compared with 302 and 296 per 100,000, respectively, in the first and second six-month periods of the no-fault system. The incidence of claims was higher for women than for men in each period; the incidence decreased by 43 percent for men and by 15 percent for women between the tort period and the two no-fault periods combined. The median time from the date of injury to the closure of a claim decreased from 433 days (95 percent confidence interval, 409 to 457) to 194 days (95 percent confidence interval, 182 to 206) and 203 days (95 percent confidence interval, 193 to 213), respectively. The intensity of neck pain, the level of physical functioning, and the presence or absence of depressive symptoms were strongly associated with the time to claim closure in both systems.

Conclusions: The elimination of compensation for pain and suffering is associated with a decreased incidence and improved prognosis of whiplash injury.

Links

DOI: 10.1056/NEJM200004203421606

PubMed: 10770984

WoS: 000086523700006

Cited Works (7)

Year	Entry
1995	Spitzer O Walter, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, Zeiss E. Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining "whiplash" and its management. Spine. 1995;20(suppl 8):2S-73S.
1964	MacNab I. Acceleration injuries of the cervical spine. J Bone Joint Surg. December 1964;46A(8):1797-1799.
1992	Evans RW. Some observations on whiplash injuries. Neurol Clin. November 1992;10(4):975-997.
1992	Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36), I: conceptual framework and item selection. Med Care. June 1992;30(6):473-483.
1998	Harder S, Veilleux M, Suissa S. The effect of socio-demographic and crash-related factors on the prognosis of whiplash. J Clin Epidemiol. May 1998;51(5):377-384.
1999	Hosmer DW Jr, Lemeshow S. Applied Survival Analysis: Regression Modeling of Time to Event Data. New York, NY: John Wiley & Sons; 1999.
1996	Schrader H, Obelieniene D, Bovim G, Surkiene D, Mickeviciene D, Miseviciene I, Sand T. Natural evolution of late whiplash syndrome outside the medicolegal context. Lancet. May 4, 1996;347(9010):1207-1211.

Cited By (21)

Year	Entry
2002	DeRosia J, Yoganandan N, Pintar FA. Small female and large male responses in rear impact. In: 46th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 30–October 2, 2002; Tempe, AZ.
2008	Bartsch AJ, Gilbertson LG, Prakash V, Morr DR, Wiechel JF. Minor crashes and "whiplash" in the United States. In: 52nd Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 6-8, 2008; San Diego, CA.117-128.
2007	Stemper BD, Yoganandan N, Gennarelli TA, Pintar FA. Toward a lower neck rear impact injury criterion: correlation of lower neck loads with spinal kinematics. In: Proceedings of the 2007 International IRCOBI Conference on the Biomechanics of Impact. September 19-21, 2007; Maastricht, The Netherlands.249-260.
2015	Sato F, Nakajima T, Ono K, Svensson M, Kaneoka K. Characteristics of dynamic cervical vertebral kinematics for female and male volunteers in low‐speed rear impact, based on quasi‐static neck kinematics. In: Proceedings of the 2015 International IRCOBI Conference on the Biomechanics of Injury. September 9-11, 2015; Lyon, France.261-277.
2009	White NA, Begeman PC, Hardy WN, Yang KH, Ono K, Sato F, Kamiji K, Yasuki T, Bey MJ. Investigation of upper body and cervical spine kinematics of post mortem human subjects (PMHS) during low-speed, rear-end impacts. In: Proceedings of the SAE World Congress & Exhibition. April 20-23, 2009; Detroit, MI. Warrendale, PA: Society of Automotive Engineers. SAE 2009-01-0387.
2000	Siegmund G, Myers BS, Davis MB, Bohnet HF, Winkelstein BA. Human cervical motion segment flexibility and facet capsular ligament strain under combined posterior shear, extension and axial compression. Stapp Car Crash J. 2000;44:159-170. SAE 2000-01-SC12.
2004	Quinlan KP, Annest JL, Myers B, Ryan G, Hill H. Neck strains and sprains among motor vehicle occupants: United States, 2000. Accid Anal Prev. January 2004;36(1):21-27.
2003	Berglund A, Alfredsson L, Jensen I, Bodin L, Nygren Å. Occupant- and crash-related factors associated with the risk of whiplash injury. Am J Epidemiol. January 2003;13(1):66-72.
2009	Salzar RS, Bolton JR, Crandall JR, Paskoff GR, Shender BS. Ejection injury to the spine in small aviators: sled tests of manikins vs. post mortem specimens. Aviat Space Environ Med. 2009;80(7):621-628.
2003	Stemper BD, Yoganandan N, Pintar FA. Gender dependent cervical spine segmental kinematics during whiplash. J Biomech. September 2003;36(9):1281-1289.
2003	Yoganandan N, Knowles SA, Maiman DJ, Pintar FA. Anatomic study of the morphology of human cervical facet joint. Spine. October 15, 2003;28(20):2317-2323.
2004	Stemper BD, Yoganandan N, Pintar FA. Gender- and region-dependent local facet joint kinematics in rear impact: implications in whiplash injury. Spine. October 15, 2004;29(16):1764-1771.
2008	Stemper BD, Yoganandan N, Pintar FA, Maiman DJ, Meyer MA, DeRosia J, Shender BS, Paskoff G. Anatomical gender differences in cervical vertebrae of size-matched volunteers. Spine. January 15, 2008;33(2):E44-E49.
2011	Curatolo M, Bogduk N, Ivancic PC, McLean SA, Siegmund GP, Winkelstein BA. The role of tissue damage in whiplash-associated disorders: discussion paper 1. Spine. December 2011;36(suppl 25S):S309-S315.
2003	Viano DC. Seat influences on female neck responses in rear crashes: a reason why women have higher whiplash rates. Traffic Inj Prev. 2003;4(3):228-239.
2009	Siegmund GP, Winkelstein BA, Ivancic PC, Svensson MY, Vasavada A. The anatomy and biomechanics of acute and chronic whiplash injury. Traffic Inj Prev. 2009;10(2):101-112.
2004	Stemper BD. Whiplash Affects Cervical Spine Biomechanics [PhD thesis]. Wilwaukee, WI: Marquette University; May 2004.
2009	DeRosia JJ. Role of Gender and Size in Biomechanics of Rear Impact Wilwaukee, WI: Marquette University; May 2009.
2010	Mang D. Using Acoustic Stimuli to Inhibit the Startle Response Triggered by Whiplash Collisions: Implications for Injury Prevention [Master's thesis]. Vancouver, BC: University of British Columbia; April 2010.
2020	Shen D. Investigation of Whiplash Associated Disorders Using Finite Element Neck Models With Active Musculature in Frontal, Rear and Lateral Impact [Master's thesis]. University of Waterloo; 2020.
2011	Zheng L. Sex Differences in Human Neck Musculoskeletal Biomechanics and Modeling [PhD thesis]. Pullman, WA: Washington State University; May 2011.