April 19, 2000 -- Patients suffering from whiplash injuries can expect to recover in about half the time under a new insurance system that guarantees treatment but virtually eliminates costly damage suits. In other words, according to Canadian researchers, taking lawsuits out of the equation is comparable to making a dramatic advance in therapy for those with nagging whiplash symptoms.
J. David Cassidy, DC, PhD, an epidemiologist at the University of Alberta in Edmonton, looked at the transition from a so-called tort system, which allows vehicle crash victims to sue for damages, to a "no fault" approach, which curbs legal action but enhances medical and income-replacement benefits. The study took place in the province of Saskatchewan and included nearly 7,500 people who filed whiplash injury claims during the changeover to no fault insurance during 1994 and 1995.
In what is apparently the biggest-ever study of its type, Cassidy and colleagues compared the accident victims' length of recovery time between the old tort and new no fault insurance methods. He describes the findings, which appear in the April 21 issue of The New England Journal of Medicine, as "astonishing." Pure no fault systems are rare. Usually, accident victims are allowed some right to sue for additional damages.
During the last six months of the tort system, the time from filing a whiplash claim to closure of the case was 433 days, but that number dropped dramatically to 194 days under no fault insurance.
"There's a huge benefit to recovery if you don't tie benefits to pain and suffering compensation. In my mind, if you can shave over 200 days of recovery time off an injury ... and if I came up with a treatment that did that, I'd be world famous," Cassidy tells WebMD.
But to critics like Michael Freeman, PhD, an epidemiologist at Oregon Health Sciences University who specializes in vehicle injuries, the researchers are "stacking the deck to show that more people have a claim closure, but I don't think we have a very good measure of how these people did."
Cassidy says he compared the tort and no fault patient population groups to make sure there was nothing distinctly different about them. In addition to the improvement in recovery time, Cassidy found that whiplash claims themselves actually dropped 28% during the study, despite the fact that accident numbers went up.
Other positive health indicators in the Canadian study include improvements in reports of symptoms like neck pain, physical functioning, and mood -- all correlated with a quicker resolution of the claim.
Freeman has been up in Saskatchewan offering support to a group that opposes no fault insurance. "These people were led like cattle to the slaughter in my opinion. They are being forced into treatment they don't want. They are being kicked out of programs if they don't cooperate," says Freeman, who has testified as an expert witness for whiplash plaintiffs.
Cassidy insists everyone in the study was given informed consent, and that his research shows the benefit of focusing on rehabilitation instead of legal remedies. "Plaintiffs' experts and lawyers certainly benefit [financially] from a tort system. ... I'm saying, why do that? Why not help people get better twice as fast and take [lawsuits] out of the equation?" says Cassidy. The researcher says that the tort system added $4 billion in excess costs to the U.S. medical bill in 1993.
In an editorial accompanying the study, author Richard Deyo, MD, MPH, of the University of Washington in Seattle, notes that many treatments for whiplash have not been thoroughly tested. For policy makers, this study should encourage further experimentation with systems like the one in Saskatchewan.
The research was supported by a grant from Saskatchewan Government Insurance -- the public agency that provides the majority of motor vehicle injury insurance in the province of 1.1 million people.