Factors that challenge health for people involved in the compensation process following a motor vehicle crash: A longitudinal study

Background
People who claim compensation after a motor vehicle accident do not recover as well as people with similar injuries who do not claim compensation. It has been suggested that this impeded recovery is caused by the stressful compensation process and the adversarial attitude of professionals. However, this theory has not been well investigated. The aim of the current study is twofold. The first is to investigate whether dissatisfaction with the insurance agency is associated with anxiety. The second is to explore what is causing dissatisfaction with the insurance company.

Methods
Participants (n = 417) were injured people involved in a traffic accident compensation scheme in New South Wales, Australia. The predictors of interest were (among others) dissatisfaction with the insurance company and catastrophizing. Outcome measures were (1) the anxiety/depression subscale of the EuroQol, and (2) comments explaining dissatisfaction with the insurance company. Interviews were conducted by phone at 2, 12 and 24 months after injury. The associations between predictors and anxiety were analysed using stepwise logistic regression analyses. The comments about dissatisfaction with the insurance company were analysed qualitatively by a cyclic process of open, axial and selective coding.

Results
The strongest association with anxiety was catastrophizing (AOR, 11.75 [95% CI, 4.97 - 27.78]; p < .001). Dissatisfaction with the insurance company was associated with more anxiety (AOR, 2.67 [95% CI, 1.37 - 5.20]; p = .004). Dissatisfaction was attributed to (1) lack of communication and lack of information, (2) delayed or denied payments of compensation, (3) slow treatment approval and discussions about causality, (4) too much complicated paperwork, and (5) discussions about who was at-fault.

Conclusions
As catastrophizing was the strongest predictor, this study suggests that injured people might best be helped by enrolling in psychological interventions aiming at tackling negative cognitions. There is also a role for claim managers who could adopt a more pro-active attitude in claims settlement.