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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.

According to the article in Reuters Health, 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.

“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. “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.

“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 Studdert said. “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.

Studies such as this one may be a basis to seek apportionment of permanent disability based upon causation. New Labor Code sections 4663, subdivision (a) and 4664, subdivision (a) eliminate the bar against apportionment based on pathology and asymptomatic causes. Thus, under the post SB 899 workers’ compensation system, apportionment of permanent disability shall be based on causation (§ 4663, subd. (a)), and the employer shall only be liable for the percentage of permanent disability directly caused by the injury arising out of and occurring in the course of employment. Creative trial work coupled with a comprehensive forensic presentation may accomplish a persuasive argument to apportion away the effects of stress from the disability after a physical industrial injury.