Can stress from PI claims affect outcomes? A story of secondary victimisation or secondary gain?

PIInjury

If an individual is eligible for compensation and their claim was successful, in most situations they are able to gain treatment or therapy quicker via the private sector as well as receiving compensation for any losses. So far, so good. Now, one would assume that through this timely process of service, patients with a successful personal injury claim may recover faster in comparison to individuals who have not attained claims for personal injuries. Wrong. In fact, evidence suggests that individuals who did not gain such compensations recovered at a faster rate than patients who sought help via personal injury compensation schemes. It is reasonable to wonder why this might be.

There are two ways in which this can potentially be explained. It could be argued that for an individual who has taken the tortuous process of personal injury claims, prolonging the ill role may gain a more substantial compensation. This side of the explanation would suggest that there is no significant financial motive for the patient to get better. This is termed “Secondary gain”. However, whilst this is one point of view, it’s imperative to consider the counter issue of “secondary victimisation”.

One can imagine that the route of successfully receiving compensation is not a path paved of roses, for many it is a long and difficult process. The mount of paperwork and legalities cannot possibly be easy. This stress may hinder the progress of recovery, as not only do patients have to worry about their well-being but also about the formalities behind the process. In effect patients are victimised twice, once by the original accident itself and then through the system of trying to attain compensation, i.e. secondary victimisation.

Grant et al in their study demonstrate how patients who are involved in compensation schemes experience high levels of stress by just being in the process. They recommend that efforts to reduce stress would enhance recovery and potentially provide savings.

Even the medical examination can be very stressful.  Waddell states, “patients are not just cases …, they are suffering human beings. When patients gain the impression that the examining clinician thinks the patient is putting on symptoms and signs, this does a tremendous disservice to patients and actually magnifies their entire pain perception; this results in despair and psychologic difficulties when trying to cope with what they consider to be their very real pain.

Grant GM, O’Donnell ML, Spittal MJ, Creamer M, Studdert DM. Relationship between stressfulness of claiming for injury compensation and long-term recovery: a prospective cohort study. JAMA Psychiatry. 2014;71(4):446–53

Waddell G. The Back Pain Revolution. 2nd ed. Edinburgh: Churchill Livingstone; 2004. Overreaction should be dropped as it is prone to observer bias and unrealiability.