Are medical reports behind the noted uptick in psychological injuries being added to whiplash claims and are firms deliberately delaying issuing claimant medical reports to save costs?

By Editor Katie Scott

Prior to the implementation of the Official Injury Claim (OIC) portal on 31 May 2021, industry commentators – such as those attending our Fraud Charter roundtable – debated whether the portal would open the door to increased fraud, centred around claimants layering psychological or psychiatric injuries on top of whiplash-based personal injury claims resulting from road traffic accidents.

Katie Scott_bw_path

Katie Scott

Although this layering does not add vast financial amounts to claims payouts, an uplift is still applied to compensation – and because tariff amounts are now lower than previous whiplash injury payouts, fraudsters may be looking for any extra bonus they can lay their hands on. They may even hope to move the claim outside of the tariff table restraints.

Speaking to Ian Davies, partner and head of motor at law firm Kennedys, at the end of last year, he confirmed that this pre-portal crystal ball gazing had, in fact, been proved true in some measure, with “a pretty significant proportion of [whiplash] claims” also featuring a psychological injury, based on data collected in October 2021 from Kennedys IQ, the firm’s claims management platform.

Looking at this data, Davies told me that “there is certainly an increase in the number of psychological, psychiatric injuries being identified” within small claims notification forms (SCNFs), citing travel anxiety, for example.

Despite acknowledging that it is still “early doors” following the OIC portal’s launch less than a year ago, Davies said the increase in psychological injuries being added to whiplash claims is “an interesting initial trend” that “does feel pretty significant”.

For example, whiplash claims with psychological injury elements made up more than 50% of the claims on Kennedys IQ as at 31 October 2021.

Furthermore, healthcare professionals conducting medical reports in support of the claims process are agreeing with claimants that they have suffered a psychological or psychiatric injury in around 30% of cases.

Davies said that these numbers are “high” and “perhaps higher than I had expected”.

Kennedys’ findings also align with the OIC portal’s own figures. Its last batch of data – covering the period 1 September to 30 November 2021 – found that 2,590 of the 68,359 claims submitted on the portal during this reporting period were non-tariff claims, covering physical only or physical and psychological claims.

Training fine tuning

Davies queried whether the increase in psychological injury diagnoses was linked to the independent medical report process in some way – he added that mixed injury claims was not a trend prior to the OIC portal’s implementation.

“Since the whole discussion around the OIC portal came about, the medics have perhaps become more tuned in to it,” he said.

“A lot of this is on the shoulders of the medics and [the medical reporting organisations] in terms of the question set that’s been given to the medics and the training that’s been given to the medics when these rules came in, if any training has been given.”

I did contact medical reporting firms On Medical 24/7 and Premex Services to try and find out more about the training providing to medical professionals following the OIC portal launch, yet neither organisation responded to my request for comment.

Davies added that doctors do have a different mindset when conducting appointments after all – for example, when taking a medical history or reviewing symptoms, they would not typically question or challenge the pain that a patient says they are experiencing. Plus, psychological injuries may also be harder to diagnose – and disprove.

He continued: “In the medical reports produced [between May and October 2021], we’re seeing a range of prognosis for psychological injury - from a matter of weeks through to just touching over six months.

“So, quite a long prognosis for a type of anxiety. Normally it would be over in a couple of months, couple of weeks maybe. But it seems to be a little bit longer.

“This particular question is around what happens in the medical examination because ticking a box in the SCNF doesn’t do anything - it doesn’t get the claimant any closer to that extra amount of damages.

“But, persuading the medic that that injury has been suffered is one step closer to those damages, or getting them across the line.”

Delayed diagnoses

Furthermore, medical reports informing claims on the OIC portal are also taking longer than expected.

Davies told me that “there is still a pretty significant lag between accident date and medical examination”.

This view is further supported by findings from Insurance Times’ December 2021 Fraud Charter roundtable. For example, David Royal, policy and claims fraud manager at insurer Aviva, said that medical reports are now just “starting to flow” – although the insurer is seeing “very few settlements” still.

He noted that he would like to see more medical reports landing on the OIC portal.

Carpenters Group director Donna Scully, however, said that she has seen “very big problems” around “technical issues loading the medicals” on the OIC portal “and then getting the medicals over to the compensators”.

She believes some firms are deliberately delaying the medical reporting process too.

She explained: “I also have heard that there are firms that are not doing medicals early – they are waiting for an admission of liability because they don’t want to incur the expense of the medical. That will cause things to delay.

“There’s definitely a school of thought that says there are certain companies that are saying ‘we’re not any medicals early, we’re going to wait and then we’re going to present’.

“[The OIC] portal allows you to do that more than the old portal did. You can go back and you can send everything at once, whereas the old portal, you had to do things at various stages. This one is less prescriptive in terms of that.”

In terms of workflow, having all the medical reports coming through the portal’s system at once is not ideal, Scully added.

Ruth Needham, partner at Keoghs, agreed with Scully. She said: “How long can claimant firms wait? There is [a] cashflow reality to this as well.

“I keep waiting for this tipping point to come, that at some stage, we’re going to get this influx of medicals. When is that tipping point going to come?”

It appears that wrinkles in the OIC portal’s processes are still being unveiled and ironed out by the industry as the portal’s functionality is tested in real time, with actual claims.

Medical reports are an important part of the personal injury claim process, mitigating fraud and helping to inform payout decisions. Claimants deserve to have their medical appointments booked in as soon as possible, so that they can start any necessary treatment and crack on with progressing their claim.

More clarity around this process and enforcing prompt action should be a must for the industry and government alike to reduce claim lifecycles and better support insurance customers.