Lastword

Has the rehabilitation process helped to reduce the cost of claims in the insurance market in the UK?

Rehabilitation has traditionally been reserved for high-value cases and catastrophic injuries. For smaller claims, the adversarial system and chronic delays in the judicial process meant rehabilitation was viewed as irrelevant. Plaintiff solicitors didn't see it as advantageous for clients to receive early rehabilitatory treatment, as this would require expenditure before liability had been accepted and so was risky and might well reduce damages awarded at the conclusion of the claim.

The changes brought about by the Woolf reforms mean that early intervention with physiotherapy, chiropractic treatment and the like is a more viable option. Liability is accepted earlier in the claim process, leading claimant solicitors to actively consider the option and there appears to have been a shift in claimant solicitor attitudes. Some still believe their role is to maximise financial compensation for claimants and thus don't want early treatments that would reduce chronic symptomology. There are even those who apply for interim payments for treatment and give the money to the claimant with the knowledge that treatment will not be sought. However, an increasing number are actively promoting rehabilitation to clients as a positive step towards returning their lives to normality, free from chronic stiff necks or the onset of osteoarthritis in later life.

Although there is little empirical evidence to prove rehabilitation has helped reduce the cost of claims, there is a subjective belief in those who have been promoting it for some time. Mobile Doctors Ltd (MDL) Rehabilitation Services is working with insurance partners in controlled studies to objectively examine the financial and physiological effects of early rehabilitation in fast track cases.

What can insurance companies do to facilitate the most effective return to work for injured parties?

To facilitate the early return to work for injured parties, insurance companies need to promote early intervention. Rehabilitation should begin as soon as the acute effects of an injury have abated. In lower value cases, this is usually within two weeks of the injury occurring, which means that insurance companies must admit liability as early as is possible and then proactively canvas the claimant side to begin on a course of treatment.

All evidence suggests that early treatments provide swifter recovery and better long-term prognosis for both minor and major injuries.

How does the provision of a fast and efficient GP medico-legal reporting service speed up the process of rehabilitation?

It can speed up the process if the expert recommends a course of treatment as part of the report. There are issues with this approach, however. Firstly, if the report is not obtained early enough in the claims process to facilitate early treatment intervention, many months will pass before the report is commissioned and it will take a further six to 14 weeks for that report to be returned to the claimant solicitors (or both parties if joint instruction) before a decision relating to rehabilitation can be made.

Leaving a chronic injury three to six months before commencing any treatment significantly reduces the effectiveness and increases the length of treatment required and hence increases the cost of treatment and damages awarded for the claimant. In short, delaying treatment increases the cost of the claim for the insurance company.

The answer to this problem is to initiate rehabilitation much sooner in the process. MDL has been working with claimant and defendant business partners to develop a service that can assess the treatment needs of a claimant and provide access to rehabilitation much earlier in the claims process, sometimes even before liability has been accepted.

MDL has pioneered a protocol whereby claimants are contacted by a GP within 48 hours of the cases being accepted by a claimant solicitor.

The GP carries out a semi-structured telephone interview with the claimant and makes an assessment of the treatment needs. This report is returned within 24 hours to MDL, which immediately liaises with the claimant solicitor and, where possible, the insurance company.

If the GP recommends rehabilitation treatment and the parties agree to go ahead, MDL arranges an appointment with the appropriate expert (physiotherapist, chiropractor or psychologist) within a week. They then examine the patient within one week and produce a report that confirms whether treatment is required or not, and a treatment plan. All of this is provided as a report, which will be forwarded to instructing parties to give the final decision to go ahead with rehabilitation.

This protocol has a number of advantages. It facilitates early assessment of claimant needs, and early intervention with the most appropriate rehabilitatory treatment. Early treatment will lead to a better prognosis for the claimant, who will make a quicker and more complete recovery. The claimant will have had treatment before the most appropriate medical expert produces the medico-legal report. This gives experts more information, enabling them to make a more definitive prognosis.

In this way, the cost of the claim is reduced, saving insurers money and a better recovery for claimants - a win-win solution.