Alex MacLachlan says there needs to be more incentives for claimants and insurers to use rehabilitation

All sides involved in personal injury claims are in favour of rehabilitation rather than simply paying compensation for accident victims.

How could they not be? From denying every claim as the starting point in every case, insurers are now offering rehabilitation as the best way to move the claim forward. All sides are focused on victim care.

But when broad ideas are agreed in principle, the devil is always in the execution and, in the detail. Research into the benefits of rehabilitation in low value cases is sketchy.

The evidence that has been gathered shows that, within reason, the earlier the rehabilitation, normally physiotherapy, the more effective it is. Historically, rehabilitation is recommended far too late in the personal injury process. The convention was to wait until liability issues had been settled and the medico-legal report, recommending treatment, was obtained.

Victims go to their GP but find they are in a queue with the prospect of treatment stretching some months ahead. The NHS, (even if it were to charge for the treatment), cannot make things happen quickly enough to make a significant difference.

The timescales are interesting. At Medico-Legal Reporting (MLR), we would not presume to obtain a GP's report prior to six weeks post accident and we would not obtain a consultant's report before six months post accident.

Frankly, at over six months post accident, rehabilitation is normally an irrelevance in respect of low-value injuries. The benefits to be gained are in obtaining medical evidence at an early stage from a GP or, following the innovative schemes introduced by Liverpool Victoria Insurance and others, of offering treatment prior to admission of liability.

However, the British Medical Association wants victims examined by people with the most appropriate medical qualification. Insurers believe that for the great majority of low value injuries a medico-legal report from a GP is appropriate. GPs can, and do, recommend specialist opinions in approximately 6% of cases.

This largely reflects the reality in respect of treatment (as opposed to medico-legal reports). Less than 5% of people with whiplash injuries are referred to a specialist for treatment.

Legal delays

There are a significant number of claimants who believe that nothing much is being done about their claim because of the delays involved in the legal process, and as a result their injuries become 'institutionalised'.

Early intervention and a caring approach by the offer of physiotherapy or other forms of rehabilitation can head off this problem, yielding significant savings for insurers.

To increase the take up of rehabilitation, it is claims handlers, at the coalface, who will have to be incentivised to buy into the whole concept.

In terms of cost recovery, there are mixed feelings in the insurance industry. Some see the case for rehabilitation as being unproven. Others, such as AIG, believe that it is highly cost effective.

As a rough rule of thumb, MLR believes that the average cost of physiotherapy taken up is about the same as one week of the average national wage.

Therefore, the calculation that has to be made by the insurer is, do they believe that the offering of physiotherapy will accelerate the claimant's return to work by more than seven days?

Finally, claimants have to be convinced that attending a course of treatment is in their interests.

We have found that the take-up of treatment by claimants directly relates to the distance they have to travel to a treatment centre.

Insurer-led schemes, utilising large medical providers, have a relatively small number of centres and it is our view that there needs to be in excess of 500 treatment centres in the UK to optimise claimant take up.