A.J. Akkermans

Do Compensation Processes Impair Mental Health? A Meta-Analysis

BACKGROUND Victims who are involved in a compensation processes generally have more health complaints compared to victims who are not involved in a compensation process. Previous research regarding the effect of compensation processes has concentrated on the effect on physical health. This meta-analysis focuses on the effect of compensation processes on mental health. METHOD Prospective cohort studies addressing compensation and mental health after traffic accidents, occupational accidents or medical errors were identified using PubMed, EMBASE, PsycInfo, CINAHL, and the Cochrane Library. Relevant studies published between January 1966 and 10 June 2011 were selected for inclusion. RESULTS Ten studies were included. The first finding was that the compensation group already had higher mental health complaints at baseline compared to the non-compensation group (standardised mean difference (SMD)=-0.38; 95% confidence interval (CI) -0.66 to -0.10; p=.01). The second finding was that mental health between baseline and post measurement improved less in the compensation group compared to the non-compensation group (SMD=-0.35; 95% CI -0.70 to -0.01; p=.05). However, the quality of evidence was limited, mainly because of low quality study design and heterogeneity. DISCUSSION Being involved in a compensation process is associated with higher mental health complaints but three-quarters of the difference appeared to be already present at baseline. The findings of this study should be interpreted with caution because of the limited quality of evidence. The difference at baseline may be explained by a selection bias or more anger and blame about the accident in the compensation group. The difference between baseline and follow-up may be explained by secondary gain and secondary victimisation. Future research should involve assessment of exposure to compensation processes, should analyse and correct for baseline differences, and could examine the effect of time, compensation scheme design, and claim settlement on (mental) health.

Factors that challenge health for people involved in the compensation process following a motor vehicle crash: a longitudinal study

BackgroundMotor vehicle crashes (MVC) are associated with diminished mental health, and furthermore, evidence suggests the process of claiming compensation following an MVC further increases distress and impedes recovery. However, further research is required on why the compensation process is stressful. The aim of the current study is twofold. The first is to investigate whether the interaction with the insurance agency is associated with anxiety. The second is to explore qualitatively aspects of dissatisfaction with the compensation process.MethodsParticipants (N = 417) were injured people involved in a compensation scheme after a motor vehicle crash (MVC) in New South Wales, Australia. Interviews were conducted by phone at 2, 12 and 24 months after the MVC. A suite of measures were used including compensation related measures, pain catastrophising and the anxiety/depressed mood subscale of the EuroQol. The association between predictors and anxiety/depressed mood as the dependent variable were analysed using forward logistic regression analyses. The comments about dissatisfaction with the insurance company were analysed qualitatively.ResultsThe strongest predictor of mood status found was pain-related catastrophising, followed by dissatisfaction with the insurance company. Dissatisfaction was attributed to (1) lack of communication and lack of information, (2) delayed or denied payments of compensation, (3) slow treatment approval and discussions about causality, (4) too much complicated paperwork, and (5) discussions about who was at-fault.ConclusionsFactors were found that contribute to anxiety in the compensation process. The association between catastrophising and anxiety/depressive mood suggests it is worthwhile further investigating the role of negative cognitions in compensation processes. People who score highly on catastrophising after the MVC may benefit from early psychological interventions aiming at addressing negative cognitions. Another important stressor is the interaction with the insurance company. Stress is associated with problems of communication, medical treatment, and claim settlement. This study additionally draws attention to some under recognised problems such as delayed payments. Pro-active claims management could address some of the identified issues, which could improve health of injured people after a MVC.

Exploring Lawyer-Client Interaction: A Qualitative Study of Positive Lawyer Characteristics

Personal injury victims involved in compensation processes have a worse recovery than those not involved in compensation processes. One predictor for worse recovery is lawyer engagement. As some people argue that this negative relation between lawyer engagement and recovery may be explained by lawyers’ attitude and communications to clients, it seems important to investigate lawyer–client interaction. Although procedural justice and therapeutic jurisprudence had previously discussed aspects relevant for lawyer–client interaction, the client’s perspective has been rather ignored and only few empirical studies have been conducted. In this qualitative study, 21 traffic accident victims were interviewed about their experiences with their lawyer. Five desirable characteristics for lawyers were identified: communication, empathy, decisiveness, independence, and expertise. Communication and empathy corresponded with aspects already discussed in literature, whereas decisiveness, independence and expertise had been addressed only marginally. Further qualitative and quantitative research is necessary to establish preferable lawyer characteristics and to investigate what would improve the well-being of personal injury victims during the claims settlement process.

De niet-financiële impact van schadetoebrenging en hoe daaraan tegemoet te komen. Over excuses, actieve schadeafwikkeling en procedurele rechtvaardigheid.

In deze bijdrage wordt verslag gedaan van een onderzoek dat in opdracht van het Personenschade Instituut van Verzekeraars (PIV) is verricht naar de baten, effectiviteit en methode van het bevorderen door verzekeraars van het aanbieden van excuses aan verkeersslachtoffers. Ingegaan wordt op de niet-financiele impact van schadetoebrenging en wat er voor mogelijkheden zijn om daaraan tegemoet te komen. Daarbij is niet alleen gekeken naar excuses door de veroorzaker van het verkeersongeval, maar ook naar wat verzekeraars zelf kunnen doen aan de omstandigheid dat verkeersslachtoffers door het ongeval en zijn gevolgen ook ‘rood staan op hun emotionele bankrekening’.

Can Money Symbolize Acknowledgment? How Victims' Relatives Perceive Monetary Awards for Their Emotional Harm.

Legal systems differ markedly on how they treat the emotional harm suffered by close family members of crime or accident victims. This paper reports the results of two empirical studies examining how citizens whose child, partner, or parent was killed or seriously injured as a result of violent crime or tort (secondary victims) perceive a monetary award for their own non-economic harm relating to the death or injury of their loved one. The objective of our research was to test the Dutch legislator’s assumption that a (modest) monetary award for secondary victims’ emotional harm can have a meaningful symbolic value by providing recognition and satisfaction. Until then, no compensation was available for such harm under Dutch law. In addition, we examined whether victims’ relatives preferred standardization or individuation in determining the amount of the award, how they evaluated the amount, and the manner in which such awards might be offered. In a first quantitative survey study conducted in the Netherlands, 726 secondary victims were asked for their evaluations of such awards for the emotional harm they suffered as a result of the death or injury of their family member. We also asked our representative sample about their actual experience of the legal process in order to put their evaluations of such awards into context. In a second qualitative study, conducted in Belgium, interviews were held with 14 secondary victims who had actually received an award for their own emotional harm under Belgian law (study 2). Results suggest that secondary victims regard an award for emotional harm as a positive gesture and may interpret it as helping to satisfy relatives’ psychological concerns by seeing it, for example, as an acknowledgment of loss and responsibility. Overall findings suggest that victims’ relatives may be seeking acknowledgement of their emotional losses and the norm violation.

De afwikkeling van medische schade onder de Wkkgz: De beloften van het klachtrecht voor patiënten, de eerste stappen naar verwezenlijking door de ziekenhuizen en de eerste verrichtingen van de Wkkgz-geschilleninstanties

De inwerkingtreding van de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) heeft grote gevolgen voor de afwikkeling van schadeclaims in de zorg. De belangrijkste blikvanger was tot dusver de laagdrempelige Geschilleninstantie die kan oordelen over schadevergoedingen tot een bedrag van 25.000 euro. Minder aandacht kreeg het schadebeoordelingstraject dat aan een eventueel geschil voorafgaat. Op grond van de Wkkgz zijn zorgaanbieders verplicht om een verzoek tot schadevergoeding zelf zorgvuldig te onderzoeken en te beoordelen, dat wil zeggen, conform de zorgvuldigheidsverplichtingen die gelden voor alle klachten in de zin van de Wkkgz, of die nu een financiele component bevatten of niet. Het maximum van 25.000 euro geldt hier niet, waardoor alle medische schadeclaims in dit traject terecht kunnen komen. Deze ruime verplichting heeft vergaande consequenties. In potentie wordt hiermee de afwikkeling van alle medische schadeclaims overgeheveld van het aansprakelijkheidsrecht naar het klachtrecht. Dat houdt weliswaar geen ander materieel schadevergoedingsrecht in – zoals we zullen zien is dat nog wel een punt van aandacht – maar wel een verandering van procedureel regime, namelijk van het reactieve en adversariele (op tegenspraak gerichte) aansprakelijkheidsrecht naar het proactieve en oplossingsgerichte klachtrecht. In theorie is dat goed nieuws voor patienten. Om dat te illustreren geven wij in dit artikel een schets van de aard van het klachtrecht en gaan wij in op de doelstellingen van de Wkkgz. Of de theorie ook praktijk wordt is uiteraard een tweede. Veel hangt af van de mate waarin de zorgaanbieders erin zullen slagen om de beloften van de Wkkgz daadwerkelijk te verwezenlijken. Ook daarover wat beschouwingen in dit artikel, waarbij wij ons om praktische redenen grotendeels zullen beperken tot de ziekenhuizen, alsmede een weergave van hetgeen bekend is over de verrichtingen van de Wkkgz-geschilleninstanties tot dusver. Vanwege de samenhang van de verschillende procedures in de zorg komt tenslotte ook het Wetsvoorstel tot wijziging van de Wet BIG kort aan de orde.

OPEN en eerlijke omgang met klachten en incidenten in de zorg Verslag van het eerste jaar van leernetwerk OPEN

Als er iets misgaat in de behandeling van een patient is het van groot belang dat daar door de zorgaanbieder openheid over wordt gegeven. Hoe dat het beste kan worden georganiseerd, wordt onderzocht in OPEN. OPEN is een leernetwerk waarin door onderzoekers en ziekenhuizen wordt samengewerkt om meer inzicht te verkrijgen in werkwijzen die openheid na medische incidenten kunnen bevorderen. In deze bijdrage wordt kort toegelicht wat OPEN als leernetwerk inhoudt. Vervolgens wordt uiteengezet wat de verplichtingen van het ziekenhuis inhouden als het misgaat en worden enkele begrippen uitgelegd. Daarna komt aan bod in hoeverre aan die verplichtingen wordt tegemoetgekomen en wordt toegelicht wat er op het niveau van patienten, zorgverleners en leidinggevenden georganiseerd moet worden voor een open en eerlijke omgang met incidenten in het ziekenhuis. (aut. ref.)

Causaliteitsonzekerheid bij informed consent. Beschouwingen naar aanleiding van Chester v. Afshar

SamenvattingDe plicht van de medische beroepsbeoefenaar tot het geven van informatie aan de patiënt is inmiddels stevig verankerd in de Nederlandse wetgeving en jurisprudentie.