Genevieve Meredyth Grant

Compensation seeking and disability after injury: the role of compensation-related stress and mental health.

OBJECTIVE Claiming for compensation after injury is associated with poor health outcomes. This study examined the degree to which compensation-related stress predicts long-term disability and the mental health factors that contribute to this relationship. METHOD In a longitudinal, multisite cohort study, 332 injury patients (who claimed for compensation) recruited from April 2004 to February 2006 were assessed during hospitalization and at 3 and 72 months after injury. Posttraumatic stress, depression, and anxiety symptoms (using the Mini-International Neuropsychiatric Interview) were assessed at 3 months; compensation-related stress and disability levels (using the World Health Organization Disability Assessment Schedule II) were assessed at 72 months. RESULTS A significant direct relationship was found between levels of compensation-related stress and levels of long-term disability (β = 0.35, P < .001). Three-month posttraumatic stress symptoms had a significant relationship with compensation-related stress (β = 0.29, P < .001) as did 3-month depression symptoms (β = 0.39, P < .001), but 3-month anxiety symptoms did not. A significant indirect relationship was found for posttraumatic stress symptoms and disability via compensation stress (β = 0.099, P = .001) and for depression and disability via compensation stress (β = 0.136, P < .001). CONCLUSIONS Stress associated with seeking compensation is significantly related to long-term disability. Posttraumatic stress and depression symptoms increase the perception of stress associated with the claims process, which in turn is related to higher levels of long-term disability. Early interventions targeting those at risk for compensation-related stress may decrease long-term costs for compensation schemes.

Gender, health and the law: opportunities and challenges for reform

The theme of this Special Issue of the Griffith Law Review is Gender, Health and Law, with a focus on the intersection between women’s health and the law. Law may be used as a vehicle for promoting and protecting women’s health. For example, in Australia, the Family Law Act 1975 (Cth) established the principle of no-fault divorce in Australian law; meaning that a court does not consider which partner was at fault in the event of a marriage breakdown. This legal development was significant for women’s health because it meant that women in abusive relationships could divorce their spouses without having to ‘prove’ the existence of such abuse. Following on from the introduction of ‘no-fault divorce’ came the gradual criminalisation of rape in marriage, culminating in the seminal 1991 High Court decision of R v L in which the court confirmed that the ‘marital rape exemption’ was no longer a part of Australian law and that a husband may be prosecuted for raping his wife. In light of the damaging effects that rape may have on women’s physical and mental health, the criminalisation of rape in marriage represented a tangible example of law responding to concerns for women’s health and wellbeing. Accordingly, in Australia the law has developed in some ways so as to recognise, promote and protect women’s health. At the same time as aspects of the law have improved from a gendered perspective, it is important to recognise that law can operate as a vehicle for undermining women’s health. This can happen in a number of ways. Increasingly, for instance, we understand that the law – and legal processes – have a stigmatising potential. As Paula Baron has recently argued, ‘there is a growing awareness [... ] of the ways in which law may contribute to, or seek to protect against, stigma’. For example, abortion is still a crime in many Australian jurisdictions. And while it may be arguable that despite remaining part of the criminal law, abortion is nevertheless widely accessible (at least for urban women seeking a first trimester abortion), the fact remains that the criminalisation of abortion exacerbates the

Judging gender in tort thresholds

ABSTRACT Compensation system design and judgments in individual cases reflect the painful losses law recognises, and those it discounts or ignores. Thirty years ago, Reg Graycar’s pioneering research highlighted the gendered nature of injury damages assessment, including the differential treatment of women’s work. Since that time, the tort threshold – a less visible but increasingly significant technology of injury assessment – has become entrenched in Australian injury law. Tort thresholds set a required level of injury or loss that must be demonstrated before an injured person can seek damages. They require judges to determine whether a claimant’s injury is sufficiently serious to merit legal recognition. Through content analysis of judges’ threshold decisions in the Victorian transport accident compensation system, this article explores the treatment of injury impacts on plaintiffs’ paid work and unpaid domestic and care work. It illustrates that the gendered assumptions of tort and damages law continue to influence the categories of injury impacts that are valued by law.

Development of prediction models of stress and long-term disability among claimants to injury compensation systems: a cohort study

Objectives We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury. Design Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury. Setting Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia. Participants 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers’ compensation scheme. Primary outcome measures 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey. Results Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R2=0.37) and calibration. The disability risk score had a score range of 0–180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0–220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes. Conclusions The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions.