This book aims to consider in some detail the range of issues that may arise unexpectedly from the ordinary processes of compensation law. It is divided into several parts. There is an Introduction, then a section on current shortcomings of personal injury compensation systems. Part III concerns apologies, and Part IV considers the responsibilities of lawyers.
A.Some Current Shortcomings of Personal Injury Compensation Systems
Part II starts with Chapter 2, âAchieving Justice in Personal Injury Compensation: The Need to Address the Emotional Dimensions of Suffering a Wrongâ by Arno Akkermans. He outlines the psychological consequences of suffering a wrong and the ensuing emotional and moral needs of personal injury victims, and argues that compensation procedures generally fail to address these needs but instead often exacerbate them, leading to the experience of injustice and considerably increasing the risk of secondary victimisation. As a growing body of evidence suggests that perceived injustice plays a central role as a predictor of worse health and recovery outcomes, this failure is not only problematic from a justice point of view, but should also be addressed to mitigate the anti-therapeutic effects of compensation procedures. Akkermans submits that these issues go beyond the differences between fault-based and no-fault compensation regimes, and elaborates on possibilities to make claims resolution psychologically more responsive and intelligent regardless of what kind of system is involved, fault-based or no-fault. He identifies adversarialism as a common noxious element, and suggests proactive claims resolution as an antidote, and changing the roles in the game by having assessments carried out by neutral third parties as the most thorough countermeasure. Other suggestions are to provide a broader scope of services than monetary compensation only, to promote personal contact between those involved in the harm-causing incident, and to promote restorative and procedural justice.
The point of view of a medical researcher considering the relationship between compensation and health is taken in Chapter 3, âCompensation and Healthâ by Ian Cameron. He discusses an extensive range of the literature on the subject, setting out the approach taken by the World Health Organization and its sub-organisations. He notes that it is well known that participation in injury compensation schemes may be associated with limited recovery after injuries sustained in motor accidents and other settings. He discusses the empirical data which suggest that this is likely to be a causal relationship rather than a mere correlation. In his chapter he synthesises the findings of all available Compensation Health Research and considers the mechanisms which may underlie the negative effects. Cameron concludes that health and recovery after injury can be improved by appropriate injury insurance scheme design, and suggests some possible useful interventions.
Alex Collieâs Chapter 4, âApples, Oranges and Bananasâ considers a range of Australian compensation schemes from the standpoint of psychology, drawing on a number of empirical studies which show that aspects of the particular design of a compensation scheme really matter to the outcome for the claimant and that no-fault schemes appear to produce superior health or recovery outcomes compared with fault-based schemes. His investigation considers the individual within the context of the complex social system we all live in. Work disability is affected by all the interactions in this social system and the âcontrolâ in the system may be highly dispersed or not in an expected place. This can make the relatively simple analyses which are envisaged by the legal system wholly inadequate. The rapid rate of change of legislation in Australiaâs workersâ compensation systems contributes to a situation which is extremely complex. The chapter reports the results of a major study of participants in workersâ compensation schemes across Australia. The results themselves show that often the changes to workersâ compensation schemes suffer from a lack of understanding of the extent of the complexity involved and may not achieve the correct goals, or only one of a multiple number of goals â for example, reducing costs as a goal is quite often achieved, but it is often at the expense of rehabilitation or return to work, despite legislative attempts to do both. The research summarised in this chapter suggests that there is substantial scope to improve workersâ compensation schemes through more effective practices and policy settings, leading to better health outcomes and significant economic and productivity gains.
Katherine Lippel, Ellen MacEachen and Sonja Senthanar in Chapter 5, âWorkersâ Compensation in Canada: Experiences of Precariously Employed Workers in the return to Work Process after Injuryâ bring us a view from Canada of workersâ compensation schemes across different provinces. They discuss the experiences of precariously employed workers in the return to work process after injury, which is an interesting comparison to Alex Collieâs chapter on Australian workersâ compensation systems and return to work patterns. In Canada each province has its own workersâ compensation system. They compare the systems in Quebec and Ontario which differ in relation to the requirements for return to work. In Quebec the employer has the right but no obligation to offer modified work, whereas in Ontario both parties are required to cooperate so that theoretically an employer could be penalised for failing to offer work (although this appears to rarely happen). In Ontario much litigation occurs in relation to the modified work process. Particular aspects of each regime give rise to obvious differences in what happens to workers. For example, in Quebec, benefits are higher than those in Ontario, which meant that sometimes it was not worthwhile for claimants in Ontario to make a claim for what would be a very low benefit. For Quebecois claimants benefits are higher and last longer than in Ontario and this gives the Quebec employer a clear incentive to take the worker back. The picture is extremely complex, which is part of the problem: lawyers may not know who is entitled without extensive investigation in Ontario, workers may be confused, and complex systems may allow employers to duck their obligations, or indeed may create a situation where they are not able to understand their obligations. Lippel et al find that the economic incentives in both systems seem to become finalities in themselves, regardless of the aims of the workersâ compensation system itself.
What happens to lump sum compensation when the plaintiff spends their money on housing? In Chapter 6, âSafe as Houses? Lump Sum Dissipation and Housingâ, Kylie Burns and Ros Harrington look at this aspect of the effects of lump sum dissipation, This is a very common way for people to use a lump sum, but it is very likely to lead to the person having insufficient resources to manage ordinary living and as many of these people are denied social security, they may become destitute. The authorsâ research involved a detailed study of the impact of spending lump sums on housing by analysis of social security appeal cases in the Administrative Appeals Tribunal in Australia. They first critique the justifications for lump sum damages, showing how seriously impeded these are by social security rules of various kinds. Lawyersâ support for lump sum damages should not be dismissed as (entirely) self-interested â many factors create the desire for lump sums, including peopleâs sense of autonomy and the wish to be free of unwarranted state interference. These are also reasons people spend money on housing. Burns and Harrington show that the social security response to people doing this is to argue that they are âdouble-dippingâ because their lump sum was supposed to be used for income support and spending on housing is characterised as not income support. This narrow characterisation ignores the cultural and emotional value of housing and the fact that income is often ultimately spent on housing.
Chapter 7 is by Christopher Hodges. It is entitled âAchieving a Just Culture that Learns and Improvesâ and it tackles a number of the barriers to open justice in relation to compensation law, particularly in relation to medical malpractice. Hodges regards this as a situation where there are two clashing institutional cultures: the medical and legal systems. The legal system is focused on individual wrongs, and deals with those after the event, often on the (wrong) assumption that this will deter poor behaviour in future, while the medical system is a systems culture where things may go wrong not because of one individual, but because of the nature of the system and where investigation of the system is more often what is required. Hodges discusses the evidence of what patients want and various approaches from NHS and other systems, and from behavioural sciences to argue where the possibilities of creating a culture that actually learns from its mistakes might lie. His analysis makes clear that both a fault-based system and an adversarial process present strong barriers both to openness of clinical staff with patients about what happened and why, and to medical learning so that future mishaps can be avoided on a wide scale. Hodges submits that âfault and adversarial systems are old technologyâ, and discusses more efficient mechanisms for delivering compensation to those who qualify, and for delivering further functions, especially caring responses, explanations and apologies, aggregating data on adverse events and feeding back information on how to improve both practice and culture in healthcare. He concludes that the traditional legal system is incapable of delivering these objectives.