Expert Opinion: Whiplash - Care not cash is answer to fraud

The furore over whiplash is gathering pace, and we are assured by government that change is imminent.

The focus seems to be on driving out fraudulent or unfair claims, the assumption being that the vast majority of whiplash claims are at best opportunistic and could be removed by a more vigorous assessment process, coupled with an increased burden of proof on the injured.

But this misses the point. The potential introduction of an independent expert medical panel to assess whiplash, as backed by the second insurance summit with government ministers on 2 May, will not cure the problem.

Claims are being made because the process is easy and claimants can expect £1000 to £2000 in cash within a matter of weeks. The outcome is quick, certain and positive, which we know is the best system for influencing behaviour.

Improved diagnosis via ‘special' doctors is naive. It may make the positive outcome harder to achieve but it will add costs, bureaucracy and friction to what has become a very efficient process.

Introducing specially trained independent doctors is a retrograde step. It was not so long ago that whiplash claims were assessed by jointly approved consultant orthopaedic surgeons.

In the drive to save money and time, they were dropped in favour of GPs, whose reports have become of questionable value, especially since the introduction of pricing agreements, which has driven process efficiency at the expense of quality.

But it is unfair to criticise GPs - they are simply servants of a broken process, working within a system they have not designed. We do not need more skilled or unskilled doctors in the process. We may not need doctors at all.

Rehab data often ignored
Compare the standard GP interview - because it hardly merits the term ‘assessment' - with the data-rich rehabilitation process that offers far more ‘evidence' of the injury, and yet is systematically ignored by both sides.

During a typical course of treatment, a physiotherapist may spend four hours with the claimant over several weeks. They, unlike a GP, will physically assess the claimant's soft tissue injury, range of motion impairment and levels of pain. Compare this to the single, 15-minute snapshot available to a GP.

To underestimate the physiotherapist's skills in diagnosing and treating whiplash is to misunderstand whiplash. Yet many, including the Justice Secretary Ken Clarke, seem obsessed with up-skilling expensive doctors to do what physiotherapists are already perfectly adept at doing.

Whiplash as the ‘fraud of choice' reflects a system that rewards injury victims with cash and not care. As long as minor whiplash injuries are primarily compensated with cash payments they will remain subject to opportunistic claims and disputed medical evidence.

To tackle the problem we need major change, not minor tweaks. The concept of placing a cash value on injuries at this level can be removed - compensation is about restoration of the status quo.

For minor injuries, the victim should be given free access to whiplash treatment for the first six weeks post-accident along with recovery of out-of-pocket expenses. No solicitor needed.

Only if the injury fails to respond to treatment or requires more than a pre-defined cost of care, should the idea of financial compensation and representation be entertained.

If someone is not injured they will not take up the treatment offer; if they are, they will be helped to recover and that is their compensation.

This single step would remove the belief that whiplash equals £1500, no questions asked. It is lazy and counterproductive to buy off claims with cash.

Fundamentally flawed
Sadly, there exists a growing trend among insurers to make ‘pre-med' cash offers without medical evidence. Offers began in the hundreds but now routinely exceed the £1000 mark. I heard recently of a £25 000 pre-med offer which, much to the distaste of the claimant solicitor, was accepted by the client.

Such behaviour only fuels the ‘whip-cash' culture by rewarding low-level injuries with cash and encouraging claims.

Insurers add to demand with their own pre-med tactics, while the industry is routinely funding and then ignoring the high-quality robust evidence of musculoskeletal specialists to help value claims in favour of GPs, who are constrained by a broken process.

By focusing the process on ‘care not cash' we could take a big step towards changing society's view of personal injury claims.

Rehabilitation First Awards 2012 - open for entries
With preparations in full swing for the grand finale event on Friday 14 September, the new website for the Post Rehabilitation First Awards is now live and the categories are open for entry. Don't miss the new category for Unsung Rehab Champion introduced this year.

Entry deadline: Friday 29 June