Wilson Carswell examines the number of personal injury claims following motor accidents that are made in the UK and asks if the figures add up.
Why is the number of personal injury claims so much higher in the UK? This specific question is set to be debated by a panel of experts next week at Post's motor claims conference — and it is an entirely legitimate one.
Motor insurers with access to very accurate claims data point to the increasing number of PI claims they have had to deal with in recent years. They also point to the well-documented, statistically significant and progressive fall in the number of people killed or seriously injured in road accidents in the UK, as well as corresponding falls in the numbers of slightly injured casualties (see graph, top right).
If casualties are becoming fewer while the number of PI claims increases, then surely more of those involved in accidents are making claims. This leads naturally to the assumption that there is a growing compensation culture, one that has wafted eastwards from the US to the general detriment of UK motor insurers.
However, the statistics suggest things may not be quite as clear cut as that.
The figure of falling casualty numbers is based on analysis of data collected by the police attending road accidents. Since 1949 the police have been assiduously compiling an elaborate form going by the jaunty title of Stats 19. This has provided a wealth of information and has supported a series of road safety measures over the years. The Stats 19 forms categorise casualties as people killed, seriously injured or slightly injured. This equates to approximately 220 000 per year — although limited information is available about the extent of those injuries.
The Stats 19 data seems to be particularly reliable for estimating road accident fatalities as its figures closely match registered road deaths over the years. However, as you may have surmised, there is a 'but' coming.
In two situations, there is no need to call the police after an accident. First, if no one is injured. Second, if the drivers involved exchange insurance details, names and addresses, details of vehicle ownership and registration numbers (www.dft.gov.uk/collisionreporting/Law/default.asp). However, as the police do not attend all accidents, even those that are reported, Stats 19 data has never claimed to provide a comprehensive picture of road accident casualties.
Another — more recent — source of the estimate of injuries in road accidents is the Hospital Episode Statistics in England and corresponding data from Scotland and Wales. HES record the number of people who are admitted to hospital as inpatients after accidents, but not those that attend A&E Units and not subsequently admitted. Nor does it include those who only consult their own doctor.
As mentioned earlier, Stats 19 show a decline over time of seriously injured casualties. Conversely, HES data shows a rise in road traffic casualty admissions (see graph, above). There are a number of different explanations for this time-related variation in trend — with one graph going down, and the other up.
More recently A&E data on road accident casualty attendances has also been recorded although the statistical treatment — and hence utility of this data — is still in its development stage.
There is yet another source for estimated numbers of road accident casualties. This is the National Travel Survey — a well-established and designed statistical survey which interviews around 18 000 adults every year. In 2007, it added questions about road accidents for the first time. Those initial two years of data are now available and the survey provides an indication of the number of casualties not known to the police or to hospitals.
According to the most recent NTS survey, about one in 25 respondents stated that they had been injured in a road accident in the past three years. This is approximately three times higher than the data derived from Stats 19 for the same time period. But the two data sets are not directly comparable.
Using the data from the NTS 2007/2008, the central estimate of all non-fatal road casualties for the UK is 800 000 a year, with a lower estimate of 680 000 and upper estimate of 920 000 (95% confidence limits).
Collating all the data from Stats 19, HES and NTS 2007/2008, a best picture of the annual number of road accidents in the UK can be generated (see diagram, bottom left). The Department for Transport's Reported Road Casualties Great Britain: 2008 suggests that "there are many more casualties — maybe half of the total — that do not become known to either police or hospitals".
Furthermore, all three data sets only estimate physical injuries associated with road accidents. As Mayou et al made clear some years ago in 2002, significant psychological injuries (post-traumatic stress disorder and travel anxiety) can happen after road accidents in the absence of physical injury. Were psychological injuries to be added to the 800 000 estimated physical injuries, the annual toll of road accident casualties in the UK may be close to a million people a year.
Even with all the available data, it is difficult to estimate with any certainty the number of road accident casualties. In time, increasing resources put into data sets will improve the reliability of estimates. Meanwhile, does it matter if we don't know how many people are injured on the roads? A pragmatic position is that it is irrelevant — as long as those injured are appropriately treated. However, health economists, planners and motor insurance decision makers do need to know the actual number with some certainty and will doubtless encourage data set collectors in this endeavour.
A small by-product of this uncertainty is the question of the existence of a compensation culture. Perhaps the number of those injured in road accidents is actually rising year-on-year and the proportion of injured persons making claims to motor insurers is constant. Then the compensation culture would be based on a statistical artefact using only Stats 19 as a data source. The answer to the question posed at the beginning of this article — 'why is the number of personal injury claims so much higher in the UK?' — might be 'because there are more personal injuries'. The definitive answer will only be found when more comprehensive data becomes available.
Dr Wilson Carswell is medical director at Moving Minds
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