Changing insurance company claims handling processes improves some outcomes for people injured in road traffic crashes

Schaafsma, Frederieke; De Wolf, Annelies; Kayaian, Areen; Cameron, Ian D. · 2012 · OpenAlex-citations

DOI: 10.1186/1471-2458-12-36

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Summary

This study evaluated whether modifying insurance claims handling processes improves health and functional outcomes for individuals injured in road traffic crashes. Motivated by evidence that claims management approaches influence recovery rates, the research compared a novel "Health Recovery Consultant" (HRC) model against standard claims processing within NRMA Insurance in New South Wales, Australia. The intervention aimed to enhance recovery through early intervention, risk screening, evidence-based management, and a focus on returning to work and usual activities. The study employed a prospective design involving 345 eligible claimants who filed Accident Notification Forms within 28 days of injury. Participants were assigned to either the intervention group, managed by consultants trained in injury management or allied health who spent approximately 50% more time per claim, or a control group managed by standard injury claims consultants. Data were collected via surveys at baseline (one month post-injury) and at seven months post-injury. Outcomes measured included health status using the Medical Outcomes Survey Short Form-12 (SF-12), anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), return to work, and return to usual activities. Statistical analyses included GLM repeated measures and logistic regression to assess group differences and predictors of outcomes. Among the 186 participants analyzed at seven months, the intervention group demonstrated significantly better outcomes in specific domains. There were significant differences in the "caseness" of depression (p = 0.04), perceived health limitation on activities (p = 0.03), and self-reported return to usual activities (p = 0.01), with the intervention group scoring favorably. While both groups showed high return-to-work rates (over 95% by seven months), the intervention group had a significantly higher rate of returning to usual activities (81% vs. 60%, p = 0.01). Regression analysis identified baseline general health as a strong predictor for both general health at seven months (OR 11.6) and return to usual activities (OR 4.6). Additionally, having a claim with an economic loss component and expecting a longer duration for return to usual activities were associated with poorer outcomes. The findings suggest that a claims handling approach emphasizing early intervention, clear communication, and health-focused support can improve specific health and functional outcomes for traffic crash victims. The study concludes that targeting individuals who report low general health or low expectations for recovery at the time of claim filing may maximize the effectiveness of such interventions. These results support the integration of health outcome information and proactive management strategies into insurance claims processes to facilitate faster recovery and reduce long-term disability.

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• demographic disparities