Murgatroyd Darnel, Lockwood Keri, Garth Belinda, Cameron Ian D
John Walsh Centre for Rehabilitation Research, Kolling Institute, The University of Sydney, Sydney, NSW, Australia.
BMC Public Health. 2015 Apr 25;15:423. doi: 10.1186/s12889-015-1739-9.
The evidence that compensation related factors are associated with poor recovery is substantial but these measures are generic and do not consider the complexity of scheme design. The objectives of this study were to understand people's perceptions and experiences of the claims process after sustaining a compensable injury in a motor vehicle crash (including why people seek legal representation); and to explore ways to assist people following a compensable injury and improve their experience with the claims process.
A qualitative study in a Compulsory Third Party (CTP) personal injury scheme covering the state of New South Wales (NSW), Australia. A series of five focus groups, with a total of 32 participants who had sustained mild to moderate injuries in a motor vehicle crash, were conducted from May to June 2011 with four to eight attendees in each group. These were audio-recorded and transcribed. The methodology was based on a grounded theory approach using thematic analysis and constant comparison to generate coding categories for themes. Data saturation was reached. Analyst triangulation was used to ensure credibility of the results.
Five primary themes were identified: complexity of the claims process; requirement of legal representation; injury recovery expectations; importance of timely healthcare decision making; and improvements for injury recovery. Some participants struggled, finding the claims process stressful and subsequently sought legal advice; whilst others reported a straight forward recovery, helpful insurer interactions and no legal representation. Most participants were influenced by injury recovery expectations, and timely healthcare decision making. To assist with injury recovery, access to objective information about the claims process using online technology and social media was considered paramount.
Participants had contrasting injury recovery experiences and their perceptions of the claims process differed and were influenced by injury recovery expectations, and timeliness of healthcare decision making. Improvements to the claims process are required, including: simplification or streamlining (possibly using online technology and/or social media to reduce paperwork); and providing access to objective information. There is a need to trial early interventions and new claims management policies that could improve injury recovery and satisfaction with the claims process.
有大量证据表明，与赔偿相关的因素与恢复不佳有关，但这些措施是通用的，没有考虑到方案设计的复杂性。本研究的目的是了解人们在机动车碰撞中遭受可赔偿伤害后对索赔过程的看法和经历（包括人们寻求法律代表的原因）；并探索帮助受伤人员并改善他们索赔过程体验的方法。
在澳大利亚新南威尔士州（NSW）的强制第三方（CTP）人身伤害计划中进行了一项定性研究。2011年5月至6月，开展了一系列五个焦点小组，共有32名在机动车碰撞中受轻度至中度伤害的参与者，每组有四至八名参与者。对这些进行了录音和转录。该方法基于扎根理论方法，使用主题分析和持续比较来生成主题的编码类别。达到了数据饱和。使用分析三角验证法来确保结果的可信度。
确定了五个主要主题：索赔过程的复杂性；法律代表的要求；伤害恢复期望；及时进行医疗决策的重要性；以及改善伤害恢复。一些参与者感到困难，认为索赔过程压力很大，随后寻求法律建议；而另一些人则报告恢复顺利、保险公司互动有益且无需法律代表。大多数参与者受到伤害恢复期望和及时医疗决策的影响。为了帮助伤害恢复，使用在线技术和社交媒体获取有关索赔过程的客观信息被认为至关重要。
参与者的伤害恢复经历各不相同，他们对索赔过程的看法也不同，并且受到伤害恢复期望和医疗决策及时性的影响。需要改进索赔过程，包括：简化或精简（可能使用在线技术和/或社交媒体以减少文书工作）；以及提供获取客观信息的途径。有必要试验早期干预措施和新的索赔管理政策，以改善伤害恢复情况和对索赔过程的满意度。
