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Tackling the whiplash epidemic

Physios could be sidelined under government proposals to create medical panels to review claims from people who say they have sustained whiplash injuries. Helen Mooney reports

The government hopes its latest plans to reduce the number of whiplash claims in England and Wales, which have been blamed for rising car insurance rates, will herald results.

Justice secretary Chris Grayling launched a three-month consultation on the new proposals in December which the government says will make it easier for insurers to challenge such claims following traffic accidents.

The plans include setting up independent medical panels to assess the validity of whiplash cases.

Unveiling his proposals, Mr Grayling hit out at the current system under which he said honest drivers had been paying for the abuse of fraudsters for too long.

‘We are proposing action to support effective whiplash diagnosis by medical experts and to simplify procedures which will help bring speculative or fraudulent claims before a judge – so genuine claims can still be settled but fraudsters are left in no doubt there will be no more easy paydays.’

The government’s action was prompted by figures showing there had been a 60 per cent increase in personal injury claims relating to road accidents since 2006, despite a 20 per cent fall in reported accidents.

An estimated 1,500 whiplash claims are made in the UK every day.

Insurers say the claims cost them £2bn a year, equivalent to adding £90 to every vehicle’s insurance policy.

Under the plans, medical panels would aim to ensure that genuine cases went ahead while exaggerated, misrepresented or fraudulent ones were robustly challenged.

The panels would be unconnected to the claimant or claims management companies.

Ministers also want options to allow more whiplash cases to be challenged in small claims courts in an attempt, they say, to change the current position where it can be cheaper for insurance companies to accept questionable claims than to contest them.

The insurance industry has lobbied hard for the government to make such changes.

James Dalton, head of motor and liability at the Association of British Insurers, has repeatedly claimed that the country is in the middle of a ‘whiplash epidemic’ and branded the UK the ‘whiplash capital of Europe’.

He said: ‘For too long, whiplash has been seen as the “fraud of choice”. Our roads are safer, yet every day over 1,500 whiplash claims are made.

‘More effective diagnosis of whiplash will help genuine claimants get paid out quickly and reduce the scope for fraud, so helping to ensure that honest motorists do not end up footing the bill for the cheats through higher insurance premiums.’

Following a meeting with insurers last year, prime minister David Cameron agreed that the government had to help ‘sort out the legal issues’.

‘Some steps have been taken by insurance companies already in terms of referral fees, [and] there’s quite a lot of space for individual action – personal responsibility, not making false claims – so I think there’s a whole set of issues and if we work together we can actually deliver,’ he said. 

Physios could be ‘washed out’ of the system

Insurers are also calling for the adoption of measures similar to those already in place in Germany where there is a 10km per hour (6.25 miles per hour) threshold for whiplash claims.

Drivers in Germany also have to obtain two medical opinions to diagnose the injury.

However, physiotherapists are concerned that the new plans could mean that they are not elected to the new medical panels.

‘My concern is that physiotherapists are going to be washed out of this, and that the government will be recreating the wheel, that is my gut feeling,’ warns Martin Doherty, a chartered physiotherapist and medico-legal expert based in Bournemouth.

‘I worry that what they will do is just create a whole new accreditation process but still end up using the same doctors and orthopaedic surgeons, who already carry out whiplash assessments, on these panels,’ he says.

Physiotherapy whiplash specialist Christian Worsfold agrees.

‘I regularly make presentations on medico-injury reporting to lawyers and there is a lot of resistance to instructing physios to assess whiplash, the preference is definitely medical.  

‘Physiotherapists are perfect for this kind of work but people don’t seem to recognise this.’

Chris Mercer, a musculoskeletal physiotherapy specialist and outgoing chair of the Musculoskeletal Association of Chartered Physiotherapists, is concerned that the government’s consultation document makes very little mention of any other specialists other than medics making up the independent medical panels.

‘These will probably be orthopaedic surgeons and there is no place for orthopaedic surgery in treating whiplash.

Specialist physiotherapists should be on these panels, and I would argue that they are better placed than doctors to do these assessments because physiotherapists know the rounder picture including the psychosocial effects of whiplash.’

Whiplash exists ‘on a spectrum’

In January 2012 a report by the Commons Transport Select Committee recommended that the government should bring forward primary legislation to require objective evidence – both of a whiplash injury and of it having a significant effect on the claimant’s life – before compensation is paid.

Most physiotherapists agree that whiplash injury, or whiplash associated disorder, does exist but admit that there are psychosocial factors in UK society which are in some cases is exacerbating the problem.

Mr Worsfold says that he sees whiplash as a ‘spectrum’ along which patients can be placed.

‘There are the criminal gangs crashing cars to defraud and they are very organised and criminal.

Then there are people putting the brakes on to cause an accident, and others who might be exaggerating their injury – whether consciously or unconsciously for attention from family and friends and for financial gain.

‘However, my experience suggests that there is a good percentage of people who really do suffer following whiplash injury.’

Identifing genuine problems

According to Mr Worsfold, one person in five with a whiplash injury experiences a  high level of pain.

These people are really restricted in terms of activities of daily living such as concentrating, reading, sleeping postures and driving.’

Roger Kerry, associate professor of physiotherapy education at the University of Nottingham agrees.

He says that while whiplash is not a ‘clear cut’ issue, most of the problems in terms of fraudulent claims arise from intermediary ‘no-win no-fee’ companies.

Although he agrees there are a small proportion of fraudulent claimants, he reckons they are ‘probably less one per cent’.

‘Any skilled physiotherapist would be able to identify quickly through examination if there is a genuine problem or not,’ Mr Kerry adds.

It remains to be seen what will emerge from the government’s consultation, and for whiplash, as with many other areas of medicine, diagnosis and treatment is not black and white.  

There is, however, a strong case to be made for physiotherapists to be at the front of the queue when it comes to assessing patients who have sustained a suspected whiplash injury.

And as Léonie Dawson from CSP’s Practice and Development Function points out, timely physio provision could resolve many of the symptoms of whiplash.

‘We could even end up saving patients – and insurers – money if we intervene early on.’

The CSP encourages members to respond to the consultation before 8 March.

See: https://consult.justice.gov.uk/digital-communications/reducing-number-cost-whiplash.

The Society’s response will be on the website by the end of January. fl.

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