Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury.

Background and Methods: The incidence and prognosis of whiplash injury from motor vehicle collisions may be related to eligibility for compensation fo r pain and suffering. On January 1, 1995, the tort-compensation system for traffic injuries, which included payments for pain and suffering, in Saskat chewan, Canada, was changed to a no-fault system, which did not include suc h payments. To determine whether this change was associated with a decrease in claims and improved recovery after whiplash injury, we studied a popula tion-based cohort of persons who filed insurance claims for traffic injurie s between July 1, 1994, and December 31, 1995. Results: Of 9006 potentially eligible claimants, 7462 (83 percent) met our criteria for whiplash injury. The six-month cumulative incidence of claims was 417 per 100,000 persons in the last six months of the tort system, as c ompared with 302 and 296 per 100,000, respectively, in the first and second six-month periods of the no-fault system. The incidence of claims was high er for women than for men in each period; the incidence decreased by 43 per cent for men and by 15 percent for women between the tort period and the tw o no-fault periods combined. The median time from the date of injury to the closure of a claim decreased from 433 days (95 percent confidence interval , 409 to 457) to 194 days (95 percent confidence interval, 182 to 206) and 203 days (95 percent confidence interval, 193 to 213), respectively. The in tensity of neck pain, the level of physical functioning, and the presence o r absence of depressive symptoms were strongly associated with the time to claim closure in both systems. Conclusions: The elimination of compensation for pain and suffering is asso ciated with a decreased incidence and improved prognosis of whiplash injury . (N Engl J Med 2000;342:1179-86.) (C) 2000, Massachusetts Medical Society.