Prognosis for people with back pain under a no-fault 24-hour-cover compensation scheme

Study Design. A retrospective descriptive casenote review of consecutive ba ck pain claimants assessing claim outcome at 12 months from onset. Objective. To assess prognosis for back pain claimants in a no-fault 24-hou r-cover accident compensation system. Background. New Zealand has a unique accident compensation system that may provide incentives for health professionals to classify people with backach e as having a back injury and incentives for back pain claimants to continu e claims longer than would be the case in other compensation systems. Methods. One hundred consecutive back pain claimants were identified from a single office of New Zealand's sole accident compensation insurer (Acciden t Rehabilitation and Compensation Insurance Corporation; ACC), who were sti ll receiving compensation payments 4 weeks after the initial date of the cl aim. The study end point was case closure in the subsequent 12 months. Case closure rate was analyzed in relation to several potential prognostic vari ables. Results. Of the 100 cases identified in which the claimant was receiving co mpensation 4 weeks from the initial date of the claim, 43 cases were not cl osed by 6 months, and 30 cases were not closed at 12 months. The Variable m ost strongly associated with case nonclosure was whether the claimant was r eceiving earnings-related compensation (equal to 80% of previous income), w ith 41% of this group still receiving compensation at 12 months verses 16% of the group not receiving earnings-related compensation (chi(2) = 8.55, P = 0.003). These results compare unfavorably with those from previous publis hed studies from The Netherlands and Jersey in the United Kingdom. Conclusion. New Zealand's unique accident compensation environment may disc ourage return to work for people with back pain. New Zealand legislators sh ould assess the impact of the ACC scheme on people with back pain, particul arly in light of the recent recommendations of the international Associatio n for the Study of Pain Task Force on Back Pain in the Workplace, that comp ensation cover for workers with back pain be limited to 6 weeks,