Information Alert and Call To Action

Insurers claim to be near breakthrough in their battle against whiplash fraud.  Here are the headlines.....

Thatcham, a British company that conducts research on crashes for insurance companies, expects to produce "court admissible" whiplash research to help insurers fend off “fraudulent” whiplash injury claims by the end of next year.

Matthew Avery, head of research at Thatcham, claims "This evidence will enable insurers to produce scientifically based risk ratio evidence illustrating the likelihood of a person being injured in a particular crash." He said that insurers will then be able to decide whether or not to refute a personal injury claim.

The work is part of an international insurance program involving insurers from Sweden, Germany and Switzerland. Thatcham has also enlisted the help of the legal profession, including a number of judges and law firms to ensure that the evidence is admissible in court. Click here to read the article

A SIF analysis of the claims made in the article indicates that the proposed “research” is yet another insurer-financed effort to draw a “bright line” injury threshold so that insurers can deny injury claims with minimal thought or effort, regardless of whether or not injury is present.

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Can 'Proxy For Injury' Impact Crash Victim Care?

We (Dr. Centeno and myself) are quite familiar with the research that is referred to in this article. The concept discussed in the article of a proxy for injury, in which some gauge of whether an injury has really resulted from a collision is used in place of a physician determination of injury causation, has been around since the mid-1990’s, with Allstate’s Minor Impact Soft Tissue program in which they denied injury whenever vehicle damage was less than $1000. While it is an appealing theory for insurers who are always mindful of their bottom line, it cannot reach the threshold for admissibility in court, at least not in United States courts. Click here for MIST paper

The reason for this is that an injury proxy is only as good as its false positive rate, and this makes the entire effort a complete waste of time. What I mean by this is as follows: the insurers behind this scheme are looking for some measurement of neck injury forces based on vehicle speed change and seat design that will allow them to predict injury risk. If speed change and seat design were the only factors that comprised risk for whiplash injury then this would be a good system, however this is not the case.

Individual susceptibility to injury is by far the largest predictor of injury presence following a low speed collision, and this is something that no system can accurately predict in any individual since there is no way to know where this threshold is until it is crossed. The proposed system would ignore physical evidence of injury in favor of the assumption that an injury “shouldn’t have happened” in spite of medical evidence to the contrary. The general claim in the article to justify the program, that whiplash injury is totally subjective, is completely false, and ignores reams of published clinical science from the past 15 years.

To come back to the issue of false positives; any test for injury that ignores physician evidence of injury will be wrong in every case where an injury has occurred below some threshold and no fraud is present. There is no evidence that whiplash injury fraud is rampant; it is likely in the 2-5% range, like other types of insurance fraud. (the circular reasoning that fraud levels are high because there are so many injury claims where there is minimal vehicle damage is clearly not valid as the authors of the article admit that they have not completed their search for a reliable whiplash injury criterion).

If fraudulent claims constitute only 2-5% of claims, then 95-98% of injured claimants will be wrongfully accused of committing fraud when they file a claim for injury and the crash force falls below the arbitrary injury threshold (95-98% false positive rate for this supposed “test” for injury). The proposed system is a violation of the essence of civil justice, which is that an allegation of a crime (fraud) must be supported by reliable evidence that is applied appropriately in the circumstances of a particular case.

The proposed system is an affront to the science of epidemiology and medicine, and SIF will do everything that we can to help illustrate this fact. It would be far more responsible for the insurers behind this story to spend their research dollars on mandating improved seat designs and evaluating better ways to reduce injury frequency rather than on this pernicious scheme to defraud crash injury victims.

Michael D Freeman PhD MPH DC
Forensic Epidemiologist

"Science is simply common sense at its best; that is, rigidly accurate in observation and merciless to fallacy in logic."

Thomas Henry Huxley (1825-1895)

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