No fault compensation schemes do not affect surgery outcomes


According to a study by Alexander Montgomery, Barts and the London Hospital, London, UK, and colleagues, patients who receive compensation through the New Zealand Accident Compensation Corporation’s “no fault” scheme do not have significantly worse outcomes compared with patients who do not receive compensation.

Montgomery, who presented the study at BASS, explained that studies have shown that patients who receive workers’ compensation have significantly worse functional outcomes following lumbar fusion surgery than patients who do not receive workers’ compensation. He said that workers’ compensation schemes “rewarded injury” and that the claimant had to prove that they were injured as a result of their employers’ negligence. However, he added that New Zealand, via the Accident Compensation Corporation (ACC), had an alternative “no fault” and universal approach that covered work and non-work injuries.

Montgomery explained: “It removes the right to sue for personal injury. It uses a system of earnings-related compensation and pays at a rate of 80% of the patient pre-injury’s earnings.”

The aim of the new study was to compare outcomes following lumbar fusion surgery in patients who received workers’ compensation with outcomes in patients who received ACC compensation. For the first part of the study, Montgomery et al searched for studies (on Medline, Embase, and the Cochrane controlled trials register) that compared lumbar fusion surgery outcomes in workers’ compensation patients with those of patients who did not receive workers’ compensation. They identified 11 studies that met their criteria and found that, in most of these studies, patients who received workers compensation had significantly worse outcomes following lumbar fusion surgery than patients who did not receive workers’ compensation.

The second part of Montgomery et al’s study was a prospective review of 390 New Zealand patients, 47% of whom had received ACC compensation, who had undergone fusion surgery. They found that in the long term, there were no significant differences in functional outcomes between patients who received compensation and those who did not. Additionally, there were no differences between compensation patients and non-compensation patients in SF-12 physical component scores or in SF-12 mental component scores.  

Montgomery concluded: “The question is can you achieve good outcomes following lumbar fusion surgery in compensation patients? Yes, you can, but it is related to the type of compensation system in place.”

Co-author of the study, Peter Robertson (orthopaedic surgeon, the Orthopaedic Clinic, Mercy Specialist Centre, Auckland, New Zealand) told Spinal News International that there are several reasons why patients who receive traditional workers’compensation schemes tend to have worse outcomes after surgery than patients who do not receive compensation. He said: “Compensation is unpredictable, often requiring drawn out legal proceedings. Any eventual payment is delayed with major financial and psychosocial consequences. The patients have to prove disability to get payments in some circumstances. This is a clear disincentive to recovery and return to normality. The need to sue an employer results in a very confrontational situation between the injured and the employer, and the early involvement of lawyers is a very negative factor in relation to outcomes after injury.”

Robertson added that although the ACC system appeared to be beneficial, it was controversial. He explained: “The removal of the right to sue is a major issue. The lawyers do not like this or the [ACC] system in general—but then it has pushed them very much out of the picture!”