Capita responds to MOJ consultation on whiplash
16th September 2013
“It should not be the job of a doctor to detect insurance fraud,” says Stuart Sheehy, managing director of medical reporting at Capita Health and wellbeing. “A doctor will not know whether a claimant is genuine or is making their fourth claim in four months.” The argument is part of Capita Health and wellbeing’s response to the Ministry of Justice consultation on reducing the number and costs of whiplash claims.
Mr Sheehy argues that although the current system has some flaws, it also has many benefits for insurers, claimants and law firms. With a number of quite minor improvements – not including, as the ABI suggests, a whole new mechanism of committees of vested parties – fraudulent whiplash claims could be tackled. These improvements would include:
- making it harder to commit fraud, by requiring an independent medical examination to be carried out before any claim is paid
- providing examining doctors with the circumstances of the claim rather than just the claimant’s account at the time of the assessment – whiplash is difficult to diagnose, and it would be easier for a doctor to judge whether it were likely if, for example, they knew that the accident had happened in a car park
- accrediting doctors to undertake medical assessments for the court, which may improve diagnoses (although many assessments are currently performed by NHS GPs, who see patients with such injuries in surgery frequently)
- basing compensation on loss of function and disability rather than on symptoms, no matter how minor – neck pain is open to exaggeration and difficult to disprove, so the claimant is currently given the benefit of the doubt, but basing the compensation on loss of function would be fairer, allowing a clearer tariff system for differing degrees of loss of function and allowing insurers to be clear in polices where whiplash injuries with less than, say, one month’s duration of loss of function were not covered.
He continues: “All personal injury medical assessments should be undertaken by medical experts who are suitably accredited and meet agreed minimum standards of experience, knowledge and expertise in assessing injuries and who understand the court’s requirements. The GMC revalidation process, along with accreditation, is the most robust process to ensure and validate competence and independence. In addition, doctors should be required to demonstrate their expertise and/or to undertake specific training and accreditation on the legal principles and the most up-to-date and relevant research on whiplash injuries.
“Capita has been working with other industry companies to develop a certification process for doctors that involves online training of doctors on the civil procedure rules and on all the latest research into whiplash. This material is mandatory for all our experts, and the online process makes it easy to demonstrate that doctors have completed the training. This material may form the basis of a wider industry standard.
“Through current technology, medical reports can be coded such that audits across a wide range of parameters, including prognosis periods, can be undertaken. This would enable electronic peer review of experts, providing feedback and challenge to experts whose results are consistently deviating from the average.
“We believe that in line with Lord Wolfe’s suggested protocols, reports should be instructed jointly by claimant and defendant and should be available to both sides simultaneously. Reports are available to all parties in a case, but there will no doubt be debate about the timing of the availability of the report to the at-fault insurer, particularly if the claimant wishes to challenge what has been written.
“Many medical reporting organisations currently adopt the standard form of report for simple injury claims, and this works very effectively. We believe that this should be mandatory.”Back