Follow-up studies of personal injury litigants

Abstract

The term “post accident syndrome” is but one of a wide variety of labels which have been applied to those injured in industrial and motor car accidents, who may go on to develop an apparent psychological disturbance when the physical injuries which may have been minor to start with appear to have been resolved. In my view the phrase “personal injury litigants” is preferable as a descriptive term which has no diagnostic pretensions. In reviewing the literature dealing with both clinical aspects and outcome studies of personal injury litigants it becomes very quickly apparent that it is a nosological quaqmire, with a profusion of terms used to describe the patients. Authors using these terms tend to imply that these are clinical diagnoses, yet in no study does there appear any attempt to establish the diagnostic validity of these terms. The wide variety of terms used by different authors is illustrated in Table 1. This wide usage is one of the difficulties in reviewing studies of personal injury litigants: furthermore, authors often use terms which are idiosyncratic, inclusion and/or exclusion criteria are not defined, duration of followup may not be stated, and the outcome variables are usually different and illdefined. The majority of studies of personal injury litigants published in the past 20 years refer to Henry Miller’s study (i961). In this influential paper Miller set out five propositions, which are summarised in Table 2. These propositions have been repeated frequently, both in the medico-legal literature and in courts of law. However, research since 1961 has indicated that Miller’s views have not been supported by results of other studies of personal injury litigants; nevertheless, opinions based on Miller’s work continue to be expressed. It is to the fifth of Miller’s propositions that this discussion is addressed: what happens to personal injury litigants after their claim is finalized? In a discussion on traumatic neurasthenia and litigation neurosis, PurvesStewart (1928) referred to 17 patients diagnosed as showing “compensation hysteria”. On follow-up he was succesful in tracing only seven of these patients: six had recovered within a short period of time and returned to work, while the seventh received a pension for some years. When the pension was terminated, he also resumed work. A different result was reported by Denker (1939). In a group of 15 patients who received a lump-sum settlement, seven showed “a distinctly favorable