Accident Compensation Research Articles

Epidemiology of tendon and ligament injuries in Aotearoa/New Zealand between 2010 and 2016

BackgroundInjuries to tendons and ligaments make up a large portion of musculoskeletal injuries, and contribute to significant morbidity and healthcare costs. However, there is currently a poor understanding of the burden of these injuries at a population level.The purpose of this study was to quantify the burden and distribution of tendon and ligament injuries in the Aotearoa/New Zealand population.MethodsUsing the Accident Compensation Corporation (ACC, a no fault comprehensive compensation scheme encompassing all of Aotearoa/New Zealand; population in 2013 4.4 million) database, data specific to tendon and ligament injuries were identified between July 2010 and June 2016. The total number of claims made and the total cost of these claims per financial year were analyzed. Injuries were categorized by anatomical site, gender, ethnicity and age of the claimant.ResultsDuring the 6-year study period, the total number of tendon and ligament injury claims was 1,112,077, with a total cost of over $1.4 billion NZD. There was a 16.2% increase in the number of claims, and a 40% increase in the total cost of these injuries during this period.The majority of claims were made by people of European ethnicity, whilst the number of claims made by people of Asian ethnicity increased at the greatest rate; 52% (from 9047 claims in 2011) during the 6-year study period. Interestingly, Māori (Indigenous New Zealanders) maintained the highest average cost per claim ($1614.05 NZD); 13% more than the overall average cost per claim ($1262.12 NZD). The most common sites of injury were the shoulder and knee; these injuries were also the greatest contributors to overall cost. The total costs of injuries peaked in claimants aged 40–54, irrespective of the number of claims made for that age group.ConclusionsHealth and economic burdens of tendon and ligament injuries in Aotearoa/New Zealand are rising. The high healthcare costs underscore the urgent need for multifaceted interventions to reduce the incidence and improve clinical outcomes of tendon and ligament injuries.

Retrospective investigation on diagnostic process for benign asbestos pleural effusion (BAPE) using checklist.

ObjectivesIn Japan, benign asbestos pleural effusion (BAPE) has been eligible for industrial accident compensation since 2003 as an asbestos‐related disease despite the lack of good criteria. We compiled a criteria into a checklist of essential items and for excluding other diseases inducing pleural effusion as a diagnosis process.MethodThoracentesis was performed in order to confirm the presence of pleural effusion at the initial diagnosis, and 105 suspected BAPE patients were retrospectively examined. We complied a checklist comprising the following diagnostic items: (a) occupational asbestos exposure; (b) confirmation of exudate of pleural effusion; (c) exclusion of pleural effusion with malignant tumors based on negative results of CEA and hyaluronic acid, and cytology of pleural effusion; (d) exclusion of rheumatic, bacterial, and tuberculous pleuritis; (d) radiological findings for exclusion of malignancies; and (e) histopathological findings based on thoracoscopy that exclude malignancies (when thoracoscopy was not performed, there was confirmation that no malignancies were present during 3‐month follow‐up observation). Cases that satisfied all items were defined as BAPE.ResultsAmong the 105 suspected cases, there were five cases that had no occupational asbestos exposure; six cases in which transudate of on pleural effusion; one case each of rheumatoid pleuritis and tuberculous pleuritis; and five cases of pleural mesothelioma based on chest radiography and histopathological findings within 3 months after initial diagnosis. Therefore, we excluded 18 cases from the 105 candidates and determined 87 cases of BAPE.ConclusionWe consider that six items described above are suitable for diagnosing BAPE.

No-fault Law on Medical Accidents in Belgium: An Evaluation after Six Years

AbstractAfter many years of criticism of the medical malpractice system based on negligence, Belgium introduced a law on medical accidents in March 2010. This law created a Medical Accidents Fund. Under this two-track system the victim of a medical accident has the choice to file a claim before the court or to seek compensation from the Fund. The Law on Medical Accidents has four objectives: (1) to create a Fund with a simple and fast procedure that is cost-free to access, (2) to channel and centralise all medical accident claims to the Fund, and to develop a prevention strategy, (3) to compensate more victims by introducing a personal right to compensation for medical accident victims without the need to consider liability, and finally, (4) to achieve a balanced budget. A medical accident without liability can be defined as an accident caused by healthcare which does not lead to the liability of a caregiver, does not result from the patient’s health condition and causes abnormal damage to the patient. The damage is abnormal if it was not supposed to occur given the current state of scientific knowledge, the patient’s health condition and its objectively predictable evolution. Following analysis of the new law, this study shows that it has created a single, central point of contact that is easily accessible and generally understood by medical accident victims. On average fifty new cases a month are submitted to the Fund. In a reasonable number of cases to date, liability of the caregiver has been accepted by the Fund. However, the Fund is rather strict in awarding no-fault compensation for medical accidents without liability. It remains to be seen whether this interpretation can resist the test of judicial review.

A descriptive study of claims for occupational mental disorder: adjustment disorder.

BackgroundThe number of claims of Industrial Accidents Compensation Insurance (IACI) for mental illness has increased. In particular, the approval rate was higher in cases with confirmed incident circumstances such as adjustment disorder, acute stress disorder, and post-traumatic stress disorder. With increased numbers of filed IACI applications and their approval rates, the need to evaluate various work-related incidents and stressors consistently is also increasing.MethodIn January 2015–December 2017, among the cases of industrial accidents filed for mental illness and suicide by the Korea Workers' Compensation and Welfare Service, 76 filed or approved adjustment disorder cases were included. The cases of adjustment disorder were applied in this study to the “Criteria for Recognition of Mental Disorders by Psychological Loads” established in Japan in 2011 and investigated if cases were approved/rejected consistently. Additionally, features with the greatest influence on approval/rejection were examined quantitatively.ResultsThe number of applications more than doubled from 2015 to 2017, with the approval rate rising from 66.7% to 90.6%. Among the major categories, applications of adjustment disorder related to “interpersonal relationships” were the largest number of applications. Applications related to “sexual harassment”, “interpersonal relationships”, and “accidents and experiences including fires” showed relatively higher approval rate. The approval rate was the lowest in the case of “change in the amount and quality of work”.ConclusionsApproved cases tend to have special precedents and strong intensity. The main reasons for the rejection were that there were no special precedents and that the intensity of the case was weak. These 2 were the most important factors in determining approval/rejection.

Vehicle-Damage-Detection Segmentation Algorithm Based on Improved Mask RCNN

Traffic congestion due to vehicular accidents seriously affects normal travel, and accurate and effective mitigating measures and methods must be studied. To resolve traffic accident compensation problems quickly, a vehicle-damage-detection segmentation algorithm based on transfer learning and an improved mask regional convolutional neural network (Mask RCNN) is proposed in this paper. The experiment first collects car damage pictures for preprocessing and uses Labelme to make data set labels, which are divided into training sets and test sets. The residual network (ResNet) is optimized, and feature extraction is performed in combination with Feature Pyramid Network (FPN). Then, the proportion and threshold of the Anchor in the region proposal network (RPN) are adjusted. The spatial information of the feature map is preserved by bilinear interpolation in ROIAlign, and different weights are introduced in the loss function for different-scale targets. Finally, the results of self-made dedicated dataset training and testing show that the improved Mask RCNN has better Average Precision (AP) value, detection accuracy and masking accuracy, and improves the efficiency of solving traffic accident compensation problems.

"I couldn’t even do normal chores": a qualitative study of the impacts of injury for Māori

Aims To investigate the rehabilitation experiences of Māori who were still reporting disability 24 months after an injury resulting in hospitalisation. Methods Participants had been hospitalised for an Accident Compensation Corporation (New Zealand’s no-fault injury compensation insurer) entitlement claim injury between 2007 and 2009, and were experiencing disability 24 months post-injury. In-depth kanohi ki te kanohi (face-to-face) qualitative interviews with 12 participants aged between 37 and 71 years at the time of interviews were conducted. Interpretive analyses of interview transcripts, focused on the impacts of injury was conducted with the aid of NVivo software. Results The overarching theme identified during the analysis was “Impact” with four sub-themes of: Impact on daily life; Impact on relationships, Impact on employment; and, long-term or ongoing impacts. Conclusions For Māori living with disability 24 months after hospitalisation for injury, adjusting to life after the injury and the rehabilitation process was challenging. Participants discussed frustration with feeling dependent on others, being bored and feeling unfulfilled after their injury, and that many aspects of their lives were impacted on and not always in the expected directions. Many reported longer lasting impacts even after rehabilitation was completed. Implications for rehabilitation programmes e.g., strengthening programmes by taking into account issues discussed by participants, recognising the long-term impacts on both those injured and their whānau (family), and further investigations required are also discussed. IMPLICATIONS FOR REHABILITATION Disability after injury can have long term impacts for injured Māori and their relationships. Social impacts can be perceived as more debilitating than the physical impacts after injury. Experiences of employment changes and future prospects are often difficult to navigate for Māori returning to work after an injury.

Takaful Diat: Alternative Compensation Mechanism for Road Accidents in Malaysia

This paper seeks to assess the suitability of “Takaful Diat” taking over the definition of „aqilah (the group of people who share the blood-money liability of any one among them), and subsequently, becoming the feasible alternative in dealing with the complicated issue of road accidents compensation in Malaysia. The paper opted for a qualitative study where the authors discussed the concept of Diat (blood-money) and Takaful (Islamic insurance) from the opinions of the Muslim scholars from the various schools of thoughts. Based on the current situation, it can be argued that takaful insurance companies are more than capable of being the „aqilah so much so that the paper is convinced that they are the ones who capable of shouldering the responsibility. As such, the government needs to study a mechanism that could make such a contribution compulsory for every individual. Through Takaful Diat, the victims‟ welfare will be safeguarded. Takaful Diat provides protection through a specially designed insurance scheme that pays a victim with a specific amount of compensation which is determined by Syarak.

Risk Factors for Revision Anterior Cruciate Ligament Reconstruction and Frequency With Which Patients Change Surgeons.

Background:Revision surgery is a known complication after anterior cruciate ligament (ACL) reconstruction (ACLR), but the proportion of patients who seek a different surgeon for their revision procedure is unknown.Purpose:To determine the rate and risk factors for revision ACLR in New Zealand and to find the proportion of patients undergoing revision ACLR who see a different surgeon compared with their primary procedure as well as the factors that may influence this decision.Study Design:Case series; Level of evidence, 4.Methods:Data from New Zealand’s single government insurer, the Accident Compensation Corporation (ACC), were analyzed. All primary ACLR procedures performed between January 1, 2009, and December 31, 2014 were evaluated, and revision ACLR procedures performed between January 1, 2009, and December 31, 2016, were evaluated to allow for a minimum 2-year follow-up period. Cases undergoing subsequent revision were divided into those with the same or a different surgeon compared with the primary procedure. Risk factors for revision and change of surgeons were assessed, including age, sex, time from injury to surgery, time between primary and revision procedures, surgeon volume, and ethnicity.Results:A total of 15,212 primary ACLR procedures were recorded in 14,926 patients. The mean patient age was 29.2 years, and 61% were male patients. There were 676 subsequent revision procedures and 510 contralateral procedures during the study period, resulting in a 5-year survival rate of 95.5% for the ACL graft and 96.5% for the contralateral ACL. Risk factors for revision surgery included male sex, age <20 years, and <1 year from injury to surgery. Of the revision procedures, 44.5% (n = 301) were performed by a different surgeon compared with primary ACLR. For primary ACLR procedures performed by low-volume surgeons, 75.0% of patients requiring revision ACLR changed surgeons, compared with 21.5% for high-volume surgeons (≤10 vs >50 primary ACLR/y; hazard ratio, 10.70 [95% CI, 6.01-19.05]; P < .001). Other factors associated with change of surgeons included older age, longer time between primary and revision surgery, and Asian and Maori ethnicities.Conclusion:A significant proportion of patients change surgeons when requiring revision ACLR. In the absence of formal follow-up systems such as registries, surgeons, particularly those with a low volume of ACLRs, may underestimate their personal revision rate.

Trends in burden of work-related upper limb amputation in South Korea, 2004–2013: a nationwide retrospective cohort study

ObjectivesThis study aimed to measure the burden of work-related upper limb amputation in Korea over a 10-year period and assess its trend.DesignEcological study.SettingNational level data in Korea between 2004 and...

택시 운전자의 사망 및 위반에 관한 로지스틱 회귀분석

Objective: This research aims to analyze the occupational deaths and violation of the Korean taxi drivers and to find out the effect of factors for recommendations on injury prevention.BRBRBackground: Although there are many studies on traffic accidents, there are few studies on taxis, which are the main means of transportation. Moreover, There is little research on the industrial accidents of taxi drivers.BRBRMethod: The data of 586 taxi drivers approved as industrial accidents compensation of years 2015 and 2016 were analyzed. Significant variables explaining deaths and violation were identified by binary logistic regression.BRBRResults: Drivers aged 65 or older are more likely to die from accidents than those under 65 (OR (odds ratio): 1.85, p =0.048). In addition, violations were more likely to lead to death than no-violation (OR: 1.94, p =0.046). Facial injuries were more likely to lead to death (OR: 2.38, p =0.003) and encephalorrhagia injuries were more likely to lead to death (OR: 3.82, p 0.001).BRBRConclusion: In order to prevent accidents of the elderly drivers, it is necessary to reinforce safety education and to manage the driving license renewal cycles according to the ages. In addition, a system for integrated management of taxi transportation should be established to improve the working environment of older taxi drivers. Systematic approach is necessary to alert taxi drivers to the fatal consequences of traffic violations and to make them to comply with the traffic rules.BRBRApplication: The effects of the significant variables on deaths and violations can be used as a guideline to develop systematic measures for prevention of accidents for the taxi drivers.

A Retrospective on the Woodhouse Report: The Vision, the Performance and the Future

The following is a revised version of the second Woodhouse Memorial Lecture given at both the Victoria University of Wellington and the University of Auckland in September 2018. It traces the history and policy iterations of New Zealand's accident compensation scheme that flowed from the 1967 Woodhouse Report (the Report), a Royal Commission report chaired by Sir Owen Woodhouse. It discusses the features of the Report and the determination it showed to get rid of the common law action for damages for personal injury. It analyses the degree to which the Report was not followed in the journey it took through the political decision-making system. There is a critical analysis of the delivery of benefits, the administration of the scheme and its financing. The performance in accident prevention and rehabilitation is briefly covered. The method of settling disputes in the scheme has seen an unwelcome return to legalism. The lecture concludes with a strong plea to remove the anomalies created by the accident compensation scheme between the victims of accident who receive earnings related-benefit and those who are dealt with under the Social Security Act 2018 under which they receive flat rate benefits. The lecture concludes with some lessons for policymakers.

Regional healthcare costs and burden of injury associated with electric scooters

BackgroundThe introduction of shared electric scooters (e-scooters) to New Zealand has resulted in a large number of injuries. Within the past year, there have been studies addressing some of the impact of these e-scooter injuries, but none have included outpatient data or total regional costs. MethodsThis was a retrospective review of e-scooter associated injuries presenting to Auckland region healthcare providers in the seven months since their introduction using Accident Compensation Corporation (ACC) Claims data. The type of injuries and key metrics of their overall hospital burden were assessed between September 2018 and April 2019. The financial cost of these injuries was also estimated. ResultsA total of 770 patient presentations associated with e-scooters were identified during the study period. Of these, 524 (68.1%) were treated in the community by primary care physicians and 246 (31.9%) were treated in Auckland hospitals. The 246 hospital presentations used a total of 5,569 hospital bed-hours with 75 patients (30.5%) requiring admission and inpatient care. Of the hospital presentations, 49 patients (19.9%) required at least one operation, and 105 (42.7%) required specialist follow up care. 26.8% of injuries were thought to be associated with alcohol use. The estimated injury rate was 60 per 100,000 trips and hospital presentation rate was 20 per 100,000 trips. The combined cost attributable to these injuries was $608,843 (NZD) for Auckland City Hospital and $1,303,155 for the whole Auckland region. ConclusionsThe overall burden of care due to the introduction of e-scooters to New Zealand has had significant impact both on the primary urban trauma center as well as community care facilities. E-scooter related injuries have had a large impact on regional healthcare costs.

Towards a safer culture: implementing multidisciplinary simulation-based team training in New Zealand operating theatres - a framework analysis

AimNetworkZ is a simulation-based multidisciplinary team-training programme designed to enhance patient safety by improving communication and teamwork in operating theatres (OTs). In partnership with the Accident Compensation Corporation, its implementation...

Injury Risk in New Zealand Rugby Union: A Nationwide Study of Injury Insurance Claims from 2005 to 2017

ObjectivesThe Accident Compensation Corporation is a compulsory, 24-h, no-fault personal injury insurance scheme in New Zealand. The purpose of this large-scale retrospective cohort study was to use Accident Compensation Corporation records to provide information about rugby injury epidemiology in New Zealand, with a focus on describing differences in risk by age and gender.MethodsA total of 635,657 rugby injury claims were made to the Accident Compensation Corporation for players aged 5–40 years over the period 2005–2017. Information about player numbers and estimates of player exposure was obtained from New Zealand Rugby, the administrative organisation for rugby in New Zealand.ResultsOver three quarters of claims (76%) were for soft-tissue injuries, with 11% resulting from fractures or dislocations, 6.7% from lacerations, 3.1% from concussions and 2.0% from dental injuries. Body regions injured included shoulder (14%), knee (14%), wrist/hand (13%), neck/spine (13%), head/face (12%), leg (11%) and ankle (10%). The probability of a player making at least one injury claim in a season (expressed as a percentage) was calculated under the assumption that the incidence of claims follows a Poisson distribution. Players aged 5–6 years had a probability of making at least one claim per season of 1.0%, compared to 8.3% for players aged 7–12 years, 35% for age 13–17 years, 53% for age 18–20 years, 57% for age 21–30 years and 47% for age 31–40 years. The overall probability of making at least one claim per season across all age groups was 29%. The relative claim rate for adults (players aged 18 years and over) was 3.92 (90% confidence interval 3.90–3.94) times that of children. Ten percent of players were female, and they sustained 6% of the injuries. Overall, the relative claim rate for female players was 0.57 times that of male players (90% confidence interval 0.56–0.58). The relative claim rate of female to male players tended to increase with age. There were very few female players aged over 30 years; however, those who did play had higher claim rates than male players of the same age group (1.49; 90% confidence interval 1.45–1.53).ConclusionsInjuries resulting from rugby are distributed across the body, and most of the claims are for soft-tissue injuries. Rates of injury increase rapidly through the teenage years until the early 20 s; for male players they then decrease until the mid-30 s. For female players, the injury rate does not decrease as players move into their 30 s. Combining Accident Compensation Corporation injury claim data with national player registration data provides useful information about the risks faced by New Zealand’s community rugby players, and the insights derived are used in the development of rugby injury prevention programme content.

The Link between Physical and Mental Injury: A Redundant Paradigm for Determining Compensation under the Accident Compensation Act

There is currently an inequitable gap in compensation under the Accident Compensation Act, whereby claimants who suffer from a mental injury after an accident but not a physical injury cannot get compensation. The purpose of this paper is to consider this gap in compensation by analysing a recent High Court Judgment, W v Accident Compensation. In this case, Collins J recognises that sometimes we will not always be able to establish a direct causal link between a physical and mental injury. However, that does not mean that we should not provide cover. Whilst Collins J’s judgment is aligned with current evidence around the causes of mental injury, this paper outlines the issues associated with such a policy change coming from the courts. Instead, this paper proposes that a legislative change is required to extend mental injury compensation to those that have suffered a mental injury from being in an accident, regardless of whether they also suffered a physical injury.

Invisible Consequences: The Health Hazards of "Women's Work" in New Zealand

Gordon Anderson has written extensively on the changes in New Zealand's labour laws that have occurred since the late 1960s, and the consequences of these changes for workers. This period saw the narrowing and individualising of work health and safety, the separation of health and safety from other areas of employment relations and the workers' compensation functions of the Accident Compensation Corporation (ACC) scheme. This article explores one of the largely invisible consequences of these shifts, arguing that gaps have emerged between these areas of law, and these gaps fall disproportionately over the types of work that women typically perform. This article outlines the current gaps in the law and identifies the areas in need of reform.

A Retrospective on the Woodhouse Report: The Vision, the Performance and the Future

The following is a revised version of the second Woodhouse Memorial Lecture given at both the Victoria University of Wellington and the University of Auckland in September 2018. It traces the history and policy iterations of New Zealand's accident compensation scheme that flowed from the 1967 Woodhouse Report (the Report), a Royal Commission report chaired by Sir Owen Woodhouse. It discusses the features of the Report and the determination it showed to get rid of the common law action for damages for personal injury. It analyses the degree to which the Report was not followed in the journey it took through the political decision-making system. There is a critical analysis of the delivery of benefits, the administration of the scheme and its financing. The performance in accident prevention and rehabilitation is briefly covered. The method of settling disputes in the scheme has seen an unwelcome return to legalism. The lecture concludes with a strong plea to remove the anomalies created by the accident compensation scheme between the vicitims of accident who receive earnings related-benefit and those who are dealt with under the Social Security Act 2018 under which they receive flat rate benefits. The lecture concludes with some lessons for policymakers.

Liability Determination of School Sports Injury Accidents: An Analysis Framework Based on Evolutionary Game.

In recent years, the outbreak of many school sports injury accidents aroused widespread public concern about liability determination of accident. Previous studies have examined the legal application of the liability principles from a law perspective, but few kinds of research attempted to analyze the progress of liability determination from the perspective of “law economics”. To fill this research gap, we introduce the evolutionary game model, as an important theoretical tool of “law economics”, to investigate how various factors influence the strategy selection of the parties, as well as examine what liability principle can effectively treat school sports injury accidents. The results indicate that the strategic selection of the subject of liability is significantly related to the accident compensation cost and the prevention cost of both parties. Moreover, we also find that both strict and proportional liability rules can play key roles in dealing with the issue of liability determination of school sports injury accidents, but the two liability rules have different effects on the strategic selection of parties. More specifically, compared to the strict liability principle, the proportional liability principle can motivate both the school and the students to adopt the active strategy of “appropriate caution” to prevent occurring sports injury accidents in schools.

Marked increase in the incidence of anterior cruciate ligament reconstructions in young females in New Zealand.

Anterior cruciate ligament injuries cause significant morbidity, and may be increasing in incidence as participation in high-risk sports increases. The aim of this study is to investigate the incidence of anterior cruciate ligament reconstruction (ACLR) surgery in New Zealand, and to analyse changes over time in demographic subgroups. Data were sourced from the Accident Compensation Corporation. Data relating to primary ACLRs performed from 2009 to 2016 were evaluated (n = 20 751). Baseline population estimates were obtained from national census data to calculate the incidence, and results were compared to previous data from 2000 to 2005 (n = 7375). The annual incidence of ACLR for 2009-2016 was 58.2 per 100 000 person-years and was greater in males than in females (72.2 and 44.9, respectively). This represents a 58% increase when compared with the period 2000-2005 (36.9 per 100 000). The greatest increase was seen in females aged 15-19 years, with the incidence increasing by 120% in the last decade, compared with 53% in females aged 20-24 years. The percentage of injuries caused by sports changed from 65% over 2000-2005 to 76% over 2009-2016, with netball, rugby and football accounting for the highest number of injuries. The incidence of ACLR procedures has increased markedly in New Zealand, and this increase was most pronounced in females aged 15-19 years. A greater proportion of procedures are now due to sport-related injuries.

Compensation for air transport accidents

Compensation is the effect of liability, which means, the penalty for breach of an obligation. When the liability of the air carrier is realized, the damage is incurred in the event of physical damage to the passenger (safety obligation), loss, damage or loss of goods or baggage Registered) and the delay in the implementation of the air transport contract. Compensation is estimated to the extent of damage according to the general rules of the Civil Code, but in the field of air transport the legislator has departed from this rule, having set a maximum compensation for the carrier responsible, In charging the carrier with liability for the entire damage (unlimited liability), the carrier may lead to the abyss of bankruptcy, thus depriving the carrier of its work in this important economic facility, while the international legislator did not neglect the passenger or shipper, as did not allow the derogation from the ceiling set by International agreements, so as to find a balance between the parties to the contract of carriage. The international legislator has endeavored to maintain the limited liability of the air carrier as long as it is good faith, but when it becomes ill-intentioned it becomes liable for the full damage and does not benefit from limited liability, and if the parties agree that compensation for the full damage is possible, because it does not contravene the public order.