Cultural Differences and Whiplash claims
Studies have shown the importance of cultural factors in the differing presentations of whiplash, contrasting outcomes after accidents in different countries. Thus, far better recovery from equivalent accidents when whiplash is involved, have been reported in Lithuania than in Canada or North America.
Most whiplash injuries resolve completely or almost completely. Sometimes symptoms last only a week or two; others resolve over 18 months to two years. A proportion do not resolve and become what is described as “late whiplash syndrome”. These are the claims that present real problems to the lawyers for claimant and defendant.
As there are rarely any clinical signs which can be seen and investigated, it is not uncommon for doctors, particularly those advising the defendant, to deny that the claimant has any significant condition or symptom, or to argue that the symptoms the claimant claims are not related to the accident and are imagined or exaggerated.
The extreme example of this opinion is to deny that late whiplash syndrome exists at all, or to say that it is very rare. Research published in 1996 by H Schrader of the Department of Neurology, University Hospital, Trondheim sought to argue this. The research was carried out in Lithuania. It was argued that, because there is no system of compensation for road traffic injury there, that factor could be excluded. The conclusion was that . . . chronic symptoms were not usually caused by the car accident. Expectation of disability, a family history and attribution of pre-existing symptoms to the trauma may be more important determinates for the evolution of the late whiplash syndrome.
The research took two groups: 202 from the records of the police department in Kaunas, Lithuania who had been involved in rear end collisions and a control group of similar size selected randomly from the same place, but age and sex matched. The figures are surprising. For instance, 71 per cent of the accident and 67 per cent of the control group reported neck pain and 53 per cent of the accident victims reported headache with 50 per cent of the control group reporting the same. The researchers pointed out a correlation between the reported incidence of chronic neck pain in the population of Finland (11 per cent) and Norway (14 per cent) and those reported by the accident group (10 per cent) and the control group (8 per cent).
However it was argued that there were many fundamental flaws with the research such as the definition of the symptoms, the method of selecting the two groups, and various other fundamental errors in the research were raised. It was pointed out, for instance, that the rates of chronic neck pain found in Norway had been variously shown in other studies as between as high as 58 per cent and as low as 12 per cent.
Whilst compensation neurosis is a recognised phenomenon it cannot be argued that whiplash does not exist as a condition, or that it is mainly a result of malingering or exaggeration. That would be to accept that a substantial number of clients have persistently and successfully been untruthful with the lawyers involved and with one or more, often several, doctors. In addition, if the condition is mainly exaggerated or made up, it would be expected that the majority of clients alleging whiplash symptoms would recover, or appear to recover, when the litigation is completed. That does not seem to be the case . In addition, studies have shown that there is no significant relationship between psychological problems following neck injury and proceedings to recover damages . Finally, the existence of the condition in general, and in particular cases, is confirmed by a substantial body of experienced medical practitioners.
Perhaps different expectations can lead to different experiences for people of different cultures, and to substantially different levels of “real”, rather than consciously exaggerated, symptoms. Those expectations, varying between cultures, have been linked with labelling through diagnosis, opportunity for monetary compensation, and attribution . The same writers suggested that psychosocial factors will tend to affect both the way an accident victim will behave after the initial injury, and how they perceive, report and attribute pain arising. They have proposed that a diagnosis of whiplash may lead an individual to expect chronic pain and disability in itself. However, it has been suggested that it is very difficult for a malingerer to fake a psychological profile typical of a whiplash patient.
Tags: claimant, defendant, department of neurology, schrader, trondheim, whiplash injuries, whiplash syndrome
