Abstract
How best to compensate claimants injured in a motor vehicle accident (MVA) has been a well-debated topic for decades. Proponents of a no-fault system argue that an at-fault system is too adversarial, costly, and unresponsive in access to health care benefits, and can result in a prolonged recovery for claimants. In contrast, a no-fault system, which provides benefits to claimants regardless of fault, is viewed as more equitable and efficient and therefore fosters a better recovery. Proponents of an at-fault system, however, highlight that claimants in a no-fault system have access to only a portion of benefits they need for full restitution of their injuries to be realized. Because full restitution reflects an important societal value, and is achieved by suing an at-fault party, an at-fault system should therefore be preserved. This study compares differences between at-fault and no-fault MVA systems and between claimants with mild TBI as compared to moderate/severe TBI on measures of adversarialness, cost, responsiveness and recovery. Data from documents contained within claims files for each type of system, and by two participating MVA insurance companies in Alberta, Canada, was analysed using a mixed methods approach. Significant differences were found between: (1) at-fault and no-fault systems on measures of adversarialness and cost, both were higher in the at-fault system; and (2) mild and moderate/severe TBI groups on measures of cost and recovery, both were higher and longer, respectively, for the moderate/severe TBI group. A subsequent analysis was conducted using a four-phased claims management process: accident/fault investigation, medical/rehabilitation, claims administration, and dispute resolution phase, to identify significant key factors (and key players who participated to address these key factors) within each of these phases. The purpose was to help explain the quantitative results from the first part of the study. One of the conclusions drawn was that higher cost was significantly associated with the type of health care a claimant accessed as part of the medical/rehabilitation phase. The thesis concludes with a discussion of implications of the results as they bear on MVA claims management practices for claimants with a TBI from an MVA.
