Professional Documents
Culture Documents
Arno Akkermans
Nieke Elbers
Kiliaan van Wees
Amsterdam Interdisciplinary Centre for Law and Health
Presentation outline
Patients
Slachtoffers
Welzijn
en
Recovery
herstel
Patients
receiving
Slachtoffers
in een
letselschadeafwikkeling
compensation
Time
Tijd
Quantitative studies
Poorer health and vocational outcomes of all kinds of injury
E.g. meta-analysis of outcomes after surgery of 211 studies: odds of
unsatisfactory outcome 3.79 time higher (Harris et al. 2005)
Compensation often found to be the strongest predictor of poor
health outcomes
Compensation a significant predictor of health care utilisation
(e.g. Harris et al. 2009)
Quantitative studies
Long term outcomes (functional outcome, return to work) up to 2 times
worse (Gabbe et al. 2007)
Lawyer involvement strong predictor of longer duration, poor
outcomes, higher costs and health care utilisation (injury severity controlled for)
(e.g. Bernacki & Tao, 2008)
Caveat: although the weight of the evidence points clearly in the same direction, not all studies find
these effects, almost all are observational, their quality and evidential power varies (e.g. Grant &
Studdert, 2010), more research is needed, and in particular: more sophisticated designs.
Explanatory theories
Secondary Gain
Being involved in compensation creates a (generally unconscious) incentive to
remain unwell
Secondary Victimisation
Being involved in compensation is a stressful and aggravating experience,
giving rise to renewed victimisation
(Schatman 2009)
Therapeutic jurisprudence
Study of therapeutic and anti-therapeutic effects of law, legal procedure and roles
of legal professionals
Procedural justice
Therapeutic jurisprudence
Lawyers should not only look at legal soft spots (areas that can lead to future
legal trouble) but should also consider psycho-legal soft spots (areas in which
legal interventions or procedures may lead to anxiety, distress, depression, hard
and hurt feelings, etc.)
Communication
Positive:
Being listened to, taken seriously, responding to issues client has put
forward
Information about what was going to happen and what to expect
Negative:
Communication one-sided, comments ignored
Being left in the dark, not having a step-by-step overview
Clear preference for face-to-face contact
Forwarded letters should be accompanied by explanation
Even when nothing was happening, a call once in two months was
considered proper frequency of contact
Empathy
Empathy
Empathy
Decisiveness
Interviewees valued an active, decisive lawyer, so that they could part
with their claim, being confident that their interests were represented
Many participants were burdened by the fact that they had to keep
their lawyer on his toes
For several participants, lack of decisiveness was the reason that their
case stagnated for an unacceptably long time. For some of them, lack
of decisiveness was a reason to switch lawyer
Some lawyers were not only passive, the even put (too) much work in
the clients hands
Decisiveness
Some complained that their lawyer was only active in sending bills:
He was a money-grabber. (...) He was a profiteer that did little or
nothing. () [The lawyer] asked whether the letters that I wrote in
response to the letters of <the insurance company> could be
forwarded in entirety, because they were satisfactory and were
good enough. In the beginning, it felt like an honour of course.
Meanwhile, I thought he was building a case, but he was doing
nothing. He only sent the letters back and forth and billed his hours
on this.
They just want money, money, money (...) You became a source
of income for the lawyer, and they dont like to lose that. They take
the longest road and not the shortest road.
Decisiveness
However, when it came to the actual settlement of the claim, some
participants were of the opinion that their lawyer acted too decisively
Independence
Lawyers who seemed to be too friendly and even dependent upon
the insurance company, were an important source of frustration
[up to 98% of all personal injury cases are settled out of court, and PI
lawyers are repeat players in negotiations with the same insurance
companies]
Some participants were very enraged that their lawyer did not want to
rub up the insurance company in the wrong way. They found that
their lawyer did not put himself enough in the service of the client
Independence
Independence
I cannot prove it, but I am one-hundred percent sure that an
agreement was already been made between <lawyer> and <the
insurance company>. That was obvious. An agreement had just been
made: we will go for that amount, and thats done. That is being told
to me on the phone, literally. Otherwise, it will take very long. (...) The
interests of the insurance company were taken care of. They wanted
to pay as little as possible, so that both insurers could hold money in
the pockets. One time <the lawyer> helps <the insurance company>
and the other time they help in reverse. As simple as that. It was as
plain as a pikestaff. Therefore, I am not prepared to settle anymore.
(...) The whole personal injury is one big boil of corruption. Its a big
corrupt nightmare.
Expertise
Experience as a lawyer in general or as a PI lawyer in specific was
found to be a topic of discussion
A client who's lawyer had failed to explain what costs were taken into
account in the calculation of the compensation, had lost his confidence
in his lawyers expertise
Some participants noted that their lawyer did not have enough legal
experience and organizational skills to bring the claims settlement to a
successful conclusion
Expertise
Expertise
He surprised us one day before the trial. He said that the court might
say something about rehabilitation. That is our weakness, he said.
Then I thought to myself: why did not you say that earlier? Then
maybe we could have worked on that. No, we heard one day in
advance that this is the case. We did not stand a chance of course.
Expertise
Accuracy was also an element on which lawyers were judged whether
they were capable lawyers or not
Some participants lost the confidence that the lawyer was able to
settle the case, because the lawyer was a terrible scatterbrain who
made an incredible mess of his paperwork, or because the lawyer
made careless mistakes in the correspondence
Expertise
Same letters with different dates. Whats that? Then you get a bit
annoyed. (...) At some point, we lost confidence. We were not
really taken seriously in that respect. (...) The calculations he had
made, we really thought: how dare you! Even I can see that it is
wrong. Then I am ashamed.
Discussion
Communication: also mode (face-to-face) and frequency are important
Involvement: some do not want to be involved to much, but prefer the
lawyer to be in control => involving should be tailor-made
Empathy: appears to be more important in the beginning of claims
settlement process than later on. Probably:
- victims are psychologically vulnerable especially in the first months after
the accident, a period in which they need practical help, information and
support, and they want to talk about their experience in an attempt to
reconstruct the event and to regain a sense of control
- some victims first need to recover from the psychological and physical
trauma before they will be able to cope with the claim settlement process
Discussion
Decisiveness: fact that decisiveness has not been mentioned in literature
seems remarkable. Long duration is one of the largest burdens.
According to participants, the lawyer can contribute significantly in
delaying or progressing the compensation process
Enhancing decisiveness and better communication about what is going
on and time frames, seem to be important strategies
Independence: has hardly been discussed in lawyer-client literature, yet
was of significant importance to participants. Lawyers should find
convincing ways to deal with this issue
Discussion
Expertise: surprising finding.
Never discussed in lawyer-client literature, and we did not expect that
clients would be able to estimate legal skills of their lawyer
Through aspects like accuracy, explanation and decisiveness, some
clients were able to get what appeared to be quite an accurate picture of
the expertise of their lawyer
Perceived expertise strongly influenced client satisfaction
Discussion
Modest study confirming existing theories and finding new points of
interest for attention in the domain of client-centered lawyering
Limited generalizability: adversarial tort system, traffic accidents
Relevant for legal education, skill training, lawyer evaluation mechanisms,
PR efforts of PI lawyers (e.g. get the maximum award)
Discussion
Further research: use of established doctor-patient research methods to
gain similar insights in patient satisfaction, recall of information,
compliance to advice, quality of life, and of health, develop models of
empathic communication and construct a reliable measure of quality of
care
Client-empowerment. So far, interventions for enhancing lawyer-client
relationship have focussed on the lawyer. Interventions could also be
focussed on the client. Empowerment interventions, increasingly via the
Internet (e-Health) are found to enhance self efficacy and mastery,
improve knowledge and behavioural outcomes, reduce health problems,
and diminish depression and anxiety