Experiences of pathways, outcomes and choice after severe traumatic brain injury under no-fault versus fault-based motor accident insurance

Abstract

Primary objective: To explore experiences of pathways, outcomes and choice after motor vehicle accident (MVA) acquired severe traumatic brain injury (sTBI) under fault-based vs no-fault motor accident insurance (MAI).

Methods: In-depth qualitative interviews with 10 adults with sTBI and 17 family members examined experiences of pathways, outcomes and choice and how these were shaped by both compensable status and interactions with service providers and service funders under a no-fault and a fault-based MAI scheme. Participants were sampled to provide variation in compensable status, injury severity, time post-injury and metropolitan vs regional residency. Interviews were recorded, transcribed and thematically analysed to identify dominant themes under each scheme.

Results: Dominant themes emerging under the no-fault scheme included: (a) rehabilitation-focused pathways; (b) a sense of security; and (c) bounded choices. Dominant themes under the fault-based scheme included: (a) resource-rationed pathways; (b) pressured lives; and (c) unknown choices. Participants under the no-fault scheme experienced superior access to specialist rehabilitation services, greater surety of support and more choice over how rehabilitation and life-time care needs were met.

Conclusions: This study provides valuable insights into individual experiences under fault-based vs no-fault MAI. Implications for an injury insurance scheme design to optimize pathways, outcomes and choice after sTBI are discussed.

• Automobile insurance
• compensation
• family outcome
• lifetime care
• motor accident insurance
• motor vehicle accident
• no-fault insurance
• outcome
• road traffic accident
• traumatic brain injury

Acknowledgements

The research reported in this article was completed as a discrete project within a broader 3-year Australian Research Council Linkage Project—Financing and Management of Lifetime Care for Adults with Acquired Disabilities and High Care Needs. The collaborating partners were: The University of Queensland, the Motor Accident Insurance Commission (MAIC) and the Public Trustee of Queensland.

Declaration of interest

The Motor Accident Insurance Commission (MAIC) acts as the government regulator of the Queensland CTP scheme and provides insurance coverage to persons injured by drivers of unregistered or unidentified vehicles in Queensland via the Nominal Defendant. Proposed 'no-fault' reforms to the Queensland CTP scheme are likely to have financial impacts on MAIC if implemented, though the direction and nature of these impacts remains unclear. Although MAIC contributed financially to the overarching ARC Linkage project related to this study, the authors alone are responsible for the content and writing of the paper.