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John Quintner’s point of view

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I’m forever searching for a decent explanation as to why the AMA Guidelines used to assess injured workers in the WorkCover system are so poor and out of date, especially when it comes to assessing chronic pain (and in my case of pudendal neuralgia measures a total score of 0!!).

Along my social media travels, searching for answers and researching for treatment or updated information regarding my condition, I have met John and had the pleasure of some great discussions. Dr John Quintner is a consultant physician in rheumatology and pain medicine and has kindly offered to share his published opinion on the matter. Thanks John!

Here’s an excerpt, or download the full pdf document.

Personal injury compensation: lessons from Talmudic law

People claiming or entitled to monetary compensation for personal injury tend to have poorer health outcomes overall than those with  comparable injuries when compensation is not an issue.1

This article examines some of the principles upon which our personal injury compensation systems are based, in order to better understand why the process of tort litigation has itself become such a major factor in healthcare in modern societies.

In attempting to explain this phenomenon, researchers have implicated a large number of psychosocial factors, but have not found any readily isolated causes. Moreover, it is not understood how the various factors might operate in individual cases.2

That the legal process itself can adversely affect the health of those litigating for personal injury compensation has long been known. As Sir John Collie, the famous British medical examiner, observed in 1932:

‘Litigation magnifies pain, perpetuates incapacity and introspection; and subjective sensations are unwittingly fostered.’3

More recently, Nortin Hadler, Professor of Medicine in North Carolina, has reiterated the negative impact of the interaction between injured people and compensation systems.4 He stated a truism: ‘[A]nyone who has to prove that he or she is ill cannot get better. In fact, they can only get more disabled; any other option will compromise their veracity.’5

THE TALMUD

A detailed exposition of the principles of compensation for injury can be found in the Talmud, which spans a period from 200 BCE to 700 CE, during which time the oral tradition of the Jewish people (the Mishnah) was committed to writing by generations of sages. The sages looked upon the law as an expression of the life of man, not merely abstract theory.

TALMUDIC LAWThe Talmud consists of 63 chapters within six categorisations. Tractate Baba Kamma (first gate) deals with Nezikim, or civil and criminal law. The laws regarding torts and damages are to be found in Chapter 8.6 The Mishnah says [83b] that:

‘One who injures a fellow man becomes liable to him for five items: for damages (depreciation), for pain, for healing, for loss of time and for degradation (indignity).’7

The Talmud explains that five was the maximum number of items that could be considered by the court. An individual case may not necessarily require compensation under all items.

Depreciation

When determining depreciation for injuries resulting in loss of a limb, loss of an eye, or a fracture, the injured person was assessed as if he or she were a slave on sale in the open market place. A valuation was made as to the person’s present worth, compared with that prior to the injury.

Obviously factors such as age, sex, education, and employment skills would be taken into consideration when judges determined the present worth of the injured person.

The offender then had to pay the amount by which he had diminished the monetary value of the other person.

When the injured person claimed to be deaf or blind, monetary compensation was paid only after a long period of observation had eliminated the possibility of pretence.8

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  • John Quintner

    Soula, one way out for people in pain would be for chronic pain to be categorized as a psychiatric condition. It would then become assessable under the Psychiatric Impairment Rating Scale. Clearly this would be unacceptable to sufferers and I doubt whether the insurers would buy it! Furthermore, psychiatry has little to offer in the way of treatment. Bring on the AMA Guides, 7th edition!

  • soula

    The pain chapter is also not included in Victoria. My Worksafe agent supervisor took the time to ask if my impairment score would have been different if i had been assessed under the current guidelines 6. I still would not have any impairment rating, even with my implant present, numbing and doc reports explaining my injury.
    Thank you for sharing your view again. We learn from hearing all views and hope that in sharing them the powers that be are also taking note and working towards a better system.

  • John Quintner

    I wrote this article in an attempt to understand the principles behind our modern day systems of personal injury compensation. In my opinion, the determination of compensation (at least in monetary terms) for pain and suffering presented such a formidable challenge to legal systems that our governments decided to award the role of judges to medical practitioners. To ensure that there would be uniformity in awards, the AMA (US) Guides to the Assessment of Permanent Impairment (now in its 6th edition) was adapted to suit the perceived needs of individual compensation systems. In my state, Western Australia, the Chapter on Pain was discarded. So pain was placed outside the assessment of permanent impairment. Strangely, psychiatric/psychological conditions were deemed to be ratable by using a “Psychiatric Impairment Rating Scale”. Here “impairment” is really a surrogate for “disability”. The bottom line is that there is no perfect system!!

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What is Pudendal Neuralgia (PN)?

Most simply put PN is Carpal Tunnel in the pelvis/buttocks. Compression of the Pudendal Nerve occurs after trauma to the pelvis and is aggrevated with pressure. The pain is often described as a toothache like pain, with spasms, sensations of tingling, numbness, or burning. It can be very debilitating.

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