Obstacles to Mental Health Care in Auto Accident Cases

The politics of therapy

Posted Aug 04, 2017

Most adults in the United States of America drive vehicles of one kind or another on public roadways and are at risk of being involved in an auto accident which may result in serious injuries or death.  According to the National Safety council’s data in 2016, over 40,000 people died from auto accident related injuries and 4.6 million required medical treatment in the U.S. 

Regarding the shocking U.S. auto accident fatality statistics, it is perhaps necessary to put it in perspective of deaths resulting from war events.  According to the National Archives’ data (https://www.archives.gov/research/military/vietnam-war/casualty-statisti...) about casualties of the Vietnam War the number of U.S. military confirmed killed in action was 40,934.  The time span of the Vietnam War is 20 years (1955 to 1975).  In 2016, we have approximately the same number killed in auto accidents on U.S. roads.

The estimated annual economic cost of these accidents vary from different sources ranging from 200 to 800 billion dollars.  Again, to gain some perspective, the U.S. defense budget for 2016 was around 600 billion dollars.  The annual economic costs from auto accidents appears to roughly parallel the annual Defense Department’s budget. 

Despite these alarming and indeed horrifying statistics, based on my informal survey with friends, and in talking with injured patients, I have concluded that few Americans actually know much about their auto accident insurance coverage that they would turn to in the event of being injured in an accident.  Most people just assume they will be taken care of somehow, and do not want to take the time to understand what kinds of coverage they have or what might be involved with funding medical care.  Let’s face it, thinking about insurance just isn’t sexy and most people would prefer to place their attention elsewhere.  I get it.  But when you see people’s lives destroyed because they can no longer pay their rent or provide for their family or receive medical care following an auto accident that leaves them injured and disabled for an extended period of time, the issue of auto accident personal injury insurance coverage suddenly takes on new meaning.

An excellent article entitled No-Fault Auto Insurance by the Insurance Information Institute (http:www.iii.org/issue-update/no-fault-auto-insurance 8/4/17) gives an overview of our nation’s auto insurance laws pertaining to coverage in the event of accident related injuries.  While the article reflects the interests of the insurance industry, it gives an informed recent history of auto insurance in America.  The types of auto insurance systems vary state by state.  Only 12 states have what is referred to as “no fault” systems.  Puerto Rico also has a no-fault system.  Prior to no-fault systems which were first enacted into state laws beginning in the 1970s, auto accidents fell under traditional liability systems meaning that expenses were the responsibility of the person who was legally found to be at fault, i.e., who caused the accident.  Determining the at-fault person often can be complicated and expensive, so some states moved to no-fault, meaning it did not matter who caused the accident; the injured person’s own insurance would cover medical, lost wages, and other costs resulting from the accident.

Under the various no-fault systems, the maximum amount of coverage for medical expenses, which would include mental health care, varies greatly.  Currently, Michigan is the only state that has no cap on medical bills related to accidents.  Michigan’s comprehensive system has allowed injured motorists the ability to receive the long-term care they need to be rehabilitated to greatest possible extent which insures the ability to receive the highest quality care possible for as long as necessary.  Michigan’s no-fault law which was enacted in 1973 has been the model system for the nation with respect to the care it allows.  Insurance companies and many politicians are currently attacking the Michigan system in an attempt to pose caps and other restrictions.  The battle in Michigan is heating up and requires interested consumers to become involved in order to preserve the best system for post-accident care the nation has produced.  There are proposals to limit the amount of medical care to $1 million dollars, and to impose fee restrictions on providers.  It is interesting that many people seem to think there are currently no restrictions on fees paid to providers.  This is false, as insurance carriers set the amounts they are willing to pay for services.  With respect to caps, if they are imposed it will have the effect of reducing the quality of care patients receive and will result in a lower quality of life.  Those with catastrophic injuries such as severe spinal cord and brain injuries may face a life in a state funded nursing home, in effect warehoused with little hope of further rehabilitation.  Michigan’s system has produced a vibrant health care industry which leads the world in many respects.  The current system serves the citizens of Michigan by ensuring the opportunity for quality care and maximum rehabilitation, and in my opinion well worth fighting for to preserve.

The concept of caps on coverage poses interesting questions regarding constitutional rights.  While Ohio is not a no-fault state, an interesting point was raised in a 2007 case heard before the Ohio Supreme Court.  In Arbino v. Johnson and Johnson, Ohio Supreme Court Justice Pfeifer wrote a dissenting opinion stating that if the legislature can have the power to cap damages, it therefore has the power to eliminate them.  According to Justice Pfeifer under the Constitution only juries have the right to determine damages.  Back to Michigan, if the legislature places a cap of $1 million dollars for costs related to an auto accident, what is to keep it from putting a cap of $1 dollar?  Perhaps there are larger constitutional issues at large that needs to brought into the conversation.

More importantly, instead of attacking the Michigan no-fault system as too costly for the insured, the real issue that needs to be the focus is auto accident prevention.  If the will of the state was focused on the issues of accident prevention, the costs associated with auto accidents would plummet.  Benjamin Franklin put forth the important axiom “an ounce of prevention is worth a pound of cure” when talking about fire safety in 1736 Philadelphia.  Nothing could be truer when thinking about costs associated with auto accidents.  The Michigan State Police has a program to teach young drivers defensive driving techniques.  This is one example of a program that could make a big difference in preventing accidents.  We need a thousand more like it.

Instead of taking away needed care to those who are injured, why don’t we as a society instead work to prevent future accidents and address the root cause of the drain to our economy.   I believe at least 80 percent of car accidents are preventable through driver education, training and sanctions.  Proactive programs by many companies addressing driving safety with their employees have proven this to be the case.  I wonder if we eliminated 80 percent of the auto accidents by an effective national prevention campaign, would our auto insurance premiums fall by 80 percent?  Regardless of the money issue, we could place our energies elsewhere to build a better world.  

The positive effects of mental health care spreads across generations.  Perhaps it is time for society to fully invest its future by creating a mentally healthy population.  If Michigan limits the health care accident victims can receive under the no-fault personal injury protection system, the often devastating psychological effects of serious accidents will go untreated, and at what cost to society?  We can and must do better to preserve our collective future.