Case Management Services Ltd (CMS) and the University of Edinburgh have collaborated on a research project to investigate the experiences of personal injury claimants after their legal cases have settled. Research to date has focused on the pre-settlement period and how it affects mental health, well-being and physical symptoms, but there has been little investigation of the psychological experience of individuals after such claims have settled.
Eleven people were interviewed and Thematic Analysis was used to study the information. Thematic Analysis is a type of qualitative analysis that involves identifying common themes across different data sets to capture the main concepts and ideas relevant to the topic in question.
The interviews lasted for between 30 and 90 minutes and were carried out either face to face or via Skype. Participants were aged between 25 and 71 years of age and their cases had settled between 5 months and 10 years prior to the interviews being conducted. The participants had sustained a range of brain and non-brain injuries including orthopaedic injuries, reduced mobility, pain and facial disfigurement.
The study found a wide range of psychological experiences in the post-settlement period including relief, a sense of fairness, joy, fear, embarrassment, shame, confusion, anger and elation. There were a number of factors that influenced these reactions including how socially isolated an individual was. It was also evident that these reactions did not only affect the individual but also their relationships with others.
Out from under the shadow: For some people, there was a sense of returning to normal as their medico-legal assessments and legal case came to an end. A theme that was common to many was of regaining a sense of control over their life. One person said “Thank God it’s over”. For some individuals, the legal process had felt relentless and they were glad that 1) the medico-legal appointments had ended, 2) there was no need to go to court and, 3) they could take back control of their lives.
Negotiating the next chapter: This theme focused on how the financial aspect of the case settlement affected participants personally and their relationships with others.
“Surprisingly not like winning the lottery” Participants described feeling grateful for the financial settlement and appreciated that it would make their lives easier in some ways, however there was agreement that the money did not compensate for what they had lost or eradicate ongoing symptoms such as pain. “I’m suffering every day, my wife’s suffering every day, money cannae stop the suffering, but it helps make my life easier.” They also felt a sense of responsibility to spend the money wisely, with some worried about whether it would be sufficient “It all cruxes round how long will I live, is it enough?”.
A number of participants spoke about how the settlement has affected their trust in others “it’s just out of habit now, I always wonder what people’s kind of objective is as to why they talk to me.” A number of people had chosen to keep the settlement private and many did not disclose that they had received money. It had increased their wariness of others’ motives and many described increased isolation. People reflected on how their social circles had shrunk, treasuring those who remained.
Feeling involved in the legal process: Participants spoke of how their relationship with their legal team affected how they felt in the post-settlement period. Positive experiences centred on regular and clear communication, a trusting relationship and feeling informed about the legal process and the options available to them. A positive quote from one participant was “If you don’t believe in your lawyers then you’re not really going to get anywhere.” However, another said “It was as if I was the little man […] I was asking questions and I wasn’t getting answers.”
The ending of the professional relationship with the legal team also influenced the post-settlement period with some individuals reporting that the relationship ended abruptly and they found it difficult when they no longer had contact with their lawyer. One person said they would have liked the opportunity to speak to them after their case had ended.
In summary, the project found that the post-settlement period is a complex transitional phase within a longer-term process of adjusting to an accident.
The study has allowed us to understand more about the range of psychological reactions in the post-settlement period and has raised questions about what predicts the different reactions people have; how does settlement impact on family members, and how do case managers understand this process and work with individuals going through it?
Using the information obtained from the study, there is an opportunity to provide training for case managers, healthcare professionals and legal specialists around supporting people during this period and the potential for producing written information for clients and families about what they might experience and ways of coping.
We are interested in speaking to family members about their experiences and to case managers about their involvement with individuals’ during the case settlement period and beyond. We hope to collaborate with the University of Edinburgh in the coming year to take these projects forwards.
We would like to thank Sarah-Jane Sewell, Isla Jack and Dr David Gillanders from the University of Edinburgh, for their skill and commitment to this project. At the time of writing, the students had submitted their MSc dissertations and were on track to pass the course with good grades. Our biggest thanks go to the 11 participants and their families who despite telling us that they were pleased to leave the questioning of the legal process behind them, allowed us to interview them one more time!