Universal No-fault Compensation is Associated With Improved Return to Work Rates in Spine Fusion

Spine (Phila Pa 1976). 2015 Oct 15;40(20):1620-31. doi: 10.1097/BRS.0000000000001096.


Study design: Retrospective cohort study and systematic literature review.

Objective: To examine the influence of "universal no-fault compensation" upon return-to-work rates in patients undergoing lumbar spinal fusion, and then to make comparison with workers' compensation (WC) and non-workers' compensation (non-WC) claimants.

Summary of background data: Compensation has an adverse influence upon outcomes and return to work in lumbar spinal fusion. It is unclear whether this is due to the compensation per se, or due to the features of WC including its adversarial environment, delayed resolution of claims, and need for disability enhancement to promote compensation. The New Zealand Accident Compensation Corporation (ACC) is a universal no-fault system offering early treatment and salary reimbursement. Given the differing features of these compensation systems, comparison of return-to-work rates may give insight into the differing outcomes for the two compensation systems.

Methods: From a cohort of 428 patients undergoing lumbar spinal fusion, 178 patients covered by ACC system underwent a structured interview to determine pre-injury, pre-surgical, and post-surgical work status. A systematic literature review was performed relating to lumbar spine fusion, return to work, and WC.

Results: The return-to-work rate for the ACC patients in work at the time of their injury was 81%. The systematic review of 21 studies including 2519 subjects revealed a return-to-work rate of 40% for WC patients, and 74% for non-WC patients (P < 0.001). There was a significantly greater return-to-work rate for ACC patients than WC patients (P < 0.001), but no difference between ACC and non-WC patients.

Conclusion: The return-to-work rates for a universal no-fault compensation system are higher than those under WC cover, and are compatible with non-WC cases. This suggests that the features of WC may contribute to the inferior return-to-work rates.

MeSH terms

  • Aged
  • Female
  • Humans
  • Lumbar Vertebrae / surgery*
  • Male
  • Middle Aged
  • New Zealand
  • Retrospective Studies
  • Return to Work / economics*
  • Spinal Fusion / economics*
  • Treatment Outcome
  • Workers' Compensation / economics*