Clearly a disturbing trend exists in the area of personal injury. Readers should understand that this RAND paper is, as the authors admit, a series of hypotheses. Many of the supporting arguments are based on supposition. And, as is often the case, alternate hypotheses might also explain some of the observations described by the authors. If that was the case, we must then entertain a new hypothesis to explain the reversed index of 0.7 observed in New York and Michigan.
Patients are generally reluctant to obtain care when their coverage is in question.
Also, in minor injuries, claims are frequently not filed because victims fear that their rates will be increased. Conversely, it has always been my experience in California that non-represented victims are frequently harassed, often relentlessly, by insurance company claims personnel. And these efforts are frequently sufficient to discourage patients from completing necessary care. Recently Dynamic Chiropractic reported a large settlement handed to plaintiffs in a class action bad faith suit file against a large auto insurer here in California, attesting to the scale of this practice of denying medical care for treatment of soft tissue claims. There is no compelling reason to believe that this practice is not prevalent in New York and Michigan.