Article Text

Did implementation of no-fault auto-insurance in British Columbia, Canada, impact return to work following road trauma? Protocol for a before–after survival analysis
  1. Herbert Chan1,
  2. Shannon Erdelyi1,
  3. Alex Jiang1,
  4. Christopher McLeod2,
  5. Mieke Koehoorn2,
  6. Jeffrey R Brubacher1
  1. 1Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Jeffrey R Brubacher; jeff.brubacher{at}


Introduction Road trauma (RT) is a major public health problem that often results in prolonged absenteeism from work. Limited evidence suggests that recovery after RT is associated with automobile insurance compensation schemes. In May 2021, British Columbia, Canada switched from fault-based to no-fault auto-insurance coverage. This manuscript presents the protocol for a planned evaluation of that natural experiment: We will evaluate the impact of changing automobile insurance schemes on return to work following RT.

Methods and analysis The evaluation will use a before–after design to analyse auto-insurance claims (1 April 2019 to 30 April 2024) in order to compare recovery of claimants with non-catastrophic injuries who filed claims under the no-fault insurance scheme to that of those who filed claims under the previous system. Claimants will be followed from date of injury until they return to work or have been followed for 6 months (right-censored). We will perform sensitivity analyses to examine the robustness of our findings. First, we will exclude injuries that occurred during the COVID-19 provincial State of Emergency. Second, we will use propensity score methods rather than conventional covariate adjustment to address potential imbalance between characteristics of claimants pre-change and post-change. Finally, as the implementation effect may have a heterogeneous association with time off work, we will use quantile regression with right-censoring at 6 months to model differences in return to work at the 25th, 50th, 75th and 90th percentiles.

Ethics and dissemination The study uses de-identified data and is approved by the University of British Columbia Clinical Research Ethics Board (H20-03644). This research is funded by the Insurance Corporation of British Columbia (ICBC). Findings will be published in the peer-reviewed literature and summarised in a report prepared for ICBC. We anticipate that our findings will inform policy decisions in other jurisdictions considering switching to no-fault auto-insurance schemes.


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  • Contributors The study was conceived by HC and JRB. HC wrote the first draft of the manuscript. SE wrote the analysis section. AJ extensively reviewed available data and, together with SE, HC and JRB, had a series of meetings with Insurance Corporation of British Columbia to understand data definitions and limitations. JRB completed the injury classification. MK and CM critically reviewed and contributed to the methods section. All authors reviewed and approved the final manuscript.

  • Funding This research is funded by a research contract with the Insurance Corporation of British Columbia.

  • Competing interests This research is funded by a research contract with the Insurance Corporation of British Columbia (ICBC). ICBC may object to a proposed Presentation or Publication on the grounds that it contains Restricted Information or Confidential Information that was disclosed to the Institution (ie, The University of British Columbia) by ICBC. If ICBC makes such objection, the Institution will ensure that the Research Team removes such Restricted Information or Confidential Information, as applicable, immediately from the proposed Presentation or Publication, after which the Institution can publish or present. Importantly, ICBC does NOT have authority to delay or prevent publication or presentation of any findings by the Research Team.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.