Case study: The role of the expert in proving causation

Causation is generally accepted as being one of the most difficult areas for medicolegal experts to address. Even in seemingly clear cut pain cases as the one outlined below, it’s essential to engage an expert with a thorough, specialist understanding of chronic pain.  Our expert’s ability to explain in a clear and logical way and to detail the impact of both the incident and resulting injuries on the claimant were instrumental in the outcome of the case.

The case:

A grandmother from overseas visiting her family in the UK tried to intervene when her daughter was attacked in the street. The attackers drove over the grandmother, reversed over her a second time and dragged her along the road. This tragic incident resulted in life threatening, multiple and complex injuries.  These included dislocation of her left shoulder, significant tear of the left shoulder muscle, multiple fractures of her ribs, fractures to her spine, significant fractures to the pelvis and abdomen and extensive urogenital injuries (bladder and vaginal) caused by sharp bony fragments of her crushed pelvis.  After many months of complex surgeries and lengthy stays in hospital, she was released into the care of her daughter.

She was left with severe chronic pain in her shoulder, arm and pelvis, which prevented her from resuming work.

The expert diagnosis:

It was clear to our expert that causation was as a result of the accident.  However, the defendant expert argued that an extensive past history of physical complaints (labelled as chronic pain syndrome) represented a constitutional vulnerability to pain that effectively caused her to suffer “more pain from tissue damage” than most individuals.  He argued that causation was therefore not entirely due to injuries from the accident and further claimed that there appeared to be exaggerations and inconsistencies in her testimony.

The outcome:

Beyond the obvious appalling intent of the incident, our expert was able to link causation systematically to the life threatening injuries and psychological trauma the grandmother suffered as a result of the accident. He was able to satisfy the court that the claimant’s distress was entirely genuine and in accord with the events that had happened to her. He demonstrated that she was a reliable witness with an entirely consistent history and presentation. He demonstrated in his evidence that the resulting chronic pain was a direct cause of the incident and had genuinely impacted her ability to resume work and therefore that this should be a consideration in the award. The claim was settled with a substantial award in favour of the claimant.