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Here, CRPS solicitor The accident
One Sunday in the spring of 2021, a family stroll in a South London park proved life-changing for Tom. Tripping over a pothole, he instinctively put out his arms to break his fall. Immediately, he was aware that he had injured his right wrist.
Tom’s wife drove him to A&E, where he was triaged and referred for an x-ray. By now, his wrist was very swollen, and the pain was worsening. The x-ray confirmed he had suffered a distal radius fracture, so he was put in a cast and discharged home with advice to take painkillers.
Early days
Tom worked as a surveyor, spending much of his time in the office making detailed technical drawings by hand. Being right-handed, he could not work, and at home, he struggled with many basic activities of daily living. He felt awkward and embarrassed that his wife had to cut up his food at mealtimes and help him with bathing and dressing.
As the days went by, instead of improving, the pain in his right wrist and hand became worse, throbbing and burning beneath the cast. On its removal, his arm appeared very pale and dusky grey and was excruciatingly painful to touch. The nurse removing the cast did not comment on the colour, appearing unconcerned, which reassured Tom. She applied a sling and told him the physiotherapy team would be in contact.
Over the following days, he was very protective of his right arm. He supported it in the sling most of the time, except when practising the daily exercises the nurse had taught him.
The claims’ factory experience
Stuck at home, much of Tom’s day became dominated by daytime TV. Struck by the number of “no win no fee” adverts aimed at accident victims, he eventually gave one of these companies a call. He assumed that as they were advertising on national TV, they must be reputable and experienced.
Not knowing what to expect, he found himself talking to a call handler who took some basic information before advising him that a “panel solicitor” would be in touch. A week later, Tom received an e-mail from a firm of solicitors in Manchester. They said they had been “appointed” to assist him with claiming compensation for his injury and losses. There were several forms to complete.
Within a week, the solicitor referred him to a GP for a medical report. Even at that stage, Tom struggled to understand why they had instructed a GP when he had suffered a wrist fracture. The GP did not examine him; instead, he asked Tom to complete a tick-box questionnaire. On pointing out that the answer to one question was neither ‘yes’ nor ‘no’, the doctor insisted he must tick one or the other. The appointment lasted less than five minutes, and the doctor bluntly refused to answer any of Tom’s questions.
When the report arrived a few weeks later, it simply recommended a referral to an orthopaedic surgeon. “What a waste of time and money,” said Tom. “I could have told them that myself!”
Orthopaedic appointment
Tom was hopeful that in addition to a report, his appointment with the orthopaedic surgeon would enable him to finally get some answers as to why he was not getting any better. It was now three months since the accident, and he was in more pain now than in the first few days following the fall.
The orthopaedic surgeon told him that he needed further but more intensive physiotherapy, arranged privately through a medical agency. He told Tom that he should fully recover within nine months with physiotherapy but was vague when pressed on what the underlying problem might be.
Work
Understandably, Tom felt nowhere near ready to return to work. However, he was worried because there had been rumours of redundancies in the weeks before his accident following the loss of a big contract. Whilst waiting for the orthopaedic report to come through, he was contacted by his head office, asking him to come in to discuss his plans to return to work. Following a series of meetings and a referral to an occupational health doctor, his employment was terminated on the grounds of incapacity.
Tom was surprised at how quick the process had been. Whilst he did not consider himself ready to return, he felt the whole process was more likely a convenient way to make him redundant, bypassing the formal redundancy process. When he raised this with his solicitors, they simply suggested he contact the job centre!
Orthopaedic report
The orthopaedic surgeon’s report contained little in the way of a diagnosis. As expected, he recommended further physiotherapy, and his prognosis was a full recovery within nine months.
However, during the first session with his new physiotherapist, she told Tom that she suspected he had developed “complex regional pain syndrome” (CRPS). His condition was far from straightforward, and he needed specialist care, so she recommended a referral to a specialist pain consultant at St George’s Hospital in London. Tom said that researching CRPS “put the fear of God into me, particularly when I read about amputation in some cases!”
Appalling legal advice
Incredibly, his solicitors seemed totally uninterested in this development, telling Tom that he must follow the orthopaedic surgeon’s recommendation. If he insisted on seeing the pain specialist, they said he should seek a referral via his GP. In the meantime, they also explained that the local authority’s insurance company had admitted liability and offered £5,000 in settlement. They recommended acceptance!
Tom explained that he had lost his job and had little prospect of finding another in the immediate future. He said, “Despite this, they were utterly disinterested, verging on hostile. I was told that if I didn’t like the orthopaedic report, I could pay for another myself. I said things had moved on and this was no longer an orthopaedic case, but the shutters were already down.”
Moving forward
Tom was distraught, fighting with the people who were supposed to be helping him. While researching CRPS, he came across an article by one of my colleagues. After some hesitation, he picked up the phone and found himself speaking to me.
I remember that call very well. Understandably, Tom was incredibly anxious about what he saw as his impossible situation. We spent an hour and a half on the phone as I addressed his immediate concerns and explained that it was not too late to get his claim back on track. A complicating factor was that Tom required both employment and personal injury advice. As he was almost out of time on the employment matter, I arranged an immediate referral to an employment specialist.
Subsequently, I met with Tom, and we agreed on a plan of action. Of primary importance was obtaining and reviewing a complete set of medical and other records – GP, hospitals, therapists, etc. Thereafter, I drafted a detailed letter of instruction to a pain specialist whose clinical practice included treating and managing CRPS. I also spent a considerable time obtaining detailed witness statements from Tom, his wife, parents, friends and former colleagues. These are vital in painting a picture of Tom’s life before the accident, compared with life now with CRPS.
In a case involving CRPS, it’s invariably necessary to obtain an expert report from a psychiatrist with a clinical interest in chronic pain. However, before doing so, I prefer to wait until I have a pain report to provide the psychiatrist with the benefit of the pain specialist’s opinion.
Spinal cord stimulation
Sadly, the pain specialist concluded that Tom’s CRPS was too well-established to expect any improvement. So, turning to the long-term management of his condition, he recommended that Tom be assessed for his suitability for spinal cord stimulation (SCS).
In due course, with a lengthy NHS waiting list, we secured funding from the insurance company for Tom to proceed privately with SCS. Following a successful trial and full implantation, Tom estimated that pain level was reduced by 50% – an incredible result.
The outcome
We also obtained funding for Tom to undergo some retraining in using computer-aided design (CAD) software. I was delighted to hear that he was then able to secure part-time employment as a surveyor using his new skills.
Ultimately, the insurance company’s solicitors accepted our invitation to a joint settlement meeting where Tom’s claim settled for £650,000.