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Specialist CRPS and chronic pain solicitor New clients are often surprised by the extent of my request for medical records. But they really are absolutely crucial to making a successful CRPS compensation claim.
Medical records: Proving your case
To understand their importance, we need to start with basic principles. As the claimant, the law requires you to prove every aspect of your claim to the court’s satisfaction. In other words, there’s no requirement for the defendant to produce their own evidence (although, understandably, they inevitably will). Instead, they can simply put your evidence to the test and hope the court agrees that you have failed to prove your case.
In a civil claim for compensation, the court requires you to prove your case ‘on the balance of probabilities’, i.e. it’s more likely than not. This is a less stringent test than in criminal cases, ‘beyond reasonable doubt’ (these days expressed to a jury as ‘so that you are sure’).
Example
Let’s take the example of a person suffering a soft tissue injury to their right wrist following a fall at work. Over the following weeks, they develop CRPS in their right forearm and hand. As a result, they cannot return to work and have substantial financial losses, which are ongoing. We’ll assume their employer has admitted liability (fault) for the incident, which the claimant says caused the original wrist injury.
The admission of liability is simply an admission by the employer that they breached their legal duty to the employee, causing them to fall. The admission does not extend to the nature or extent of the injury or the financial losses sustained. So, the employee must prove ‘on the balance of probabilities’ an unbroken ‘chain of causation’, showing that:
- the fall caused the soft tissue injury to the right wrist; and
- that soft tissue injury triggered the CRPS in their right forearm and hand; and
- as a result, they sustain losses, each of which they must prove.
Proving 1 and 2 above begins with medical records.
Medical experts
In a CRPS compensation claim, you will likely require medical experts in several disciplines. They must advise the court within their area of expertise and give their opinion evidence ‘on the balance of probabilities’. The starting point is the claimant’s medical records. Returning to the example above, the claimant should have:
- an orthopaedic surgeon to prove a causal link between the fall and the wrist injury.
- a pain medicine specialist or rheumatologist to prove a causal link between the wrist injury and the development of CRPS.
- a psychiatrist with a special interest in chronic pain to prove the psychological or behavioural components of the claimant’s condition.
In each case, in addition to examining the claimant, the expert requires a full medical history from their complete medical records to support an unbroken chain of causation. So, for example, the orthopaedic surgeon sees from the A&E record on the day of the accident exactly why the claimant attended, what they told the A&E doctor and what was found on examination. But what if the claimant did not attend A&E? What if the first medical attendance following the fall was a GP appointment three days later where the GP records “injured wrist in a fall at home one week ago”? [It does happen!] Unless there’s a provable explanation why this entry is wrong, on the face of it, the chain of causation breaks, and the claim fails.
View your GP records
Pre-accident medical records
Your pre-accident medical history is also very relevant. For example, in one case where my client had CRPS in his right forearm and hand, his medical records showed he had developed CRPS many years before in his left wrist following surgery. Fortunately, he had achieved remission of his CRPS on that earlier occasion. He recalled a prolonged recovery from surgery but had no idea that he had previously been diagnosed with the condition. However, his medical records showed a predisposition to CRPS.
CRPS is a very strange condition that is still not adequately understood. The condition can spread to other parts of the body, even to areas remote from the original presenting site. So, for example, if the claimant believes CRPS affects their teeth and gums, dental records become relevant. With eyesight, we need opticians’ records. We regularly obtain occupational health records. Even the records of alternative practitioners might be relevant as evidence of what the claimant told the practitioner or the symptoms found.
My job is to fully investigate and prepare the strongest possible claim, hopefully ensuring an unbroken chain of causation. Remember, the defendant will be performing their own forensic analysis of the evidence in the hope of breaking the chain of causation and undermining your claim.