Causation, causation, causation

The case of Cossey v the Buccleuch Estates [27.07.22] concerns the assessment of medical causation in the face of a pursuer claiming to have suffered from life altering injuries as a result of falling into a manhole.

Background

On 12 August 2017, the pursuer was returning home from visiting a neighbour’s house when she fell into a manhole causing injury. She attended Accident & Emergency immediately following the accident. X-rays confirmed that she had suffered no fractures and the various injuries were diagnosed as being soft tissue only.

In the following months, the pursuer re-attended hospital and her GP on a number of occasions complaining of a variety of symptoms. Despite being examined by various consultants of different disciplines and undergoing testing to ascertain the root cause of these ongoing complaints, no underlying causes could be identified.

Liability for the accident was admitted by the defender prior to litigation. The only issue in dispute therefore was quantum, with the key issue in the case being medical causation.

Decision

The case was heard by Lord Turnbull over nine days. The discrepancies in the pursuer’s reporting of the accident circumstances resulted in the judge assessing her to be an unreliable witness.

The pursuer had an extensive history of medical problems. The judge noted that not only was she not forthcoming at interview with the various medical experts, she in fact denied to them that she had any significant pre-existing conditions. The experts agreed that the pursuer had a long-standing history of a somatoform symptom disorder which, in short, is classified as a mental disorder where the individual will experience pain in various body parts without an identifiable organic or neurological cause. Interestingly, the expert in neuropsychiatry and psychological medicine, instructed by the defender, noted that: “patients with somatoform symptom disorder sometimes attribute their symptoms of pain to a particular event and refuse to accept that these same symptoms were present before that point”.

The defender instructed surveillance, with video footage showing the pursuer going about her daily business “with no apparent difficulty”. This directly contradicted the account that she had provided to a number of experts and in court. The surveillance was clearly a key factor in the judge’s decision-making.

The judge commented on the pursuer’s presentation and honed in on a number of discrepancies in her narration of the post-accident timeline provided to the experts. Aside from the issues in her medical presentation, the pursuer provided information relating to her employment which was factually incorrect.

Ultimately, Lord Turnbull found the pursuer to be an unreliable historian and concluded that any symptoms directly caused by the accident were minor in nature and resolved within a short timeframe. An award of damages of under £5,000 was made against a claim purported to be worth in excess of £100,000.

Comment

The case serves as a stark reminder of the importance of undertaking a holistic analysis of all available evidence when assessing medical causation. The pursuer’s evidence was challenged with documentary evidence and expert reports which established that a number of statements made were either false or misleading. Thorough investigations undertaken by the defender throughout the life cycle of the claim resulted in a nominal award of damages, vindicating their position on quantum.