Chief Adjudication Officer v. Faulds (Scotland)

The House of Lords held that, for the purposes of entitlement to industrial injuries benefit under section 94(1) of the Social Security Contributions and Benefits Act 1992, a claimant must establish (on the balance of probabilities) an identifiable "accident" or series of identifiable incidents which caused the personal injury (here post-traumatic stress disorder). The court emphasised that the statutory phrase "by accident" requires the identification of an event or events (an "accident" to the claimant) rather than treating any stress arising from a stressful occupation as automatically accidental. Where facts are unclear about which incident(s) caused the psychiatric injury the matter should be further investigated and, if necessary, remitted to the commissioner for fuller factual and medical examination.

The respondent, a senior fire officer, claimed industrial injuries benefit for post-traumatic stress disorder allegedly attributable to repeated attendance at fatal and distressing incidents in the course of his employment. He sought declarations and benefit under section 94(1) of the Social Security Contributions and Benefits Act 1992, asserting his psychiatric condition was "caused by accident arising out of and in the course of his employment."

The factual record before the appeal tribunal identified a number of incidents attended by the claimant over several years. The tribunal found that the claimant suffered from post-traumatic stress disorder and recorded that a "series of incidents" had occurred and had resulted in industrial injury, but did not identify which specific incident or incidents had caused the disorder. The adjudication officer appealed to the commissioner, who stated the tribunal erred in parts of its reasoning but nonetheless substituted a decision in the claimant's favour. The adjudication officer then appealed to the Court of Session (Extra Division) which refused the appeal (1998 S.L.T. 1203). The Secretary of State (replacement for the adjudication officer) appealed to the House of Lords.

Issues framed by the court:

• Whether the claimant's psychiatric injury was "caused by accident" within section 94(1) of the Benefits Act.
• Whether the tribunal and commissioner were correct to treat an accumulation of occupational stress exposures as an "accident" or series of accidents rather than a process.
• Whether, on the facts and evidence presented, there was sufficient identification of any causative incident(s) to support a declaration and award of benefit.

Court's reasoning:

• The House reiterated that the statutory scheme contemplates an identifiable "accident" (an external event or bodily activity) which causes personal injury; earlier authorities on workmen's compensation provide guidance but the modern social security legislation and its detailed provisions require identification of "an accident" for section 94(1) claims.
• The court drew the distinction between injury caused by a discrete accident (or ascertainable series of accidents) and injury caused by a continuous process; while the latter may be compensable under prescribed-disease provisions, it does not fall within the section 94(1) requirement of injury "by accident."
• The evidence in this case did not sufficiently identify which, if any, of the incidents alleged by the claimant caused the post-traumatic stress disorder; the tribunal and commissioner had not adequately addressed that causation question.
• Because the facts were insufficiently explored, the appropriate remedy was to allow the appeal and remit the matter to the commissioner for fuller factual and medical investigation (including expert medical assistance where appropriate).

Appeal allowed. The House of Lords concluded that section 94(1) requires identification of an "accident" (an event or series of ascertainable events) that caused the personal injury; the tribunal and commissioner failed adequately to identify or investigate which incident(s) caused the respondent's post-traumatic stress disorder. The case was remitted to the commissioner for further investigation and, if required, expert medical assistance to determine causation.

Social Security Appeal Tribunal decision in favour of the respondent (23 May 1995). Adjudication officer appealed to the Social Security Commissioner who reviewed and substituted a decision. The adjudication officer appealed to the Court of Session, Extra Division (reported at 1998 S.L.T. 1203), which refused the appeal. The Chief Adjudication Officer (subsequently the Secretary of State) then appealed to the House of Lords, which allowed the appeal ([2000] UKHL 26).