Lay v Cambridgeshire and Peterborough Mental Health Partnership NHS Trust & Anor

In a personal injury claim, a claimant must prove the alleged injury and its causal connection with later symptoms on the balance of probabilities. The court may determine those issues by evaluating the claimant’s account alongside contemporaneous records, expert evidence and the medical history. The absence of an early report of a particular symptom is not decisive where there is a credible explanation for the omission and later evidence supports the alleged injury. Where a traumatic injury and a pre-existing condition overlap, the recoverable period depends on the evidence distinguishing accident-related symptoms from the underlying condition.

The claimant sought damages after slipping at work and injuring her lower back. The defendant admitted that the floor was unsafe and accepted injury to the coccyx and lumbar spine, but disputed any neck injury and its consequences. The trial was directed to three preliminary issues: whether the claimant injured her neck in the accident; whether that injury caused her subsequent symptoms and for how long; and what her prognosis would have been without a neck injury. The claim also involved subsequent spinal surgery and third-party proceedings against the surgeon.

1. Neck injury. The claimant’s evidence about the accident was clear, consistent and cogent. Although the earliest medical and occupational records did not mention a neck injury, that omission was plausibly explained by the much greater lumbar pain and the claimant’s condition at the time. Later physiotherapy, general practitioner and osteopathic records supported her account. On the balance of probabilities, she injured her neck in the accident (paras 8–16).
2. Causation and duration. The claimant had a significant pre-accident history of neck and lower-back pain, but the court accepted that she gave her evidence honestly and did not regard those episodes as a constitutional neck condition. The experts agreed that, if the accident account were accepted, the claimant suffered a minor soft-tissue neck injury and that the accident caused a period of post-accident neck symptoms. The court preferred Mr Kirkpatrick’s evidence that attributable symptoms continued for 24 months. The absence of later references to neck symptoms did not disprove continuity in the circumstances, particularly given the focus on the lumbar injury and the subsequent surgery (paras 17–41).
3. Prognosis issue. The court did not determine what the claimant’s prognosis would have been had she not injured her neck, because the issue was not required for the judgment and neither party advanced a contrary position (para 42).
4. The parties were directed to agree and draft an order reflecting the judgment (para 43).