Hibberd-Little v Carlton

In a personal injury claim involving disputed diffuse axonal injury, the claimant bears the burden of proving causation on the balance of probabilities. In exceptional cases involving complex medical evidence, the burden may remain decisive where the court cannot reach a definite conclusion. A diagnosis based substantially on a claimant’s history requires a reliable and coherent account and a reasonably clear temporal link between the accident and the symptoms. The absence of an alternative diagnosis is relevant but is not conclusive. Retrospective post-traumatic amnesia is one diagnostic tool, not a substitute for assessing the whole evidential picture.

The claimant sought substantial damages for injuries allegedly caused by a rear-end collision. Negligence was admitted. She alleged whiplash injuries, diffuse axonal injury, audio-vestibular problems, post-traumatic stress disorder, obsessive-compulsive disorder, cognitive and behavioural symptoms, and consequential loss of earnings and care costs.

The defendant accepted some orthopaedic injury but disputed brain injury, vestibular injury, causation of the claimant’s career change, and the reliability of the claimant’s account. The central issues were whether the claimant had proved a brain injury and related symptoms, whether those injuries caused her losses, and how far retrospective medical opinions could safely rely on her history.

1. Burden and causation. The claimant had to prove the alleged injuries and their causal consequences on the balance of probabilities. In an exceptional case involving complex and controversial medical evidence, the burden of proof could remain important if the court was unable to reach a definite conclusion. The absence of an alternative diagnosis did not reverse or discharge that burden.
2. Reliability and temporal connection. A diagnosis of diffuse axonal injury required consideration of the claimant’s history across the whole range of symptoms, the coherence and consistency of her presentation, and a clear temporal link between the accident and the enduring symptoms. The claimant’s evidence was internally inconsistent, conflicted with contemporaneous medical records, and did not establish a reliable timeline. The absence of high-risk features, including significant rotational forces or contact injuries, made the reliability of the history and retrospective assessments particularly important.
3. Retrospective post-traumatic amnesia. Retrospective assessment was a useful but limited diagnostic tool. It was not determinative by itself. Its value depended on the quality and reliability of the information supplied, the skill and objectivity of the assessor, and the consistency of the assessment with the other evidence. The claimant had not proved any period of post-traumatic amnesia.
4. Findings. The claimant proved a substantial whiplash-type injury, a left thumb injury, headaches, limited psychological sequelae including obsessive-compulsive symptoms, and associated short-term fatigue and anxiety. She did not prove diffuse axonal injury, other brain injury, enduring cognitive or behavioural symptoms caused by the accident, or accident-related loss of teaching earnings. Her career change would have occurred independently of the accident.
5. Disposition. Judgment was entered for the claimant for £41,249.94, comprising general damages, treatment costs, gratuitous care, travel and other proved special damage. No future losses, dementia-related damages, continuing care, case management, therapies or equipment were awarded.

not stated in the judgment.