Addressing functional neurological disorder in personal injury claims

I was very pleased to have hosted my first APIL London Regional Group meeting with my joint co-ordinator Andrew Benzeval of Stewarts last month.

We had fantastic speakers including Dr Mike Dilley, Consultant Neuropsychiatrist, Maudsley Hospital, Professor Mark Edwards, Consultant Neurologist, Brain and Mind Ltd, Neil Irwin, commercial director at Proclaim Care and Pankaj Madan of counsel, 12KBW who gave excellent talks on the mind-boggling issue of functional neurological disorder (FND).

Contrary to assertions, it is a very complex, but real phenomenon affecting a remarkable number of claimants following injury. It is a disorder of the nervous system functioning without visible structural damage seen on the MRI or CT scans that may be obtained to explain often inexplicable symptoms, including tremor, gait disorder and sensory loss. Of course, questions and, even allegations of fundamental dishonesty can arise in such cases in the absence of any structural brain damage.

One does not need to have pre-existing psychological issues or trauma to develop FND. Triggers include accidents and pain episodes.

Dr Dilley and Professor Edwards emphasised that lack of understanding and limited resources, mean that diagnosis is often made far too late in the day leading to irreparable damage. There are far and a few experts specialising in FND making it difficult for those with the condition to be diagnosed with it and receive proper care.

Those with FND may face immense challenges because accident-related injuries, for instance, may have resulted in them behaving in ways that even they cannot understand. Left undiagnosed and untreated, FND can have a devastating, domino effect leading to breakdown of relationships, loss of job and home if support is not provided in a timely manner.

These types of cases are far from straightforward, and it is important, practitioners try to establish as soon as practicable whether they may be dealing with clients with FND.  Obtaining detailed witness evidence together with  detailed chronology of clients’ lives and medical history can be useful tools in determining how best to approach such claims.

Sadly, it seems FND is often the last condition to be assessed for, after every other possible condition on the list has been exhausted, by which time to precious time and resources have been wasted. The insurance industry should be encouraged to fund assessment for early diagnosis as that would ultimately save a lot of money and time, not to mention, claimants from a prolonged ordeal of frustration, pain and anxiety as well as uncertainty.

Early intervention, assessment and treatment of FND, usually intense rehabilitation with a multi-disciplinary team, can make a world of difference to those who find themselves in this unfortunate predicament. Typically, it then becomes far less fraught to address the Issues of causation and quantum.