When Should a Solicitor Obtain a Psychiatric Report in a Personal Injury Claim?
Psychiatric injury can form an important part of a personal injury claim. Following a road traffic accident, workplace accident, assault or other traumatic event, a claimant may experience ongoing psychological symptoms alongside — or sometimes in the absence of — significant physical injuries.
For solicitors handling these cases, an important practical question arises: when should a psychiatric medico-legal report be obtained?
An independent assessment by a Consultant Psychiatrist can provide expert medical evidence regarding diagnosis, causation, severity, functional impact, treatment and prognosis.
However, not every claimant reporting psychological distress will require psychiatric expert evidence.
When Might a Psychiatric Report Be Required in a Personal Injury Claim?
A psychiatric medico-legal assessment may be appropriate where a claimant reports significant or persistent psychological symptoms following an accident or traumatic event.
These may include:
Post-traumatic stress symptoms
Anxiety or panic attacks
Depression or persistent low mood
Flashbacks or intrusive memories
Nightmares and sleep disturbance
Travel anxiety following a road traffic accident
Avoidance of driving or other activities associated with the accident
Difficulty returning to work
Reduced social or occupational functioning
Persistent psychological symptoms despite physical recovery
The presence of symptoms alone does not determine whether a psychiatric disorder exists. A Consultant Psychiatrist can assess the claimant and provide an independent medical opinion regarding whether a recognised psychiatric condition is present.
Psychiatric Injury Following a Road Traffic Accident
Road traffic accidents are a common reason for psychiatric medico-legal referral.
A claimant may recover from their physical injuries while continuing to experience psychological difficulties associated with the accident.
For example, an individual may experience anxiety when driving, avoid the location of the collision, develop sleep disturbance or intrusive recollections, or become unable to travel as a passenger.
Where symptoms are significant or persistent, a psychiatric assessment following a road traffic accident can help determine whether they meet the diagnostic criteria for a psychiatric disorder and assess their likely prognosis.
PTSD and Personal Injury Claims
Post-traumatic stress disorder (PTSD) is one of the conditions that may be considered following exposure to a traumatic event.
However, experiencing distress after an accident does not necessarily mean that an individual has PTSD.
Symptoms may instead be consistent with another psychiatric presentation, such as an adjustment disorder, anxiety disorder or depressive disorder. In other cases, symptoms may not meet the diagnostic threshold for a psychiatric disorder.
A Consultant Psychiatrist can assess the claimant's symptoms, clinical history and relevant medical documentation before providing an independent diagnostic opinion.
This distinction can be particularly important where PTSD is alleged as part of a personal injury claim.
What Does a Psychiatric Medico-Legal Assessment Examine?
The scope of the assessment depends upon the circumstances of the case and the solicitor's letter of instruction.
A Consultant Psychiatrist will commonly consider:
The circumstances of the accident or relevant event
The claimant's psychiatric symptoms following the event
Previous psychiatric and medical history
Relevant GP, hospital and mental health records
Treatment received to date
Current medication
Occupational functioning
Social and family functioning
Current mental state
The progression of symptoms since the incident
The psychiatrist can then address the specific medico-legal questions contained within the letter of instruction.
Diagnosis
One of the principal reasons for obtaining psychiatric expert evidence is to establish whether the claimant has developed a recognised psychiatric disorder.
Depending upon the clinical presentation, this may include conditions such as:
Post-traumatic stress disorder
Adjustment disorder
Depressive disorder
Anxiety disorders
The diagnosis, if any, is based upon the psychiatrist's clinical assessment and consideration of the available evidence.
Causation
Diagnosis and causation are separate questions.
A claimant may have a psychiatric disorder, but the medico-legal issue may be whether — and to what extent — that condition is attributable to the accident or event at the centre of the proceedings.
The psychiatrist may therefore be asked to consider the temporal relationship between the incident and the onset of symptoms, the claimant's previous psychiatric history, other relevant life events and the available medical records.
What if the Claimant Has a Pre-Existing Psychiatric History?
A previous history of anxiety, depression or another psychiatric condition does not necessarily remove the relevance of psychiatric expert evidence.
Instead, it may make specialist assessment particularly important.
The psychiatrist may need to consider whether the incident:
Caused a new psychiatric disorder
Exacerbated a pre-existing condition
Accelerated or contributed to an existing psychiatric difficulty
Had no material effect upon the previous condition
A detailed chronology and appropriate medical records can therefore be important when instructing a psychiatric expert in cases involving pre-existing mental health difficulties.
Assessing Prognosis
Prognosis is another important component of a psychiatric medico-legal report.
The psychiatrist may consider the claimant's progress since the incident, the severity and duration of symptoms, treatment undertaken to date and other relevant clinical factors.
Depending upon the instructions received, the expert may provide an opinion regarding:
Expected course of the psychiatric condition
Likelihood of improvement
Further treatment requirements
Anticipated duration of symptoms
Potential long-term psychiatric effects
In some cases, the psychiatrist may recommend reassessment at a later stage before a definitive long-term prognosis can be provided.
Functional Impact
Psychiatric injury may affect considerably more than an individual's subjective emotional wellbeing.
The assessment may consider the effect of symptoms upon:
Employment and ability to work
Education
Driving and travel
Family relationships
Social activity
Sleep
Everyday functioning
Participation in previously normal activities
This can help provide the instructing solicitor and, where relevant, the court with a clearer picture of the practical consequences of the psychiatric presentation.
When Is the Right Time to Obtain a Psychiatric Report?
There is no single timeframe applicable to every personal injury claim.
An assessment conducted very shortly after an accident may occur before the longer-term psychiatric picture has become clear. Conversely, delaying specialist assessment unnecessarily can leave an important component of the medical evidence outstanding.
Factors to consider may include:
How long the symptoms have persisted
Their severity
Whether the claimant has received treatment
Whether symptoms are improving or continuing
The stage of the legal proceedings
The particular medico-legal questions requiring an expert opinion
In some cases, an initial psychiatric report may be obtained with a subsequent review if an updated prognosis is required.
Psychiatrist or Psychologist: Which Expert Does the Case Require?
Psychiatrists and psychologists have different professional training and areas of expertise.
A Consultant Psychiatrist is a medically qualified doctor who has undertaken specialist training in psychiatry. A Clinical Psychologist has specialist psychological training and expertise in psychological assessment and treatment.
Both can undertake important medico-legal work.
The appropriate expert depends upon the issues requiring determination.
Where the solicitor requires an independent medical psychiatric opinion concerning psychiatric diagnosis, causation, medication, treatment or psychiatric prognosis, instruction of a Consultant Psychiatrist may be appropriate.
What Should Be Included in the Letter of Instruction?
Clear instructions allow the psychiatric expert to focus on the issues relevant to the proceedings.
Depending upon the case, a solicitor may ask the psychiatrist to provide an opinion on:
Whether the claimant has a psychiatric diagnosis
The severity of any identified disorder
Whether the condition is attributable to the relevant incident
The significance of any pre-existing psychiatric history
Current functional impact
Treatment requirements
Prognosis
Whether further psychiatric review is required
Relevant medical records and other supporting documentation should also be provided where appropriate.
Independent Psychiatric Medico-Legal Reports
The role of the psychiatric expert is to provide an independent medical opinion.
A medico-legal assessment is therefore distinct from a therapeutic psychiatric consultation.
The psychiatrist considers the history provided by the claimant alongside the available medical evidence and their own clinical assessment before providing an independent opinion addressing the questions raised by the instructing party.
Psychiatric Medico-Legal Reports Across Ireland
MLG MedicoLegal Group provides access to Consultant Psychiatrists for psychiatric medico-legal assessments throughout Ireland.
Our psychiatry panel provides independent expert reports for solicitors, insurers and other instructing parties across a range of matters, including:
Personal injury claims
Road traffic accidents
Psychiatric injury and PTSD
Workplace and occupational matters
Capacity assessments
Other civil litigation
MLG provides access to psychiatric medico-legal assessments nationwide, including Dublin, Cork, Galway and Limerick, with remote assessment available where appropriate.
Request a Psychiatric Medico-Legal Report
If you are a solicitor or other instructing party and require a Consultant Psychiatrist medico-legal report, MLG can coordinate the referral, assessment and reporting process.
Contact MLG MedicoLegal Group
Email: info@mlgroup.ie
Phone: 085 187 9332
Alternatively, use our online referral form to request a psychiatric medico-legal report.
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