My previous blog provided an overview of the various personal injury claims for psychiatric injuries. When pursuing any such claims, one of the most complex aspects is dealing with pre-existing psychological conditions. Many claimants worry that having a history of mental health issues may prevent them from recovering compensation. However, the law in England and Wales recognises that individuals with pre-existing conditions can still suffer new or aggravated harm due to someone else's negligence.
How does pre-existing conditions affect psychiatric injury claims?
The key legal principle that applies in these cases is the 'eggshell skull' rule, also known as the 'thin skull' principle. This doctrine states that a defendant must take their victim as they find them. In other words, even if the claimant would have suffered less or even no harm in the same circumstances had they not had any pre-existing psychiatric conditions, the defendant is still liable for the full extent of the harm that they caused.
This doctrine provides protection for claimants with pre-existing psychiatric conditions provided they were directly involved in the incident. The challenge in these claims lies in distinguishing between the psychiatric injury caused by the incident and the symptoms that existed before.
What is the divisibility of psychiatric injuries?
I stated above that the defendant is liable for the full extent of the harm that they caused. However, the defendant could be held liable for the entire psychiatric injury (including any pre-existing condition) if the injury is considered to be indivisible.
A divisible psychiatric injury means the harm can be apportioned between different causes (i.e. the harm caused by the pre-existing condition and the harm caused by the incident). In that instance, the courts may assign liability proportionally based on the contribution of each cause. Conversely, if the injury is indivisible, liability for the entire psychiatric injury falls on the defendant.
Determining the divisibility of a psychiatric injury requires expert medical evidence.
What is the role of medical evidence?
Medical records and expert psychiatric reports play a crucial role in these claims.
The claimant's solicitor will obtain the full medical records of the claimant from their GP and any other clinic they have received therapy. There is ordinarily no time limit or cut off point for these medical records. It is important to obtain the claimant's complete records (dating back even as far as their childhood) so that an accurate picture of their mental health prior to the incident can be determined.
Typically, a claimant will then undergo an independent medical assessment by a psychiatrist. This expert will review the claimant's medical records and assess the claimant during the appointment to:
- Determine the claimant's medical history prior to the incident.
- Assess the claimant's condition and symptoms after the incident, providing a diagnosis as well as commenting on the claimant's prognosis and recommended treatment.
- Provide an opinion on whether the incident caused the onset of a distinct psychiatric injury or worsened a pre-existing psychiatric condition (and if so, to what extent).
- Determine whether the psychiatric injury is divisible or indivisible.
If the medical evidence confirms that the incident caused at least a significant deterioration in the claimant's mental health, the claimant is likely to succeed in their claim.
What are the difficulties in claims involving pre-existing conditions?
Insurers may try to reduce the claimant's compensation by arguing that:
- The claimant's psychiatric injury is unrelated to the incident. The claimant must show (via medical evidence) that the incident caused or aggravated their condition. There must be a clear link between the incident and the onset of a new psychiatric injury or the worsening of the pre-existing psychiatric condition.
- The claimant's psychiatric injury would have deteriorated in any event, either in its expected natural progression or because the claimant was vulnerable to psychiatric injury and would have suffered a decline as a result of some other event regardless. If a psychiatric condition was stable or improving before the incident but worsened significantly after it, this can support a claim. Expert medical evidence is also vital in determining the claimant's vulnerability to psychiatric injuries.
How is compensation calculated?
Compensation in psychiatric injury claims consists of two main elements:
- General Damages – This covers pain, suffering, and loss of enjoyment of life. The severity of the psychiatric injury, its impact on daily life, and the length of recovery all influence the level of award.
- Special Damages – These cover financial losses such as medical expenses (for treatment and medication) and loss of earnings (where the new or exacerbated psychiatric condition has had an impact on the claimant's ability to work).
As I touched on above, in cases where the claimant has a pre-existing psychiatric injury, the compensation will reflect only the additional suffering, impairment and expenses caused by the incident rather than the full impact of the underlying condition unless expert medical evidence determines the psychiatric injury indivisible.
Final thoughts
Having a pre-existing psychiatric condition does not bar a claimant from seeking compensation for additional psychological harm caused by an incident. While these claims can be complex, with strong medical evidence and expert legal advice, individuals with pre-existing conditions can successfully prove their entitlement to compensation and secure the support they need to recover.
Originally published March 31, 2025.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
