Articles

Support Following a Serious Injury

Following a serious injury, an individual will face immediate and profound changes to their life. Physically, this could vary widely depending on the nature and severity of the injury. Some individuals may require the amputation of a limb, which can lead to significant adjustments in mobility and the ability to complete day-to-day tasks.

Alternatively, it could result in the paralysis of the lower body, necessitating the use of a wheelchair and a period of intensive and ongoing rehabilitation. manifest as requiring an amputation of a limb or living with paralysis of the lower body.

Psychologically, the aftereffects of a serious injury can be equally, if not, more challenging. Following an injury, many individuals experience a range of mental health issues, may include such as depression due to the sudden change in lifestyle and loss of independence, anxiety driven by concerns about the future, or PTSD, which may present itself through flashbacks or severe anxiety.

The physical and psychologic challenges can create a complex and demanding recovery process, with rehabilitation needed to address both physical rehabilitation and mental health support. To address the various needs of the individual, a case manager will conduct an Immediate Needs Assessment (INA) as part of the client’s case management process. This assessment with identify the client’s urgent post-injury requirements, focusing not only on the physical injury and aftercare but also providing a provision for psychological support.

The impact of serious injuries on a persons mental health

Serious injuries can profoundly affect a person’s mental health. Fear, anxiety, frustration; sadness are just some of the emotions a client may experience following the injury. The sudden shift in physical capabilities can often lead to feelings of helplessness and vulnerability and many individuals may also struggle with a sense of loss.

Understanding the effect of the injury, creating coping methods for pain, or coming to terms with a client’s disability will cause the psychological impact of an injury to extend beyond the initial shock. This will often manifest as mood swings, insomnia, depression, or even post-traumatic stress disorder (PTSD).

Insights from our case management team

A holistic plan is crucial for the client’s recovery. Our team work closely with psychologists and psychiatrists, and other specialists, as instructors of a multidisciplinary team (MDT) to ensure the entirety of the client’s needs are met.

Empowering U case managers introduce personalised rehabilitation plans and coordinate various aspects of treatment to ensure comprehensive recovery. Understanding that addressing mental well-being is just as important as treating the physical injury itself, we address both aspects equally

Incorporating insights from our experienced case managers enhances the quality of care provided to individuals recovering from serious injuries. Their commitment to individualised support helps foster resilience and promotes overall well-being throughout every step of the recovery journey.

The inseparable link between physical and mental care

When it comes to recovering from a serious injury, the connection between physical and mental well-being is undeniable. The body and mind are intricately linked, with each impacting the other in significant ways. Physical pain can often lead to emotional distress, while mental health struggles can manifest physically.

An integrated approach recognises that recovery goes beyond just physical rehabilitation; it involves supporting emotional resilience as well.

Our case managers understand the importance of comprehensive support that addresses not only the visible injuries but also the invisible. By acknowledging this crucial link, they strive to ensure our clients achieve a true and lasting recovery.

What is Parkinson’s? 

Parkinson’s is a progressive neurological disorder that affects movement. It develops gradually, usually starting with minor tremors in one hand. Over time, the symptoms worsen and can include stiffness or rigidity of muscles, Bradykinesia (slowness of movement), impaired balance and coordination, and difficulties with speech and writing. 

What causes Parkinson’s? 

Parkinson’s disease primarily affects the brain’s nerve cells responsible for producing dopamine, a chemical messenger essential for smooth and coordinated muscle movements. As dopamine levels decrease, individuals experience a variety of symptoms, including tremors, stiffness, slowness of movement, and impaired balance. 

There are several types of Parkinson’s disease, with the most common being idiopathic Parkinson’s disease, which has no known cause. Other types include Parkinsonism, which refers to conditions with similar symptoms to Parkinson’s disease but with different underlying causes, such as drug-induced Parkinsonism or vascular Parkinsonism. 

Is there just one type of Parkinson’s? 

Parkinson’s is just one condition that falls under the Parkinsonism umbrella. This is a term that covers a wide range of conditions with symptoms like Parkinson’s. 

Idiopathic Parkinson’s 

Meaning the cause is unknown, this is the most common form of Parkinson’s and accounts for the vast majority of instances. 

Young-onset Parkinson’s 

Typically, Parkinson’s occurs in individuals over 50 however when it occurs in a person under 50, this is called Young-onset Parkinson’s. Young-onset Parkinson’s differs from Idiopathic Parkinson’s in several ways: 

• Slower progression over time 
• Less frequent cognitive problems such as Dementia 
• More frequent dyskinesias (involuntary body movements) 
• Earlier and more frequent dystonias (cramping and abnormal postures) 

Vascular Parkinson’s 

Also known as Arteriosclerotic Parkinsonism, this is when the blood supply to the brain is restricted. This may develop in individuals who have had a mild stroke. 

Comprehensive Support at Empowering U 

Empowering U is dedicated to empowering individuals with Parkinson’s to live fulfilling and independent lives. Our team of experienced care managers and healthcare professionals provides personalised support tailored to each individual’s unique needs. 

Holistic Care Approach: 

We understand that Parkinson’s impacts every aspect of a person’s life, from physical health to emotional well-being. That is why we take a comprehensive approach to care, addressing not only the physical symptoms but also the psychological and social aspects of the disease. 

Not everyone with Parkinson’s has the same set of symptoms; at Empowering U, we take a person-cantered approach to helping those in our care. People with Parkinson’s are experts in their own condition, and we encourage and assist them in advocating for their needs, emphasising what they can do rather than what they can’t.

Rachel Cox, Clinical Lead

Specialised Services 

Our range of specialised services includes: 

1. Care Coordination: We work closely with healthcare providers to ensure seamless communication and coordination of care, including medication management and therapy sessions.
2. Symptom Management: Our team develops personalised care plans to address specific symptoms, such as tremors, rigidity, and gait disturbances, utilising a combination of medication, physical therapy, and other therapeutic interventions.
3. Education and Support: We provide educational resources and support groups to help individuals and their families better understand Parkinson’s and learn effective coping strategies.
4. Assistive Technology: We offer guidance on the use of assistive devices and technology to enhance mobility, communication, and overall quality of life.
5. Emotional Support: Living with Parkinson’s disease can be emotionally challenging. Our compassionate team provides support to help individuals and their families navigate the emotional ups and downs of the disease.

Why Empowering U? 

1. Expertise: Our team consists of experienced healthcare professionals with specialised training in Parkinson’s management.
2. Comprehensive Support: From symptom management to emotional support, we offer a comprehensive range of services designed to address the diverse needs of individuals living with Parkinson’s disease.
3. We Empower U: We believe in empowering individuals with Parkinson’s to take control of their health and well-being. Through education, support, and access to resources, we help our clients live fulfilling and meaningful lives despite the presented by Parkinson’s.

We are committed to providing individuals with Parkinson’s, and their family, the resources, guidance, and support they need to live their best lives.  

If you or a loved one is living with Parkinson’s, contact Empowering U today to learn more about how we can help 

Call: 0330 128 1722 or email: hello@empoweringu.co.uk

What is the 2015 Rehabilitation Code? 

First introduced in 1999, and later reformed in 2007 and 2015, the Rehabilitation Code promotes the collaborative use of rehabilitation and early intervention in the compensation process. Its main aim is to encourage this collaboration to enable the best and quickest possible medical, social and psychological recovery of an injured person (‘Claimant’) regardless of the severity of the injury, returning them as much as possible to the position they were in before the accident.

The third version was introduced in 2015 and created by representatives from ABI, APIL, CMSUK, FOIL, IUA, MASS and PIBA. The largest difference is that lower-value claims (up to £25,000) are now included, recognising the need for early intervention in all cases. 

Claimant Party 

After an individual is injured, the solicitor is responsible for advocating on behalf of their client’s best interests, which goes beyond just securing financial compensation.  It also includes assessing whether medical or rehabilitative treatment would improve the client’s present or long-term situation. This role is continuous throughout the lifespan of the case but of particular significance during the early stages of the claim. 

It is also the duty of the claimant solicitor to meet with the claimant and/ or their family to identify if there is an immediate need for aids, adaptations, or adjustments to employment, facilitating the claimant’s continued performance in their existing job, securing a suitable alternative role with the same employer or aiding in retraining for new employment opportunities. The solicitor must also, where practical and proportionate, work with the claimant’s employers to ensure that the position is kept open for them as long as possible. 

The solicitor then needs to communicate any requirements to the compensator as soon as is practical to enable them to work collaboratively to address all rehabilitation needs. 

The Compensator 

From the earliest practical stage, it is the duty of the compensator to consider whether the claimant would benefit from additional medical or rehabilitative treatment. This duty continues through the life of the case. 

If the claimant has been identified as requiring rehabilitation, the compensator must contact the claimant solicitor as soon as possible to collaboratively work together to address the claimant’s needs.

The Case Manager 

In catastrophic and severe cases, the 2015 Rehabilitation Code recommends a qualified Case Manager should be appointed before any rehabilitation commences. In some cases, this may not be possible but should be considered a priority. 

The Case Manager’s role is to assess the client’s needs, coordinate various services, and facilitate rehabilitation efforts. In medium, severe and catastrophic injuries, a Case Manager will notify the need for and type of rehabilitation assistance by means of an Immediate Needs Assessment (‘INA’). The INA will be carried out by a Case Manager or appropriate rehabilitation professional, e.g. an NHS Rehabilitation Consultant. 

The Code notes that a Case Manager must be professionally and suitably qualified and experienced according to the injury sustained. Our Case Managers are trained in a range of fields: 

• Brain Injury 
• Spinal Injury
• Orthopaedics 
• Paediatrics 
• Functional Neurological Disorder (‘FND’) 
• Amputation 
• Neurological Disorders 
• Mental Health 
• Drug Misuse  
• Musculoskeletal 
• Complex Care and Complex Polytrauma 

They are also registered with professional bodies including: 

• BABICM (‘British Association of Brain Injury & Complex Case Management’) 
• CMSUK (‘Case Management Society UK’) 

Our Approach and Expertise 

The primary goal of the Code is to prioritise the injured individual’s involvement in the entirety of the process, empowering them to maintain control over their treatment whenever feasible. 

Our team employs a collaborative and transparent approach, serving as a central figure within a Multi-disciplinary Team (‘MDT’), and holds a respected position within the clinical negligence and personal injury sectors. 

Instructed by some of the UK’s leading solicitors and law firms, our team uses their expertise to conduct Immediate Needs Assessments, create reports, and play a vital role in orchestrating and strategising the necessary care and rehabilitation for the client. 

Who is Nadia Hussain?

Nadia is an Occupational Therapist and Case Manager at Empowering U Case Management with over 6 years of clinical experience.  

She is also a practicing Muslim and is observing Ramadan in 2024. We recently asked Nadia to speak about what Ramadan means for her, the advice she has for non-Muslim colleagues and clients, and advice for workplaces during the month. 

What is Ramadan?

The ninth month of the Islamic calendar is one of the holiest events for Muslims around the world. The Islamic calendar follows the cycles of the Moon with Ramadan starting 11th March 2024, the first appearance of the new Moon, and ending 9th April 2024. 

During this month, most Muslims observe a strict fast from dawn until sunset and those who do fast, are unable to eat or drink during daylight hours. Fasting allows Muslims to devote themselves to their faith and is thought to teach self-discipline. 

What does the month of Ramadan mean to you? 

The month of Ramadan for me is a month of spirituality and connecting with ourselves. The purpose of Ramadan is to give us one month in the year to reflect and think about those less unfortunate in the world who do not have the same privileges and luxuries that we take for granted every day.  

We learn self-discipline by adhering to fasting times which then makes us feel mentally strong as the days go on. It’s also a month where families and communities come together to cook for one another, share food and eat together! Many people tend to say there’s just ‘something peaceful in the air’ during this month. Everything feels calm, joyful and rewarding. We have a celebration to mark the end of Ramadan and our achievements called ‘Eid-ul-fitr’ which can last up to 3 days of celebrating. 

Do you have advice for colleagues and clients who are non-Muslim?

Be Mindful: 

Muslims practice their religion all year round, however some people find Ramadan as a good opportunity to start practicing stronger with their prayers. It is important to make sure Muslims are able to take time out for daily prayers in their working day and they should be accommodated a quiet space/room to pray if they work in an office. 

Also, people with health issues, young children, pregnant women and breastfeeding mothers are usually exempt, but it is up to the individual if they choose to fast. While some may not be fasting, they may be observing other spiritual aspects of Ramadan, such as prayers and giving to charity.

Sometimes people feel the need to apologise if they’re eating in front of someone fasting. I know it comes from a place of wanting to be respectful but when we are fasting, we are not usually phased by that as we build a lot of self-discipline and resilience up! 

What role can a case manager play when a client is fasting?

• Start off by wishing them ‘Ramadan Kareem’  
• Be mindful when scheduling any meetings in case they clash with prayer times or the time of breaking their fast. 
• Ask them if they require any support 

How can an employer support Muslim employees who are fasting?

Ask Questions:

Muslims are happy to discuss and explain their faith especially Ramadan as it is such an important month for them. It is a positive thing to increase our knowledge of different faiths and backgrounds so don’t be shy to ask questions. 

Flexible Working:

Fasting starts from sunrise to sunset which means we wake up quite early just before sunrise to have something to eat (suhoor) and then we do not eat until sunset (iftar). Therefore, people might be more tired than usual in the day without food and drink in fasting hours and may need flexible working hours. For example, they may benefit from moving their shift hours temporarily to 10-6pm as opposed to 9-5pm. 

An introduction to Warren Maxwell

Warren Maxwell is a Partner at Stewarts Law, the UK’s largest litigation-only law firm. With over 400 staff and 80 partners, they have an international reputation for excellence, and we are delighted to be able to work with Warren Maxwell in providing this knowledgeable article.

At Stewarts, Warren works within the personal injury department and represents claimants in high-value and often complex personal injury claims. With significant experience in representing child and adult claimants with the most severe of cases, Warren is ranked Band 2 in Chambers and Partners and is described as “well versed in cases involved serious injuries arising from workplace incidents and RTAs”. Stewarts are also ranked Tier 1 in The Legal 500 with Warren noted as “at the top of his game and has a superb manner with clients and experts alike.”

When is an accident a claim?

At the outset, it’s important to recognise that accidents happen and not every accident gives the injured person a right to claim compensation.

Most of the accidents I deal with involve road traffic collisions, accidents at work or in a public area. I have also represented people injured while playing contact sports or horse riding.

In order to claim damages, it is essential to prove fault either in full or in part on another party, whether that be another driver, your employer or a contractor on site, local authority or sports player. That means being able to show that they:

• owed you a duty to take reasonable care;
• their conduct fell short of that duty; and
• they exposed you to a reasonably foreseeable risk of harm.

Another consideration is whether the party who caused your injuries has insurance or other funds to meet your damages claim, and your potential legal costs. Often this is a straightforward issue, particularly with road traffic collisions and accidents at work as insurance is a legal requirement, but it can become complex. Investigations are sometimes required into cover held on household insurance policies and whether the wrongdoer has sufficient money to meet the costs of the claim personally.

I have successfully obtained damages for a number of clients who did not think they had a case so, if there is in any doubt as to whether a claim for compensation is possible, it is always best to check with a suitable lawyer.

When looking for a suitable lawyer, a useful starting point is to ensure the lawyers you speak with are experienced in handling cases involving the same type of injury as yours, for example spinal cord injury or brain injury. One way of doing this is to check whether they are accredited in that field by the Association of Personal Injury Lawyers (APIL)  www.apil.org.uk.

It is important to ask how many cases the lawyer currently handles. At Stewarts, each lawyer handles 10-12 cases at most as, in cases involving life changing injuries, it is important that no stone is left unturned in order to ensure the very best outcome is achieved for every client in terms of rehabilitation, care and damages.

Where a claim exists, the aim of the law is to put the injured person in the position they would have been in had the accident not happened, insofar as is possible. At Stewarts, our clients often have significant and lifelong needs, so that aim involves helping our clients to become as independent as possible so they can return to their previous lives as much as they are able.  We have an emphasis on ensuring our client’s quality of life is a good as it can possibly be, despite life-changing injuries.

The role of the personal injury lawyer in serious injury cases is to ensure their client recovers the maximum damages to which they are legally entitled. We do this by firstly ensuring our clients obtain the best rehabilitation and support available; introducing our client to experienced and suitable case managers as quickly as possible is the first step in achieving that aim.

How do you choose a case manager to work with your client?

Firstly, I always use the starting point that it is my client’s decision as to who they would like to appoint as their case manager.  The client is at the centre of the claim and this is integral to developing a trusting relationship, as claims usually take several years to conclude.

In our almost 35 years in practice, Stewarts’ personal injury lawyers have only represented accident victims with life changing injuries. As such. we have worked with many different case management companies and case managers across the country. Those we choose to work with are tried, tested and most importantly trusted, with excellent governance, record keeping, established working relationships with excellent clinicians in the wider MDT fields and a strong commitment to helping seriously injured people.

When choosing a case manager, I am a strong believer in the ‘meet & greet’ process. This is where clients are introduced to two or three case managers in order to decide who they wish to instruct. The case manager has to “fit” with the client, and with their family. It is important to remember that the client’s family are hugely affected by a life-changing injury to a loved one and must be included in accordance with the client’s wishes.  I am happy to attend the meeting to help guide the client through the process and ask any important questions.

This approach increases the client’s understanding of case management and the role the case manager will have in their rehabilitation journey, which in turn provides them with an informed choice. It also gives the client an opportunity to ask questions of each case manager as to their knowledge, their clinical and case management experience, and their likely approach to the client’s rehabilitation and care needs.

How important is the case manager in a serious injury claim?

Case managers have a key role in a serious injury claim. As our client’s ‘guides’ through their post-accident journey, their knowledge of suitable local care and rehabilitation providers is crucial in ensuring the right therapists are involved from the outset, and managed in the longer term. At Stewarts, we are always keen to work with talented and committed case managers and making new contacts is another benefit of the ‘meet & greet’ process.

When it comes to working with case managers, collaboration is crucial. Clients who have sustained life changing injuries need a huge amount of support and guidance in order to maximise the benefits of the rehabilitation and support package and regain as much independence as possible. The many ‘moving parts’ need attention and the solicitor can and should support the case manager if needed. Similarly, if funds are running low or there is an unexpected item of expenditure now on the horizon, the lawyer needs to know so that funds can be obtained before it is too late. It’s therefore essential that the case manager feels comfortable enough with the solicitor to pick up the phone and speak if needs be.

It can take time to obtain interim payments from insurance companies to fund the client’s care and rehabilitation package while the claim is running. Insurers often reasonably wish to understand what the funds are being spent on and feel confident that the funds will be used to to provide a real benefit to the injured party. Having the support from an experienced, knowledgeable and efficient case manager is often vital in securing the funds quickly.

Case managers are also important witnesses and I invariably take a witness statement from them to support the client’s claim. They have usually been involved with their client’s rehabilitation from the outset and have an intimate and detailed knowledge of our mutual client, their family and support network, rehabilitation and care needs, and how they have been met over the course of the legal claim.  Giving a statement on behalf of the client means it is likely the case manager will be called as a witness to give evidence at trial if settlement negotiations have failed and the issue of the damages, needed to meet the injured person’s lifetime needs, is determined. Fortunately such trials are relatively rare and most cases settle by negotiation.

It is also important that experts instructed by the parties to provide evidence to the court hear what the case manager has to say. These experts receive all of the relevant notes, records, reports and statements ahead of an assessment, but may only spend a few hours with the claimant before writing their reports setting out their expert opinion as to what a person’s needs are and what their long-term outcome is likely to be. The case manager should attend the expert meeting, or speak with the expert afterwards, to ensure nothing has been missed.

What are the pros and cons of the Rehabilitation Code 2015?

The Rehabilitation Code 2015 (“the Code”) provides a framework for the parties in a claim to work together outside of the litigation process to provide  rehabilitation and support to an injured person. The Code can be found here: Rehabilitation Code 2015

One of the biggest benefits of the Code to claimants is that payments that the other party’s insurer makes under the Code are paid on a 100% basis. Even if the claimant is subsequently found to be partly at fault for the accident, or even fully to blame, the insurers will have paid for the agreed items in full and cannot seek to recover the cost from the client.

One of the trade-offs is that the insurer receives simultaneous disclosure of the Immediate Needs Assessment (INA), the document produced by the case manager following our initial review of the injured person. This prevents the claimant’s solicitor having a first peek at the report and perhaps working with the case manager to emphasis certain parts of the INA for the claimant’s benefit. Other trade-offs are that;

1. the case manager cannot be a witness in the claim, and
2. the INA should fall outside the litigation and should not be referred to by the litigation experts.

In practice, the parties often agree to the contrary. That is my preference as case managers often make important and powerful witnesses. Experts also benefit from seeing the INA, as it is the very foundation of the care and rehabilitation package which will be subsequently commented upon by the litigation experts when they provide their reports to the court.

One issue that I do see arising, often after a case is transferred to Stewarts from another firm of solicitors, relates to ongoing simultaneous sharing of documents. Whilst the INA should be sent to the claimant and defendant’s representatives at the same time, all other notes and reports created during the subsequent case management process are covered by the usual legal principle in relation to disclosure of documents and medical records relating to the claimant, unless the parties agree otherwise. They should be sent to the claimant’s solicitor first; it is for the claimant’s solicitor to send them to the insurer or their representatives as the case progresses.

What does the perfect Case Manager’s file look like?

The claimant has a duty to disclose the case manager’s file notes and it is therefore essential that the file is prepared properly. Disclosure usually starts relatively early with the claimant agreeing to voluntary disclose documents on a rolling, often quarterly, basis.

When receiving documents from case managers, I expect to see all correspondence and telephone notes taking place over the relevant period. It is often also helpful to see notes containing the case manager’s thoughts and views at that time and any justifications for measures they have suggested, or input they consider appropriate. These contemporaneous records are often illuminating and helpful as, it has to be born in mind that memories fade and it may not be until some years later, when giving a witness statement or in trial, that the case manager is asked to explain why they chose to recommend a certain route to the claimant.  Documents can also be exhibited to a witness statement and are often helpful for the court.

Case management files are sometimes split into ‘privileged’ and ‘non privileged’ documents. This is helpful but case managers should not be too worried about getting this perfectly correct; it is the lawyer’s role to advise their client on which documents are privileged and should not be disclosed to the defendant’s insurer.

Carers daily records are also very important documents, which will be passed to the litigation care experts to comment upon. They need to be legible, thorough and informative. I often ask for ‘highs and lows’ to be recorded. Care is often one of the most contested area within damages, so good notes that justify the support and the benefit to the client are worth their weight in gold.

Having copies of all invoices evidencing the claimant’s expenditure allows their lawyer to keep an up-to-date Schedule of Loss, a document that it is necessary to provide if a court hearing to determine whether a further interim payment should be made is needed.

The least valuable document is a goal sheet that wallows without any update. If goals are not progressing, it’s best to explain why. This is something insurers will nearly always pick up on.

I always review the case manager’s notes and records as they give me another insight as to what is happening in my client’s life and rehabilitation. If there are particular issues that the claimant is struggling, the solicitor can often assist or bring in further support from the client’s barrister and/or experts who can work through any issues the claimant has.

When writing notes, it is best to always assume that the other party’s legal team and insurer, experts, barristers and judge may well read the document and that you could be questioned upon it.

It’s best not to refer to information contained in expert reports or recite the content of calls with lawyers of either side. Recordings of expert assessments should not be made unless asked by the parties’ lawyer and I would recommend that the case manager always check first with the expert before making a recording.

What are your five top tips for Case Managers?

1. Talk to your solicitor; we should always be approachable and available to you. Sound us out on your thoughts for our mutual client’s rehabilitation and care. Ask us when funds are due in.
2. Evidence your work. If it’s not recorded, then it (arguably) didn’t happen.
3. Give us plenty of warning and lead in time. Often evidence is needed to justify interim payments and various steps may be needed before the request or application for funds can be made.
4. Help out at expert appointments. You have so much useful information about your client’s care and rehabilitation needs that the court will benefit from hearing.
5. Talk to your solicitor; it’s so important, it’s worth mentioning twice.

For further questions and queries contact:

Barry Lehane

RGN, LLM

Head of Case Management and Rehabilitation

barry.lehane@eucm.co.uk – 07928 511 071

Jenny Mitchell

BA (Hons), CMgr, MCMI

Head of Business Operations

jennifer.mitchell@eucm.co.uk – 07842 245 019