Chronic pain cases

Early identification of chronic pain cases is often difficult. A case involving seemingly modest injuries at the outset can often end up evolving into a costly claim for Insurers. 

The analysis of our data reveals why early identification (and subsequent settlement) of such cases is at times problematic. However, if defendants and their insurers can identify these claims at the earliest possible stage the potential financial benefits are significant. 

We examined our database of settled large loss claims  and found that alongside tetraplegic cases, chronic pain cases have the longest average period from the date of accident to date of settlement, at 1,331 days (approximately 3 and a half years). 

Where our data most starkly demonstrates the potential difficulties identifying chronic pain cases is when looking at the period between the date of accident and the date when instructions are received from Insurers. The chronic pain injury type has far and away the longest period between date of accident and date of instruction, at an average of 823 days (approximately 2 ¼ years). For comparative purposes, the injury type with the second longest period has a period of 485 days (nearly 11 months less compared to chronic pain cases). 

A natural question which follows is: do chronic pain cases also have the longest average period between receipt of instructions and settlement?  In short – no,, far from it. Our data demonstrates that the average period from the date of instruction to date of settlement for a chronic pain case is the third lowest of the injury types, at 508 days. For comparative purposes, the injury type with the longest average period from instruction to settlement is tetraplegic injury at 1,165 days, and the shortest average period is orthopaedic injury, at 427 days. The overall average period from date of instruction to date of settlement across all cases of all injury types is 630 days.

Early identification of a chronic pain case has the obvious and immediate benefit of enhanced insight as to the claim’s potential value. Armed with this knowledge, claim strategies and early settlement offers are better informed. Similarly, early settlement coupled with swifter panel instruction can also have the additional advantage of reducing the ultimate monthly “burn rate” cost of the case. Our data shows the average chronic pain case has a monthly burn rate of £8,341.   

It is important that insurers spot potential red flags early in what can be difficult circumstances when there may be little engagement from the claimant and their team in some cases. Insurers in these scenarios are too often left in the dark as to the claim’s true potential value. This approach also makes it more difficult to alter the claim’s trajectory once multi-disciplinary medical reports are obtained and treatment programmes are already in place. 

So, how can Insurers spot potential red flags and other issues to identify sooner the potential of a chronic pain case developing? One or more of the triggers below may indicate a person is susceptible to develop or suffer a pain condition:

• Ongoing symptoms greater than 6 - 12 months.
• Pain and disability exhibiting without cause.
• Deteriorating symptoms.
• Pain and disability greater than can be explained by underlying physical cause.
• No anatomical or physiological explanation in some cases.
• 50% of neurology outpatients have a functional symptom.
• Are medical records being withheld without cause?
• Is there a ‘diagnosis’ or any reference to pain in medical records, comments made to experts by a claimant or by an expert generally?
• Look for possible motivational factors as to the benefits of being ill and/or disabled the need for reward for the disability.
• Is there any history of sexual, physical or emotional self-harm, eating disorders, IBS, marital and family problems or financial issues?
• Is the claimant still off work after a long period of time?
• Were there any repeated absences from work prior to the accident?
• Is there a referral to a pain specialist or care expert in terms of further treatment and assistance with recovery?
• Have the claimant’s solicitors advised further medical evidence is being obtained or they cannot yet disclose medical evidence?
• Is there any evidence of psychological issues?

If one or more of these red flags are present, then it may be a key indicator in identifying a potential chronic pain case. Proactive steps can be taken following identification to ensure that these cases are carefully managed and claim life cycles reduced. See our very helpful chronic pain guide for further information on tactical approaches in these claims to achieve this.