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Personal Injury Claims - Psychosocial flags

There needs to be early focus on identifying psychosocial flags in personal injury claims

What we insurers and solicitors call a red flag in terms of factors which tend to increase a claim’s value, the medical profession have a more sophisticated flag colour system with a dedicated category for psychosocial factors we are told by Physiopedia, a UK charity providing rehabilitation knowledge for the physiotherapy profession (www.physio-pedia.com, “The Flag System” and various cited primary sources).

Pain experts will often report that reported symptoms in a claimant are being perpetuated by psychosocial factors, but what does that really mean and what should we be looking for to spot them as early as possible?

Psychosocial flags are non-clinical flags. So we are not looking for pathology (red flags for the medical profession e.g. neurological or musculoskeletal damage or disorders) nor mental health and psychological problems (orange flags e.g. PTSD or clinical depression) but the person themselves, their problem and social context and how those factors are affecting their recovery to full independence and work capacity. We are looking to identify that the person is at risk of chronic disability out of proportion with their injury/condition.

Psychosocial flags (yellow, blue and black flags) fall into three categories:

  1. Psychological presentation falling short of clinical condition i.e. beliefs, appraisals and judgements; emotional responses and pain behaviour:
    • Beliefs, appraisals and judgements – the belief without any physical or psychological mechanism that their pain is permanent or likely to worsen or that treatment is unlikely to assist.
    • Emotional responses - distress failing short of mental disorder about their condition.
    • Pain behaviour – avoidance of activities for fear of pain and reinjury or a reliance on passive treatments.
  2. Negative perception about their future dependence and inability to work.
  3. External obstacles e.g. prolonged litigation perpetuated by those around them not disagreeing with their negative thoughts and actions such as their family, treating medical practitioners and solicitors. Or clashes with employers over sickness absence or return to work. In this regard, one thing we often see is lengthy treatment of pain with medications such a gabapentin during the course of litigation, unlikely to improve non pathological or mental health symptoms.

In the current economic climate, with increased financial pressures on most, the likelihood of psychosocial factors prevailing is increased. With that comes the risk of no return to work or independence with resultant significantly increased claims cost. It is crucial that we don’t find out that such factors are at large at proceedings stage, three years on from injury when behaviours or external factors are entrenched, making reversal of the same less likely. The message for handlers is to look further than physical and mental health recovery to other more subtle bars to the claimant returning to normal life rather than just assuming that the claimant is exaggerating and that we will get surveillance or other intelligence to defeat the case. The claimant’s solicitor’s behaviour and approach to the claim can be a significant factor.

As we were reminded in a recent Law Times Canadian Law article (14 January 2025), claimant’s solicitors are only too aware of the need early on to distinguish a credible claimant from one who is exaggerating, to get the usual treatments in place (whether they succeed or not) and the correct expert on board to support those claimants they represent who appear credible. They will advise social media abstinence to avoid a claimant being judged by activity on “good days” and advise flexibility with the way they describe their functional ability so they cannot be backed into a corner having said they cannot do something when they can do it on occasion. So, it is an uphill battle mounting a successful challenge to such carefully constructed cases when dealing with experienced claimant personal injury solicitors. There needs to be early focus on identifying the flags and putting in place appropriate rehabilitation aimed at the factors perpetuating non recovery as early as possible alongside consideration of credibility.

Rebecca Blythe 

For further information, contact our defendant catastrophic personal injury solicitors.

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