Angles on Amputation with Crown Office

Transcript

Elizabeth Wallace:

Hello, and welcome to the next episode in our Large Loss podcast series for Weightmans. I’m Liz Wallace, a Partner in the Weightmans Large Loss team in Manchester, handling catastrophic injury claims for insurers and large corporates. I also head up our Large Loss Technical Unit, and I have a particular interest in amputation claims.

I’m pleased to be joined by Gemma Witherington from Crown Office Chambers, a barrister who is consistently recognised as a leading junior specialising in personal injury, insurance fraud and professional negligence, as well as sitting as a Deputy District Judge and Recorder for civil work. Gemma and I have worked on several cases together, including amputation cases, and I’m delighted that she’s joined us today to give us her perspective.

Today, in the next episode of our series, we’ll take stock of where we are with amputation claims in 2026, which of course means touching on prosthetics, osseointegration, claims management and rehabilitation.

I think we’ll start with amputation itself. Although many of the cases we see involve traumatic amputation, where the limb is lost at the time of the accident or during surgery immediately afterwards, we also see a number of elective amputation cases where, despite everyone’s best efforts, the claimant and their surgical team decide to amputate at a later stage.

We know that, not least because of the incredibly functional prostheses now available, and probably because of the severe pain many claimants suffer following injury, the prospect of life after elective amputation can seem very attractive. Claimants may choose amputation in the hope of achieving a pain-free life with improved functional ability. However, in our experience, treating clinicians will still take every possible step to salvage the limb.

Gemma, I know you have some views on this. What’s your position?

Gemma Witherington:

I agree. Removal of a limb is always going to be a last resort. However, there are some really interesting rehabilitation programmes available very early on that can help preserve a limb.

For example, there’s an NHS service called the Oxford Bone Infection Unit, which is dedicated to investigating and treating patients with serious bone infections. As we know, following severe crush injuries, infection can become a significant issue and is often one of the main reasons an amputation is ultimately required.

If you look at the unit online, you’ll see they have very high success rates in treating infection.

It’s only a relatively small unit, with around 26 beds, and of course patients need a referral. I have no doubt it’s very difficult to secure a place there. However, I think it’s important to look proactively at rehabilitation early in a case and consider what treatment options are available. Services such as the Oxford Bone Infection Unit can make a real difference for the right patient.

Another interesting aspect of the unit is that they’re involved in clinical trials and are exploring more experimental treatments. For example, they’re looking at different types of antibiotics that patients can administer at home to reduce infection.

That can have a significant impact on a case because it reduces travel requirements, inconvenience for the claimant and disruption to their rehabilitation programme. There are lots of exciting developments taking place within the NHS, and I think it’s really important to be aware of them so that when a case crosses your desk, you know what options may be available.

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Elizabeth Wallace:

Absolutely.

I suppose when we’re talking about limb salvage or elective amputation, it would be remiss of us not to mention the shocking case of Dr Neil Hopper, who amputated his own legs.

Gemma, would you like to outline the facts of that case?

Gemma Witherington:

Absolutely. It was a truly shocking case, and if you haven’t come across it before, it’s certainly worth reading about. It’s also still developing in the news.

Dr Neil Hopper was an NHS vascular surgeon. In May 2019, he underwent bilateral below-knee amputations, claiming they were necessary because of a serious medical condition.

In reality, he had used dry ice to deliberately freeze his own legs so they would require amputation.

To cut a long story short, investigators looking into online body mutilation networks discovered that he had been purchasing videos of people mutilating themselves and had developed an interest in this type of content.

He was subsequently prosecuted for insurance fraud after making claims worth almost half a million pounds following the amputations.

He’s now serving a prison sentence of two years and eight months for insurance fraud and possession of extreme pornography.

However, the wider concern, which is still the subject of ongoing investigation, is that as a vascular surgeon he treated many hundreds of patients who underwent amputations. Investigations are continuing into whether all of those procedures were clinically justified.

So I think it’s a case to watch, and we’ll almost certainly hear more about Dr Hopper in the future.

For the purposes of today’s discussion, though, it also highlights the enormous impact that psychological issues can have in cases involving amputation.

Elizabeth Wallace:

Yes, absolutely.

Whether it’s following an injury or relates to a pre-existing psychological condition—because, of course, you take your victim as you find them—or someone experiencing body dysmorphic disorder, we mustn’t underestimate the psychological impact of amputation.

Psychiatric evidence can be incredibly important. How does somebody feel about the limb they’ve lost, or the possibility of losing it? People respond in very different ways.

There can also be cultural differences in attitudes towards amputation.

In some parts of the world, cosmetic prosthetics are much more popular than the more obviously bionic appearance, with people preferring to disguise the fact they’ve undergone an amputation.

Gemma Witherington:

Absolutely.

Another case worth mentioning is Halley v Newcold in 2025, because we don’t see many reported amputation cases anymore. The vast majority appear to settle, and I believe this was the only reported amputation case in 2025.

It’s particularly interesting in relation to elective amputation.

The claimant brought a claim worth close to £1 million following a serious workplace crush injury. Liability wasn’t in dispute. However, five years after the accident, the claimant elected to undergo a below-knee amputation.

He significantly increased the value of his claim on that basis.

However, the judge concluded that the amputation was elective, was not reasonably required and therefore broke the chain of causation.

Unfortunately for the claimant, that aspect of the claim failed.

I think it’s an important reminder to look very carefully at the evidence in these cases. If an amputation is elective, is it genuinely and reasonably required? If not, a claim for damages arising from that decision may not succeed.

Elizabeth Wallace:

Yes, absolutely. That’s really interesting.

And the Dr Hopper case is just mind-blowing on so many levels.

Perfect! Here’s Part 2 edited and formatted so you can paste it directly into your transcript.

Elizabeth Wallace:

Moving on to touch on osseointegration. I know that our own experience at Weightmans, and in claims generally, is that these cases remain few and far between. Whilst osseointegration is much more likely to be explored as an option by treating clinicians and claimants, we’re not really seeing it translate into claims.

Have you seen many osseointegration cases, or do you think it has changed the type of prosthetic solutions claimants are seeking?

Gemma Witherington:

You know, I really thought about ten years ago that we were going to see an absolute explosion of these sorts of cases. However, in my experience, they just haven’t really filtered through.

Like you, I’ve seen a handful of the more serious cases. They’re generally younger, more active claimants who are looking for that type of technology. But as a general rule, I don’t tend to see these cases in the average claim.

I don’t know whether that’s because many claimants are put off by the permanence of the procedure. In my experience, many amputees actually adapt better than they initially expect and, by the time the claim progresses, they’re often less keen to pursue osseointegration because they’ve become accustomed to using removable prosthetics.

I simply don’t see as many cases as I expected.

I was speaking to an expert the other day about this, and he reminded me that whichever part of the body has been injured, the success of different prosthetic options varies enormously depending on whether you’re dealing with an arm, a hand, a leg or a knee.

It’s important to remember that when I first came into practice almost twenty years ago, you couldn’t even access osseointegration in the UK—you had to travel to Australia.

I remember sitting in conferences discussing claims for flights, accommodation and all of the associated costs because the treatment simply wasn’t available here.

The fact that it is now available demonstrates just how much technology has progressed over the last twenty years. It’s fascinating, but I don’t really know why we’re still not seeing these cases become more commonplace. Perhaps we will over the coming years.

Elizabeth Wallace:

Of course.Thinking more generally about prosthetic advancements and the prevalence—or perhaps lack—of artificial intelligence, I still don’t think we’ve seen the technological breakthroughs that many anticipated, particularly following developments such as 3D printing.

There certainly have been advancements. I know the NHS fitted its first patient with a Hero PRO bionic arm last year, which was fantastic. The NHS is probably still behind the private sector in terms of prosthetic provision, but that’s an incredibly positive step.

I also think developments in neurotechnology are clearly on the horizon and, hopefully, will lead to much better outcomes for amputees. The question, though, is when. It doesn’t seem to be a matter of one, two or even three years as perhaps many people expected.

Gemma Witherington:

I completely agree.

I think we’re realistically looking at another ten or even twenty years before we see these technologies become more widely available and significantly more affordable.

There was some thought that the war in Ukraine, with the tragic number of amputations occurring, might accelerate innovation and encourage manufacturers to develop more accessible prosthetics, including limbs produced using 3D printing.

However, much like osseointegration, we’re simply not seeing that technology filtering through yet.

When I speak to experts, they all say the same thing—it’s coming, but it isn’t here yet, and it’s unlikely to become mainstream any time soon. Perhaps we’ll see it towards the end of my career, if I’m still practising in another twenty years.

Elizabeth Wallace:

Yes, it’s something we all hope for because wider availability will only benefit amputees. But, at the moment, the reality is that we’re simply not there yet.

The same probably applies to AI. From speaking with care providers and case managers, AI currently seems to be more useful in supporting the administration of case management, coordinating rehabilitation and assisting with care planning rather than directly impacting amputation outcomes themselves.

I’m sure that will evolve over time, but that’s where we currently seem to be.

Thinking about claims handling more generally, our experience is that, despite the significant value often attached to life-changing amputation claims, they are actually capable of settling relatively quickly.

Although damages are often at the higher end of the spectrum, that doesn’t necessarily mean claims have a longer lifecycle. Whilst every amputee’s needs are different, there is often a degree of predictability around damages, particularly where there are no additional serious injuries. The injury itself is medically objective and comparatively stable, which provides greater evidential clarity.

A key factor is that, where liability is not seriously disputed, insurers can facilitate early specialist rehabilitation with appropriate prosthetic input. We know that leads to improved independence, better mental health and, in many cases, a successful return to work.

What do you see as the main sticking points that can extend the lifecycle of an amputation claim?

Gemma Witherington:

In my experience—and I’ve just come out of a joint settlement meeting this week in a high-value amputation case—the biggest issue remains accommodation.

Even though the law surrounding accommodation claims is now much more settled, there’s still the fundamental dispute about whether accommodation is actually required.

It’s often assumed that because someone has undergone an amputation, there must automatically be an accommodation claim. However, that doesn’t necessarily follow.

Modern prosthetics are now so advanced that many people return to work, maintain active social lives and function extremely well without requiring entirely new accommodation, particularly in the early stages.

So the question often becomes whether existing properties can be adapted, with more extensive adaptations becoming necessary later in life as mobility changes, or whether a completely new property is genuinely required.

Depending on where somebody lives, an accommodation claim can easily add £1 million to the overall value of a claim.

Elizabeth Wallace:

Absolutely. That’s a significant issue.

It’s also important to consider the adaptations themselves. Depending on the property, features such as through-floor lifts and wet rooms can often create accommodation that’s effectively suitable for single-level living without requiring an entirely new home.

I think that brings us nicely to our conclusions.

Looking back at where we are in 2026, it’s clear that technological advances continue to be made. However, over the last few years they haven’t yet proved transformative, either in terms of functionality or cost, from a prosthetics perspective.

What continues to make the biggest difference is targeted rehabilitation delivered as early as the claim allows.

Whilst there remains an irreducible minimum value attached to many aspects of amputation claims, I do think the areas of dispute are reducing.

I’m seeing fewer expert reports recommending multiple prosthetic limbs, which historically was often an area of disagreement. More generally, there seem to be fewer heads of loss that remain in dispute.

What would your final piece of advice be from a claims handling perspective?

Gemma Witherington:

I think prosthetic experts are obviously fundamental to these cases, and their evidence is incredibly valuable.

However, I think it’s equally important to look beyond the standard report and focus on the individual claimant.

Experts are excellent at explaining the available prosthetic options, how often they require replacement, their weight, functionality and cost.

What I sometimes think is missing is a more personalised analysis.

How old is the claimant? What’s their level of fitness? What underlying health conditions do they have? Have they actually trialled the prosthetic being recommended? How have they managed so far? What evidence is there about how successful that particular limb has been?

Ultimately, the important question is: what benefit does this prosthetic actually provide to this individual claimant? Equally, if another option is being rejected, why?

Providing that level of analysis would help narrow the issues much earlier.

For example, if osseointegration is genuinely in dispute, it can have an enormous impact on quantum and become a significant barrier to settlement.

That evidence also informs many other aspects of the claim, including care, travel, holidays and practical issues such as whether a waterproof rather than water-resistant prosthetic is required, or how many limbs are genuinely necessary.

If experts explained more clearly why they had recommended a particular option, it would enable advisers to provide much clearer advice to their clients.

Doing that early, alongside early rehabilitation, is key to progressing these claims efficiently and reaching an appropriate settlement as quickly as possible.

Ultimately, whether you’re representing a claimant or a defendant, that’s what everybody wants.

Elizabeth Wallace:

Absolutely. The best possible recovery for the claimant is what everyone is working towards.

Gemma, thank you very much for joining us today. It’s been incredibly helpful.

And thank you to everyone for listening. If you’re still with us, that’s all from us.

Gemma Witherington:

Thank you.

Elizabeth Wallace:

Goodbye.