Clinical negligence practitioners will be used to seeing spinal injury claims. Whether due to a delay in diagnosing cauda equina syndrome or a complication of surgery causing spinal cord injury, spinal cases are prevalent in a clinical negligence context. One of the more contentious issues in such cases is whether the patient is capable of returning to work. 

It is estimated that only a third of patients will return to work after sustaining a spinal injury. However, American studies considering the association between return to work post injury and life expectancy in spinal cord injury patients, conclude that individuals with a spinal cord injury who report being employed 30+ hours per week have a reduced risk of mortality compared with those who work less or are unemployed. While it is important not to conflate a correlation with a causative impact, there is no doubt that there are other benefits. 

Beyond the obvious financial benefit, it can increase a patient’s sense of purpose, self-worth and self-confidence. It gives them a social connection that may be lacking after a spinal injury. The routine has ancillary benefits on sleep regulation and on bladder and bowel management where mealtimes are defined. Finally, there is the reduction in secondary complications associated with a more active lifestyle and a better routine. 

Having considered the outcomes in the claims recently resolved by Clyde and Co’s leading Healthcare Team, there is a clear theme around the ability of spinal injury patients to return to work due to the increase in remote working. 

This theme is reflected in other emerging evidence and patient testimonies, which indicate that working from home options are addressing the primary barriers that have previously kept patients out of the workforce. These include: 

1. The ability to more easily manage bladder and bowel continence for those who are catheterised and or experience faecal urgency or incontinence.
2. Avoiding a commute that might act as a barrier to employment whether because of mobility difficulties or continence issues.
3. The ability to manage symptoms more efficiently, for example, managing fatigue with greater flexibility to take breaks during the working day, or working around their medication regime.
4. The ability to more easily fit therapy sessions around work, for example with a physiotherapy session or remote assessment in a lunchbreak more accessible when working from home.
5. The ability to have all the necessary equipment available at home, without having to transport it to the office.
6. Dynamic positioning and the flexibility to swap between an ergonomic chair, standing desk or other chair to alleviate pressure.

Clearly returning to work after a spinal cord injury (SCI) or cauda equina syndrome (CES) depends on a variety of factors including the nature and extent of the injury, prior employment history and psychosocial issues. However, there are clear benefits for both claimants and defendants if a return to work can be facilitated. 

In a recent concluded case following an admitted delay in diagnosing cauda equina syndrome, the experts considered the barriers and benefits of the claimant returning to work. The experts accepted that the claimant’s need to self-catheterise and her faecal urgency would present a challenge. It was agreed that sedentary work and suitable toilet facilities were essential. While there were challenges associated with finding office work, it was accepted that if the claimant could work from home, she was capable of returning to work. 

Ultimately, we were able to settle the claim at a sum that fairly reflected the likelihood of the claimant returning to work in the future, which was ultimately at a lower level than it might have been pre-Covid when working from home was far less prevalent. 

In conclusion, the increase in home working will inevitably have a significant impact on the level of lost earnings claimed in spinal injury claims, which will come as welcome news to defendants. However, it also contributes to positive outcomes for claimants, and from that perspective is a “win win”.