Claims by amputees can now reach into seven figures. With the impact of the London Paralympics still upon us, it is ever more important to ensure that claimants do not get carried away claiming for the latest technology.
What is right for this claimant?
The latest "high tech" prostheses will not necessarily be the most appropriate, just because they are the most expensive.
The claimant needs to be considered individually. What suits different claimants with the same injury may not be the same. A good starting point is to consider basic details such as their age, weight and fitness and activity levels. These will affect which prostheses a claimant can benefit from.
Medical conditions are also of significance, for example:
- Will a claimant with a cardiac problem be able to provide the increased energy required to use a prosthesis?
- Will a claimant with a neurological condition have the capacity to understand and make use of the type of prosthesis claimed?
- The claimant needs to be considered as a whole. A claimant who has suffered multiple injuries including an amputation on one side may have other impairments, for example on the unamputated side, which will affect their ability to use a prosthesis.
- Claimants with renal conditions have the most problems with sockets, because of the effects of dialysis, and prosthetic provision is harder in these cases.
Upper limb prostheses fall into three categories - cosmetic, body functioning and myo-electric. Interestingly, research shows that often those with functioning upper limb prostheses do not actually use the functions of the prosthesis, but merely use the prosthesis for cosmetic reasons. Research also shows there is up to a 75 per cent rejection rate with myo-electric prostheses.
There are also a number of special activity limbs available, such as water activity limbs. However, consideration needs to be given to whether a particular claimant actually needs the special activity limb sought. For example, swimmer Natalie du Toit underwent amputation to her left leg, but swam to international level against able bodied swimmers and did not use a prosthesis to do so. An artificial leg makes swimming harder work.
In the right case it may be appropriate to allow a claimant a number of limbs, but careful thought should be given to whether the need is reasonable. A prosthesis for skiing or snowboarding would, for example, be reasonable for someone who took part in these activities regularly before, but perhaps not for a claimant who suggests that this is something they might like to do in the future.
Generally the trend for claimants is to seek the latest technology, but this might not actually match with what is reasonable:
- The next generation i-limb (prosthetic hand) costs £20,000 to £25,000 and looks much more natural, but it still has significant limitations.
- Another new trend for the established prosthetic user could be fixation of their prosthesis into bone.
- No patient in the UK has yet undergone targeted reinnervation for enhanced prosthetic function - meaning the patient thinks, and the arm moves. This could be the next trend.
- Defendants should carefully consider a claimant’s medical history, in conjunction with the nature of the injuries sustained as a result of the incident in question. Basic details, such as age and weight, are important too. Careful analysis of the GP records is a good starting point.
- Defendants should also seek evidence at an early stage of any special activities with which a claimant claims involvement. In the absence of evidence there are grounds for resisting expensive claims for special activity limbs.
- Often it will only be after the claim has settled and the claimant has the funds to obtain the prosthetics that it will become clearer what they will use and benefit from. That is too late for defendants. However, defendants can usefully examine how a claimant is utilising any prosthetics already provided, for example through the NHS.
With thanks to Professor Hanspal, Consultant in Rehabilitation Medicine at Hillingdon Hospital, Uxbridge, and the Royal National Orthopaedic Hospital, Stanmore.