Functional Neurological Disorder and related injury claims

What is FND, why should businesses be aware of it and how can related injury claims be fairly managed and responded to?

Picture the scene: a recently married couple were hosting friends for dinner one evening. All seemed well until Mrs Host took so long over a comfort break that Mr Host left the dining table to investigate. Mrs Host was found lying face down on the bedroom floor, conscious (eyes open) but only capable of noise rather than defined speech and entirely incapable of moving any limbs or raising her own head. With a medical history including Transient Ischaemic Attack (a “stroke”) ten years earlier, paramedic response, hospitalisation and urgent brain imaging was quickly identified as the only appropriate intervention.

CT and MRI scans ruled out any vascular/neurological component to the instantaneous loss of motor function. Mrs Host also began to regain movement and the ability to communicate. With a recent personal history that included high levels of work stress, the death of a parent, and an acute life-threatening psychiatric illness on the part of a close family member, Mrs Host was diagnosed with acute stress and anxiety contributing to a “Functional Stroke”. Happily, there were no lasting effects, and a full recovery was made.

Functional Neurological Disorder (FND) can have a much less dramatic onset but is a medical condition in which patients (like Mrs Host) experience neurological symptoms such as weakness, movement disorders, sensory symptoms and blackouts, all genuinely occurring, but in the presence of a structurally normal brain, with no obvious organic component (vascular or neurological) as to what is actually causing the reported debility.

Potential “markers” and triggers

Retrospective analysis of the incidence of FND has identified a number of “markers” strongly associated with an increased risk of the onset of a related condition as follows:

• Biological sex: Majority (78.8%) of patients are women
• Early life trauma: Unresolved traumatic memories of life events
• Sexual abuse: 36.4% incidence of childhood abuse
• Relationship difficulties: Either abnormal attachments/struggle to form them
• Personality disorders: Borderline conditions/incidence of “internal voices”

Incidences of FND can be triggered by seemingly innocuous accidents and unremarkable “short term” injuries that may, on first presentation, attract little in the way of investigation or support from an employer or other duty-holder. And so it is that the “ankle sprain”, minor-concussion or even asthmatic sensitisation can develop into a range of other conditions whose subjectively experienced symptoms appear consistent with potentially long-term neurological disorders, but which lack the organic components that might make them more easily diagnosable and subsequently treatable.  

Treatment

Treating FND can be a complex, challenging and lengthy process drawing on expertise from a multi-disciplinary team of clinicians including:

• Neurology
• Neuro-physiotherapy
• Occupational therapy
• Speech and language therapy
• Psychological support (to address underlying or unresolved personal trauma)

In the context of an employer trying to support and manage a team member experiencing a period of prolonged sickness-absence, the depth of investigation and complexity of clinical support needed to resolve those sorts of complaints can be overwhelming even with HR and OT professionals available to advise and assist.

Related injury claims and litigation

In the context of a defendant and its insurer wanting to validate the nature and extent of any accident-related injuries and symptomatology, determine whether to engage in rehabilitative remedies, and how best to do all of that, the challenges can be even greater. When the presentation of symptoms can be so varied but almost exclusively subjective in their reporting and assessment, the desire for “validation” while also seeking to support “mitigation” can often bring a claims strategy into internal conflict. A suspicion of FND can also warrant a wholesale shift in the overall potential for damages and costs and the need to carefully review (“increase”) the applicable valuations and reserving for the claim.

Any “temporal link” between a relatively minor accident and the onset of symptoms can represent a trap for the unwary expert. Only by developing the wider context for the injured party from those objective indicators of long-term history, behaviours, risk factors and post-accident prevalence of symptoms, can a more reliable view be taken (or offered by experts when asked to provide their opinions for the benefit of the court).

The range and quantity of medical and other records can be vast, difficult to assimilate and even harder to successfully analyse. But those evidential steps remain the fundamentals of a reliable determination on causation, and a well-reasoned claims strategy whether terminating at “early negotiated compromises” or “traditional dispute resolution” through court process and trial. 

There is no substitute for building the evidential context and deploying well-selected and well-instructed neurology, psychology and other expert disciplines to properly understand and assess a claim with the hallmarks of a “FND” scenario. The appropriate claim strategy can vary massively in light of that, but a business and its insurer should expect a level of confidence in diagnosis and resultant claims advice before determining in which direction its best interests lie.