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Published 8 September 2022
Approximately one million amputations are reported around the world each year. As at 2017, 57.7m people globally have been living with traumatic amputation1. One US lawyer’s website suggests that “at least” 30,000 traumatic amputations occur in the USA every year2.
Amputations can be necessary due to illness/disease as well as trauma. A study of the incidence of lower limb amputation in patients aged between 50 and 84 in England found that, between April 2003 and March 2009, there were 25,3123.
The number of patients with either amputation or limb deficiency attending specialist rehab centres in the UK is estimated to be between 55,000 and 60,000, costing about £60m a year4.
The cost of dealing with amputation claims has risen enormously over the last 20 years and this has largely been driven by advances in prosthetic hardware and the systems which control them. They have become more lightweight, easy to operate, adaptable, multi-functional and, last but not least, expensive. An entirely non-systematic search on Google produced no fewer than 28 different companies ranging from well-known providers such as Ottobock to small start-ups in the USA, so the market is there.
By way of an example Ottobock makes the Michelangelo bionic hand, which is controlled by signals from the user’s brain. This has been fitted to a an injured person in the UK and, according to the Healthcare Global website, cost £47,000.5 The LUKE arm system is a modular arm/shoulder available in the USA6 which has been pleaded at a cost of £242,000 per 5 year cycle.
It is almost inevitable that a claim for privately-funded prosthetics will be made, rather than via the NHS. The claimant is likely to be able to obtain a technologically more advanced prosthetic via the private route and the availability of cosmesis privately is also an attractor. In law, the claimant is not restricted to seeking support from the state and is able to recover the cost of a privately-funded prosthetic (and its replacements over time) so it is not difficult to see why a claimant would go down this route. The cost of all this pleaded in a schedule of loss will add considerably to the overall cost of settling the claim.
A few cases highlight the issues:
This case is an example of how need drives damages. The final agreed figure for prosthetics was £1.6m.
The claimant (C), 28 year-old male, suffered an above knee amputation. The most significant issue between the parties was the value of the prosthetic limbs C said he required. C claimed for 14 different prosthetic limbs including on and off-piste ski limbs, on and off-piste snowboarding limbs as well as limbs for mountain biking, rollerblading, swimming and running. The total claim for future prosthetics came to £1,957,811. In addition there was a claim for ancillary costs including liners, sleeves, on piste prosthetic adjustment, travel to prosthetic appointments and so on totalling £917,366. In response D allowed £1,032,105 for future prosthetics and £77,317 for future ancillary prosthetic costs. Whilst the claim for the BiOM iWalk was eventually agreed between the parties' respective prosthetic experts (replacing a standard ADL limb), there was a significant dispute regarding the remaining prosthetic limbs. D argued that C would not be able to maintain so many limbs. In response C called evidence from his treating prosthetist who confirmed that he thought he could maintain at least 10 prosthetic limbs and that C was very keen to return to as many of his previous sporting activities as possible.
C suffered a traumatic amputation when his arm was caught in rollers on a conveyor belt. This was a case in which C was advised he was a candidate for a new bionic arm and TMR procedure . He was awarded £1.75m including £110,000 for PSLA. This case is an example of how “eye-catching” technology can drive cost in these claims.
You will all know of this case because of the subsequent appeal of the first instance decision relating to accommodation claims. In fact all but the damages for accommodation costs were decided at first instance. Agreement to an overall lump sum award was upheld by the judge rather than a lump sum and PPO. C had suffered crush injuries to both feet and lower legs. She underwent a left below knee amputation. The right leg and foot were retained, although she suffered from stiffness and pain. The judge awarded a total of just under £4.1m including £913,299 for aids and equipment, including a “daily” prosthetic limb, a water activity limb and a sports activity limb among other items. C’s successful appeal on the capital accommodation question added another £801,913 net.
This is the scientific term for bone ingrowth into a metal implant. An artificial implant is permanently, surgically anchored and integrated into bone, which then grows into the implant. The process involves gradual and increasing loading of the implant after it is fitted before any prosthesis is attached.
The advantages of osseo-integration are, according to the HSS website:
Having said this, there are limitations placed upon the recipient:
Even if all that looks OK, there are disadvantages to the procedure:
The cost of the surgery is between £40,000 and £80,000, with extra cost for the “interface” components which need to be replaced typically every 2-3 years and the rehab following. It is not available on the NHS as yet; two private centres operate in the UK.
Due to the cost it is perhaps unlikely that the NHS will ever elect to provide such surgery and the procedure is unsuitable for many, so the take-up may continue to be low as well.
The JC Guidelines contain several sections relating to damages for injuries causing or necessitating actual or potential amputation, but they are not always clearly indicated. The following tables compiled from entries in Chapter 7 of the JC Guidelines, 16th edition, bring all the disparate entries together.
JC Guidelines section
Loss of both arms
£240,790 - £300,000
Loss of one arm:
(i) At shoulder
(ii) Above elbow
(iii) Below elbow
At least £137,160
£109,650 - £130,930
£96,160 - £109,650
Total/effective loss of both hands
£140,660 - £201,490
Amputation index and middle/ring fingers
£61,910 - £90,750
Serious hand injuries, incl. amputation and re-attachment or amputation of fingers/palm
£29,000 - £61,910
Severe fracture of fingers – may lead to partial amputation
Up to £36,740
Amputation of both legs:
(i) Above the knee or one at high level above and one below
(ii) Below knee
Amputation of one leg - above knee
Amputation of one leg - below knee
£240,790 - £282,010
£201,490 - £270,100
£104,830 - £137,470
£97,980 - £132,990
Amputation of both feet
£169,400 - £201,490
Amputation of one foot
£83,960 - £109,650
(e.g.) Traumatic amputation forefoot with risk of need for full amputation
£83,960 - £109,950
Amputation of all toes
£36,520 - £56,080
Amputation of great toe
In region of £31,310
Injuries leading to amputation of one or two toes (not the great toe)
£13,740 - £21,070
Next issue - Dealing with spinal injury claims.
If you would like any assistance in dealing with amputation claims, please contact a member of our Complex Injury Team.
+44 (0) 117 918 2062
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