It is of course very distressing to witness a loved one who experiences a traumatic brain injury. The family’s sense of upset and bewilderment is inevitably heightened when this occurs abroad. Aside from the language and cultural differences, relatives are often concerned about the standard of medical care and how they will arrange for repatriation. There may also be numerous other practical difficulties, including communications with the police, the local consul and insurers, and the cost of securing long stay accommodation.
UK holidaymakers should always purchase a suitable level of travel insurance before they go on holiday. Without doubt, the most important aspect of a travel insurance policy is the section that relates to medical expenses. In certain jurisdictions, particularly the US, the cost of medical treatment for a brain injured person can be astronomical, so it is essential that this is covered by travel insurance.
Some policies exclude cover for certain types of activities that are often associated with head injury. For example, some (even winter cover policies) exclude cover for accidents that occur whilst skiing off piste. There is inevitably a greater likelihood of a serious head injury whilst skiing off piste because the terrain is inherently more dangerous. The tragic circumstances surrounding the catastrophic head injury sustained by Michael Schumacher in 2013 are testament to the risks, so it is important to check whether skiing off piste is covered if going on a ski holiday.
Another typical exclusion clause relates to the use of motorised vehicles. We were previously instructed by the family of a teenager who sustained a severe head injury when he collided with a tree, whilst driving a quadbike in Greece. His travel insurers relied on this exclusion to decline cover, leaving the family to pay the significant costs of repatriation and medical treatment.
So read the small print, or ask the insurer for written confirmation that the policy covers all relevant activities.
British holidaymakers should also obtain a European Health Insurance Card (EHIC) before making a trip to Europe. This gives access to state provided healthcare during a temporary stay in another European economic area, and covers treatment that is medically necessary until the planned return home. In theory, treatment should be provided on the same basis as it would be to a resident of that country, either at a reduced cost or, in many cases, for free. However it remains to be seen whether British nationals will continue to be entitled to rely upon the EHIC card, pending Brexit negotiations.
If there is an accident and someone is injured, family members should immediately liaise with the British consul and also contact their insurers to notify them of what has happened. In the case of a brain injury, travel insurers and their appointed assistance companies should then arrange and coordinate a transfer to a reputable neurology department and also facilitate repatriation once the patient is considered safe to fly.
In cases involving serious head injury, it may be necessary for the injured person to remain in a foreign hospital for several weeks or months before he or she is in a sufficiently stable condition to be repatriated to the UK. This often means family members have to extend their stay to support the relative in hospital.
Whatever the circumstances of a serious injury overseas, family members should consider the following steps whenever possible:
Once a brain injured patient has been repatriated to a UK hospital, family members will inevitably need to spend a great deal of time liaising with the hospital staff and treating practitioners. This is a very emotionally demanding time and family members need to be given as much help and support as possible. It is worth noting that travel insurers are not contractually responsible for the cost of ongoing medical treatment once the insured has been repatriated to a UK hospital.
Depending on the severity of the injury there may be a long and costly rehabilitation process ahead involving professional care and/or expensive equipment and new accommodation. So, where there is a third party claim, it is vital that the family instruct a specialist firm of solicitors at as early a stage as possible. They can then engage with the other party and invoke the Rehabilitation Code to ensure that both parties apply their minds to the individuals rehabilitation needs at an early stage in order to facilitate the best possible recovery. The solicitors are also likely to instruct a case manager who will prepare an Initial Needs Assessment and liaise with the treating medical experts to ensure the patient receives all the care that he or she needs.
Where there is a possible claim, the legal team will also need to apply their minds to the key issues of jurisdiction and applicable law:
All options need to be evaluated before deciding where to pursue a claim; do not assume that it is necessarily best to issue the claim in the UK. For example, if the accident occurred in the US, it may be in the claimant's best interest to pursue the claim there, where damages are likely to be higher.
For claims that are pursued abroad, foreign law will apply to all issues associated with the case, including liability, quantum (or value of the claim), limitation and costs recovery. There may also be important cultural differences to be considered and advice from a local agent can be invaluable.
In cases involving severe head injury, we will usually recommend that the claim is pursued in the English courts, whenever possible. It is important to consider whether the claim can be anchored to this jurisdiction at the outset.
European law entitles an English claimant involved in a road traffic accident to initiate a claim against the foreign insurer in the UK (provided the law of the relevant EU country permits a direct right of action). In that scenario, the English courts will ordinarily assess liability and quantum with reference to the law of the country where the accident occurred. This again reinforces the importance of credible, and experienced local lawyers, who can prepare formal reports on foreign law for the UK courts and attend trial to give evidence.
In these types of claims, the most contentious (and valuable) aspect of the claim will typically relate to the cost of professional care. Foreign insurers will usually argue that the cost of care is not a recognised head of loss* according to the foreign law. However it can be argued that the English judiciary has a discretion to award damages for the cost of care based on English standards. This is often where the battle lines are drawn.
*Heads of loss – or claim – are common elements that influence the amount of compensation a claimant will receive. In serious head injury cases, the head of loss for future paid care could be very significant.
We acted for the British victims of a fatal road accident in Portugal, which resulted in the death of the father and a severe traumatic brain injury and orthopaedic injuries to the mother.
Their two adult children also suffered from post-traumatic stress disorder. Following extensive treatment in Portugal, our client was airlifted back to the UK and spent nine months in a neurological rehabilitation unit. She no longer has capacity to manage her own affairs and requires professional care for the rest of her life. She was also reluctant to agree to professional care which raised issues associated with deprivation of liberty.
The Portuguese insurers disputed liability and quantum, and initially offered a sum of €250,000 inclusive of costs. Working closely with our Court of Protection team we secured a seven-figure compensation settlement (including provision for long-term care) plus costs just a week before the case was scheduled for a six-day quantum trial at the High Court.
Our client was just seven years old when he sustained a severe brain injury falling through an unprotected skylight whilst on holiday in Lanzarote.
The report from a Spanish lawyer indicated that the skylight was in breach of local standards, although liability was denied.
Proceedings were issued in the UK and a claim was pursued against the tour operator, pursuant to the Package Travel Regulations 1992. The tour operator then brought in the Spanish hotel as an additional defendant. Although liability remained in dispute, the parties agreed an apportionment of liability at a roundtable settlement meeting, with the claimant conceding 25% for contributory negligence. The defendant also agreed to an interim payment in the sum of £100,000.
We are seeking an order to appoint a deputy since the neurological evidence suggests our client will not have capacity when he turns 18. To assess the value of the claim, we are also collating documentary evidence from his schools, to clarify his academic ability before the accident, compared with his results since the fall. This evidence could have a significant impact on the value of his claim for future loss of earnings.
A teenage boy sustained catastrophic injuries in a road traffic accident in France in October 2015. Police reports confirm that the driver of the lorry which struck the vehicle was texting and driving at an excessive speed at the time of the accident.
He suffered a life-threatening traumatic brain injury and remained in a critical condition for months before repatriation to the neurological ward at St George’s Hospital, Tooting, and subsequent transfer to The Children’s Trust, Tadworth. Whilst he made good progress, he will require long-term 24 hour care.
We secured an admission of liability and substantial interim payments from the French insurers which have funded the cost of equipment and the professional care he needs following discharge from The Children’s Trust.
The family home is completely unsuitable for him, and our Court of Protection team allocated funds to adapt a local rental property. It will be necessary to buy a new property appropriately equipped for the boy and his care team for the long-term.
Penningtons Manches, the French insurers (AXA) and their London based solicitors are signatories to the Serious Injury Guide and have adopted a collaborative approach to ensure that the boy receives the best possible treatment to aid his recovery.
This article was published in Brain Injury News in November 2016.