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‘Sitting Duck’ phenomenon: the cumulative effects of accidents: Medico-legal and clinical implications

Dr Hugh Koch, Dr Rhiain Morris and Dr Alice Knight

Key words: Multiple accidents - cumulative trauma effects or ‘But For’ test - use of percentage contribution.
Literature: 1) Court of Appeal:- Peace V Linfield 1/4/2003.
  1. The outcome of 2 or 3 accidents occurring in relatively rapid succession can result in a state of chronic anxiety or low mood with complex cognitive, behavioural and social aspects.
  2. As such, it can be the case that this chronic psychological state is a recognised outcome of the cumulative effect of 2-3 accidents together.
  3. In the above circumstance of cumulative psychological effects, the loss of employment may not typically be able to be put at the door of only of the one accidents.
  4. Consideration of time elapsing between 1st and 2nd, or 2nd and 3rd accident need to be taken into account.
  5. The latter (2nd or 3rd) accidents may act as a ‘trigger’ for a loss of working ability but need to be seen in the context of cumulative effects.
  6. One of the key factors in determining severity and proportionality is if and when a) phobic avoidance occurs, with significant increase in description of social and occupational activity and significant risk of chronicity and b) ceasing of working activity.
  7. In the Court of Appeal case referral to the above (2003), it was acknowledged that ‘three accidents together were responsible for the claimant’s current state involving a chronic pain state, and inability to work.

    In this case, the Court suggested that the cumulative effects of the three accidents should be looked at, rather than using the ‘but for’ test for each separate accident. It suggested that the contribution of each respective accident in a percentage term to the injury as whole.
Dr Rhiain Morris regularly provides clinics in Oxford, High Wycombe and Aylesbury
Dr Alice Knight regularly provides clinics in Barnstaple and Penzance.


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