A medical assessment process for a large volume of medico-legal compensation claims for hand-arm vibration syndrome

BACKGROUND: The judgement on preliminary issues of nine lead cases of suspected hand-arm vibration syndrome (HAVS) in former coal miners in the UK ruled that there was evidence of damage and breach of duty of care (Armstrong and Others v. British Coal, 1996). In anticipation of > 120 000 cases and at significant cost, a handling agreement was prepared in 1999. This recommended a single medical assessment process (MAP) to determine general damages for which almost 200 doctors attended 2 days of training. AIMS: This paper outlines the assessment process and the results to date. METHODS: Seventeen test centres across the UK were commissioned. Standardization of the performance by both the doctors and technicians within individual examination centres and across all centres was necessary. A pragmatic solution using 'best available assessment techniques', whilst at the same time coping with the large number of claimants, was required. Doctors were trained to administer questionnaires for clinical symptoms, past medical history and occupational history, and a standardized clinical assessment pro-forma. Three standardized tests were used: vibrotactile thresholds, thermal aesthesiometry and cold water provocation testing. A modification of the Stockholm Workshop Scales and scoring system was adopted. At time of writing, 52 490 claimants had been assessed by the MAP. RESULTS: Analysis of results showed that 5% were assessed at 0SN, 15% at 1SN, 18% at 2SN (early), 28% at 2SN (late), 33% at 3SN, 21% at 0V, 13% at 1V, 38% at 2V and 28% at 3V. CONCLUSION: It is concluded that the MAP is a practical and time-efficient tool for assessing a large volume of claimants with suspected HAVS. Further analysis of the process and staging is required to confirm its validity as a medico-legal examination.