Stress test

Litigation stress has been described as: "Involvement in litigation which renders claimants susceptible to stressors and to influences that may lead to increased impairment, biased reportage, and retarded recovery". Research conducted by Dr Hugh Koch and colleagues in 2006 found that both lawyers and psychologists believe litigation stress has moderate to major effects on claimants' psychological symptoms. (For more information, see the article 'Litigation Stress' by Hugh Koch and others in Solicitors Journal, September 2006.) However, the full extent to which litigation is stressful and what factors of litigation exacerbate or mediate psychological symptoms has not been well studied.

Sources of stress

What do claimants find stressful? As part of their research, Dr Koch and colleagues undertook a survey of the views of 50 personal injury lawyers and 50 psychologists. In doing so, they identified four main stresses:

• Stress resulting from the litigation process alone (eg court procedures, depositions);

• Stress secondary to financial difficulties (eg loss of income, legal fees);

• Stress from a combination of the initial trauma (eg road traffic accident) and litigation process; and

• Stress due to uncertainty in the claimant's life (eg when litigation will end, when they will return to work).

The most commonly cited source of litigation stress was the litigation process alone.

Who gets stressed?

Three separate groups of people who became distressed during litigation included:

• Those who became progressively more agitated and began to exhibit increasing rates of post-traumatic symptoms following repeated interviews;

• Those who had not previously exhibited trauma-like symptomology, but began to do so once they commenced serial interviews; and

• A group of claimants who became irritated and resentful as a result of the experience of repeated interviews, but did not develop a trauma-like response to the process.

During the authors' own medico-legal practice of assessing victims of road traffic accidents, they have witnessed the existence of litigation stress. Claimants frequently cite loss of income and uncertainty in their lives as sources of stress, and also mention their desire for an end to the litigation process, which typically takes several years and prevents them from moving on psychologically from the trauma they have experienced and thereby developing a sense of 'completion'. Claimants also mention the stress incurred by having to refocus on the trauma each time they are interviewed and that this process typically lasts from the moment that they receive the initial appointment letter until the completion of the interview. This is clearly evident from the distress that some people display at interview.

Vignette: Mrs T

"I have been involved with my road accident claim for two years now. My solicitors have changed three times and it is often difficult to get in touch with them. I have been sent to several medical people to prepare reports but often the appointments offered have been very inconvenient and inflexible. I don't know how many times I've been through the accident. I also get asked about other things in my life which just don't seem relevant. All in all, it's been very stressful and I find it hard to put the accident 'to bed' and forget it. I'm sure once the case is concluded, I can try and do this".

Recent survey

A study was undertaken in 2014 to elicit the views of 22 claimants (13 female and 9 male, in an age range of 18 to 63), who were being assessed for their psychological injuries.

After a number of exploratory interviews, a typology of the most cited reasons for stress was drawn up. Claimants were then asked to identify which reasons applied to their current claim experience, and of these identified reasons, which were the most stressful.

Figure 1 illustrates the 24 main reasons cited by claimant for their stress.

Figure 1: 24 main reasons for stress

1. Getting information from those you are dealing with

2. Change of people dealing with your case

3. Getting through to people dealing with your case

a. By telephone

b. By email

4. Attitude of people dealing with you

5. Feeling claim is taking too long

6. Problems of liability - ie who is to blame

7. Understanding the whole claims process

8. Getting treatment you need

9. Dealing with paperwork

10. Paperwork getting mislaid

11. Time and location of appointments to see medical experts

12. Attitude of expert

13. Unsympathetic approach of expert

14. Waiting time for medical appointments with experts

15. Being asked about the event again and again

16. Being asked about your medical history

17. Understanding medical reports

18. Attitude of employer about claim, time off, planned return to work or adjustment needed at work

19. Financial effects of accident

20. Follow up after attending A&E (hospital)

21. GP sympathy with emotional aspects of accident

22. GP offering counselling/psychological help

23. The idea of maybe needing to go to court

24. Getting help to manage your pain

The average length of a claim at the time of the survey was 11 months. (The duration of claims ranged from 3 months to 36 months.)

The main stressors (ie, those given a 'top five' rating) are shown as figure 2.

Figure 2: Top five reasons for stress

Reason for stress and number of people citing reason

Being asked about the event again and again: 11

Change of person managing case (legal): 8

Idea of maybe needing to go to court: 7

Getting information from case handler: 6

Feeling that claim is taking too long: 6

Time/location of appointment with medical experts: 5

Financial effects of accident: 5

Understanding the whole claims process: 5

Conclusion

We need to acknowledge that it is inevitable that, during the process of ligitation, litigants will experience some elements of stress that cannot be ameliorated, such as uncertainty or financial loss. However, some of the factors that cause stress can be attended to with some simple steps:

1. A structured interview that would gain the relevant background information needed by all professional involved.

2. A typed chronology of GP attendance history so that all visits to a GP for accident-related problems are known to the expert prior to the assessment.

3. Clearer dissemination of information about the ligitation process to claimants.

4. Full description of the accident provided in the instruction letter.

Experts would subsequently be able to limit their own interview to the specific information relevant to their specialism, which would thereby omit the need for the client to recount their traumatic story again at great length.

Another aspect of reducing stress and enabling claimants to resolve their trauma more quickly is to ensure that they have access to recommended therapies (for example psychotherapy and physiotherapy) in a timely manner following recommendations made in expert reports.

Finally, it would be helpful if the length of the litigation process could be reduced. This would reduce the time period during which litigants are susceptible to the effects of litigation stress and enable them to resolve their trauma earlier and move on, both in practical and psychological terms, with their life.

Litigation stress is an under-recognised phenomenon that is capable of exerting considerable impact both on the outcome of the litigation case and on the psychological recovery of the individual litigant. It is a subject that demands increasing attention and one that should be subject to further, more scientific, research. Until then, it is likely that it will continue to subtly interfere with claims situations in the manner outlined above.

For more information, see other work by Dr Hugh Koch and colleagues.

Dr Hugh Koch is a chartered psychologist and director of Hugh Koch Associates. Dr Katie Newns, Dr Tracey Jackson and Dr Syd Hiskey are all chartered psychologists at the firm.

www.hughkochassociates.co.uk