Pre-existing conditions and aggravation
Where the claimant had mental health problems before the abuse or the negligent care, a reasoned opinion on what was already there, what the events added, and what would have happened anyway. Free initial screening call and fixed fees with no hidden charges.
- APIL Tier 1 Recommended Expert
- Claimant, defendant and SJE
- Reports usually 1–2 weeks from assessment
What was there before, and what the events added
Claims involving earlier mental illness are often disputed, and the records may conflict. Dr Pradhan explains where they do, and gives her reasons for separating earlier vulnerability from the injury the events caused.
The report looks at the claimant’s mental health before the events, how it changed afterwards, and how it would probably have developed without them. It addresses whether the events caused a new condition, worsened an existing one, or brought forward a deterioration that would have happened in any event, and for how long.
Dr Pradhan is dual-accredited for claimant and defendant work, and judges have commended her reports for clarity.
What the report covers
Reports on pre-existing conditions commonly address:
- The claimant’s mental health before the events relied on
- Earlier diagnoses, treatment and periods of recovery
- Whether the events caused a new psychiatric condition
- Whether they worsened an existing condition, and how much
- Whether a deterioration was brought forward, and by how long
- The probable course of the earlier condition without the events
- Vulnerability that made the claimant more likely to be harmed
- Apportionment between the earlier condition and the new injury
- The effect on work and daily living before and after
- Treatment needs arising from the events, as distinct from earlier needs
- Prognosis, taking account of the earlier history
- Joint statements, supplementary questions and second opinions
Send a short summary of the events relied on, a note of the earlier mental health history and the questions for the expert, and Dr Pradhan will confirm the scope of opinion and a fixed fee.
Submit an enquiryFour ways an earlier condition can matter
The report says which of these fits the evidence most closely, with the reasons, because each leads to a different approach to damages.
A new condition
The events caused a psychiatric condition the claimant did not have before, although earlier vulnerability may have made it more likely.
Aggravation
The events worsened an existing condition, for a period or permanently. The report describes the extra harm.
Acceleration
The events brought forward a deterioration that would have happened anyway. The report gives the likely period.
No lasting effect
The present difficulties would probably have been the same without the events, or the effect has passed.
Eggshell skull, crumbling skull and the psychiatric evidence
A defendant takes the claimant as they find them, so a vulnerable claimant can recover for an injury that a less vulnerable person would not have suffered. But a defendant is not liable for a deterioration that would have happened anyway. The psychiatric evidence is what tells the court which applies, and to what extent.
For claims in England and Wales the report is structured for CPR Part 35 and Practice Direction 35. Reports for proceedings in Scotland and Northern Ireland are prepared to the requirements of those courts.
Also called the thin skull rule: the defendant must take the claimant as they find them. The “crumbling skull” principle limits damages for harm that would have occurred in any event.
Related pages
Pre-existing condition questions
If your question is not answered here, call and Dr Pradhan will advise on scope and timescale.
Call 0121 752 6065The claimant was already receiving treatment. Can the report still find an injury?
Yes, if the evidence shows the events made the condition worse or caused something new. The report compares the claimant’s mental health before and after, using the records from both periods.
Can the report say how long a deterioration was brought forward?
Where the evidence allows, the report gives the likely period of acceleration and explains it. Where it does not, it says so.
What records are needed?
The GP records and any mental health records from several years before the events are usually the most important, with the records since.
Is this part of a psychiatric injury report?
Usually, yes. Earlier history is normally dealt with in the main report. A separate report is useful where the earlier condition is the central dispute or a second opinion is needed.
How quickly can a report be delivered?
Usually 1–2 weeks from assessment, and urgent reports can often be provided in 2–5 working days where the papers and appointment can be arranged promptly.
Instruct Dr Pradhan where there is earlier history
Send a short summary of the events relied on, a note of the earlier mental health history, the funding route and any relevant dates.
- Phone0121 752 6065
- Emailinfo@
doctorpradhan.co.uk - Consulting Rooms NationwideAbacus Court, Harborne, Birmingham B17 0HH
Please do not include medical records or a detailed personal history in this form. Dr Pradhan will confirm how to send the papers once the instruction is agreed.
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