That is what one nursing sister claimed. The court's rejection of her contention is good news for insurers, say Chris Phillips and Judith Martin….

A recent case highlights just how important it is for claimants suing for work-related stress to establish a link between their condition and their job. It also offers some consolation to insurers in the degree of proof it required of this link.

The claimant, R, was a nursing sister at defendant B's hospital. R alleged that her working conditions caused her to be absent from work from October 1994 to March 1995 with irritable bowel syndrome (IBS) and anxiety. R alleged that she told B, in a meeting in February 1995, that her ill health was caused by her working conditions. She claimed she was told things would improve in the future and, relying on this, came back to work.

Yet, R alleged that conditions continued to deteriorate. In October 1996, she went off sick with anxiety and depression and never returned to work. She alleged her condition was caused by stress at work and likened her case to that of Walker v Northumberland County Council.

B denied the allegations.The psychiatrists instructed by both sides met and agreed that R had suffered a moderate depressive episode caused by stress in the workplace. Other potential causes for her illness were considered, but it was agreed that the condition would have taken a different course and the outcome would have been different. R's symptoms improved when she stopped working.

B disputed causation at trial and no longer sought to rely on the psychiatric evidence.

Under cross-examination, R denied that her husband's heart condition, first diagnosed in 1990, significantly affected her mental health. She maintained that work was the cause of her ill health, despite the references to her husband's health in her medical records, made on occasions when her husband was not present. These suggested that she was torn between work and wanting to be at home with her husband, whom she believed was on “borrowed time”.

No constructive knowledge
The court decided that R failed to establish that her working conditions deteriorated on her return to work; in fact, the evidence showed that conditions had improved. It was ruled that R did not tell B in the February 1995 meeting that her condition was caused by work.

The judge refused to accept R's alternative submission that B's awareness that R had been off work with “IBS/anxiety” was enough to give B constructive knowledge, as B was unaware of a link to work.

The court also rejected R's contentions that her interview with B on her return would have revealed her problems at work, because R was a private person and would not have revealed any concerns to B. Further, following her return to work, she had lied to B as to the reason for a short period of absence in July 1996. It was held that monitoring of R would have been ineffective, for the same reasons.

The judge found that the cause of R's illness was the conflict between work and wanting to stay at home with her husband. He said R would blame work when her husband was present, but would raise concerns about her husband and his health when he was not.

In doing this, the judge rejected the psychiatric reports of both experts, whom he found had depended heavily upon R's version of events and who had not heard R cross-examined. Further, he observed that in R's mental state she would be preoccupied with things that would not worry her unless she was depressed.

This case reinforces the need for legal advisers to consider carefully the issue of causation, independently of experts in occupational stress.

Psychiatry places great reliance on a claimant's history, much of which cannot be substantiated by clinical evidence. In such circumstances, it is even more important for psychiatrists to hear the claimant cross-examined.

This is often contrary to the views of the district judge, who at the case management conference will often seek to prevent psychiatrists who are in agreement from attending the trial.

The case shows that simple knowledge of an absence with a psychiatric component is insufficient to establish constructive knowledge of a vulnerability to work related stress.

  • Chris Phillips is head of insurance litigation and Judith Martin is an associate at Halliwell Landau. Both acted for Norwich Union Insurance in this case.