Case Law Clarifies Importance of Medical Evidence and Reasoning in Criminal Injuries Compensation Tribunal Decisions

Citation: [2023] UKUT 267 (AAC)
Judgment on

Introduction

The case of JM v The First-Tier Tribunal & Anor [2023] UKUT 267 (AAC) addresses several legal principles pertinent to judicial reviews of tribunal decisions in the context of criminal injuries compensation claims in the United Kingdom. The Upper Tribunal analyses and provides important clarification on the role of medical evidence in tribunal decisions, the lawful foundation of tribunal findings, and the requisite standard for providing reasons for those findings.

Key Facts

This case revolves around the applicant, JM, who sought judicial review of a decision by the First-tier Tribunal (Social Entitlement Chamber) in response to her claim made to the Criminal Injuries Compensation Authority (CICA). JM suffered from an assault that resulted in physical and psychological injuries, including PTSD and tinnitus. The Tribunal initially awarded compensation based on a combination of ailments like headaches, neck scarring, and disabling mental injury with PTSD; however, JM contended that the evidence of her continuing tinnitus and the severity of PTSD had been improperly considered or disregarded.

The Upper Tribunal addressed three primary legal principles:

  1. Evaluation of Medical Evidence: The First-tier Tribunal’s finding that JM’s PTSD was “mild,” when no such diagnosis existed in her medical records, highlights the principle that tribunal decisions must be evidence-based. Accurate and faithful interpretation of medical records and expert opinions is essential to ensure a just adjudication.

  2. Duration of Disabling Mental Injury: The tribunal’s acceptance of Dr. Cardoza’s opinion that JM’s PTSD was disabling only for a specific period, without proper reasoning or evidence, brings into focus the principle that decision-makers must not merely accept expert opinions without sufficient foundation. They must critically evaluate expert evidence, especially when it pertains to the determination of injury duration and its impact on the claimant’s life.

  3. Formal Diagnosis Requirements: The precedent set by the case also clarifies that medical formalities, such as the formal diagnosis of conditions like tinnitus, are significant in tribunal evaluations. Overlooking explicit and contrary evidence, such as an audiologist’s diagnosis, fails to meet the evidentiary standards required for a lawful and fair decision.

Furthermore, the case examines the extent to which a tribunal or CICA is bound by the opinions of medical professionals regarding the period of disabling injury under the 2012 Criminal Injuries Compensation Scheme. The legal principle considered is whether the requirement for a psychiatrist or clinical psychologist’s “confirmation of diagnosis or prognosis” pertains only to the injury’s existence or its duration as well.

Outcomes

The decision of the Upper Tribunal led to the successful outcome for JM’s application for judicial review. The Tribunal quashed the previous decision and remitted the case back for re-determination, highlighting the following errors in law by the First-tier Tribunal:

  1. Unsupported Findings: The finding of mild PTSD lacked evidence, demonstrating the need for findings to be properly supported by the case record.

  2. Inadequate Reasoning: The Tribunal’s failure to reason adequately or to explain the acceptance of expert opinion concerning the duration of disabling PTSD underscored the need for detailed reasoning.

  3. Oversight of Relevant Evidence: The omission of relevant medical evidence, such as the formal audiologist’s diagnosis of tinnitus associated with the assault, necessitated better attention to the claimant’s medical history.

The Upper Tribunal’s observation on the role of a psychiatrist or clinical psychologist under the Compensation Scheme was inclining towards the idea that their role possibly is to confirm the existence of a mental injury, but not necessarily the duration.

Conclusion

The Upper Tribunal’s decision in JM v The First-Tier Tribunal & Anor reiterates the importance of thorough and reasoned decision-making by tribunals, with an emphasis on the adherence to evidentiary standards and the requirement for detailed reasoning in tribunal decisions. The judgment underscores the principle that mere acceptance of an expert’s opinion without proper consideration and explanation is insufficient in law. Additionally, it brings clarity to the role of medical professionals in confirming the existence and potentially the duration of a disabling mental injury under CICA’s Compensation Scheme. The case acts as a pertinent indication for legal professionals regarding the necessity for scrupulous engagement with medical evidence and proper justification for tribunal decisions.