"(1) ..... in sections 11 and 12 of this Act references to a person's date of knowledge are references to the date on which he first had knowledge of the following facts - (a) that the injury in question was significant; and (b) that the injury was attributable in whole or in part to the act or omission which is alleged to constitute negligence, nuisance or breach of duty;" - (c) and (d) are not material - "and knowledge that any acts or omissions did or did not, as a matter of law, involve negligence, nuisance or breach of duty is irrelevant."
"(2) For the purposes of this section an injury is significant if the person whose date of knowledge is in question would reasonably have considered it sufficiently serious to justify his instituting proceedings for damages against a defendant who did not dispute liability and was able to satisfy a judgment."
"For the purposes of this section a person's knowledge includes knowledge which he might reasonably have been expected to acquire - (a) from facts observable or ascertainable by him; or (b) from facts ascertainable by him with the help of medical or other appropriate expert advice which it is reasonable for him to seek; but a person shall not be fixed under this sub-section with knowledge of a fact ascertainable only with the help of expert advice so long as he has taken all reasonable steps to obtain (and, where appropriate, to act on) that advice."
"When did this lady have knowledge of the significant injury? It is both a subjective and an objective test. The court can examine whether the particular plaintiff subjectively considered the injury sufficiently serious but I must also look objectively as to whether she was acting reasonably. In my judgment it was reasonable for the claimant in this case to adopt a wait and see attitude to see if the pain in her shoulder was merely a strain or ache and might soon settle and therefore was not a significant injury within the meaning of Section 11 prompting consideration of legal redress. She did, however, have that information and approach as from the time of the appointment with her physiotherapist."
" ..... it is clear that the test is partly a subjective test, namely: would the plaintiff have considered the injury sufficiently serious? And partly an objective test, namely: would he have been reasonable if he did not regard it as sufficiently serious? It seems to me that sub-s (7) [predecessor of Section 14 (2) of the 1990 Act] is directed at the nature of the injury as known to the plaintiff at that time. Taking that plaintiff, with that plaintiff's intelligence, would he have been reasonable in considering the injury not sufficiently serious to justify instituting proceedings for damages?"
"Q Can you describe what the pain felt like? A It was an acute pain, hard to describe. It stopped me moving my arm to a certain degree. Q Did it come on quickly or gradually? A Over a period of a few months. Q And was March 1997 the beginning of that? A No, it was very slight before that. In March 1997 it then started to make me take notice of it."
"MR COUGHLAN: The general practitioner entry for that date queries the diagnosis of a frozen shoulder. Was anything said to you about a frozen shoulder on that day? A No. Apparently, when you have some sort of an injury, if you don't use it because it is injured, then you get a frozen shoulder. Q Were you told when you saw your general practitioner on that day what it was that was causing you your pain? A No. He thought it was something to do with arthritis and he gave me a painkilling injection and referred me to Dr Chakravarty. Q Just so that we are clear, Mrs Collins, the fact that you were seen 11 days later on 29 August when X-rays were ordered, and on page 28 of Mr Hirschowitz's report, does that accord with your recollection? Did you have X-rays taken? A Yes. Q And was it your GP who referred you to Dr Chakravarty? A Yes. Q At any point prior to being referred to Dr Chakravarty did you know what was causing you your problem? A No. I thought I had just pulled something."
"Q ..... If you saw Dr Chakravarty in May 1998, your symptoms had been going on for over a year, so late 1996. A Yes, they had started by then. Q When you saw Mr Hirschowitz the date in March 1997, that was the date that you realised your symptoms were more serious and that they were not going away. A Yes. Q So they had presumably gone by that stage from being a minor irritation or nuisance to something more serious? A Yes."
"Q After March 1997, your symptoms obviously do not get better. If anything, they get worse, and I infer that they get worse because eventually in August 1997 you take yourself off to see your GP? A Yes."
"Q It would seem that your time off work, looking back ..... was around September/October 1997. Would you agree with that? A Yes."
"Q You accept it may be late 1996 as the onset of your problem? A Yes. Q Do you remember what you told your GP? A I think I just told him that my shoulder was hurting and that I did heavy lifting at work and that was about it really. I didn't know what was wrong with it at that time. Q I want to look at the first page of that bundle. there is a note there that reads: '18 August right shoulder ache 3/13', which is medical shorthand for three months. Do you remember telling your GP that? A I had it for three months. Q Do you think that note might be wrong? A No, I don't say it is wrong, I can't read it actually."
"Q How was the pain during January to May 1998? A Getting worse."
"Q You thought what about it getting better? A That if I took things easy it would eventually get better just like a pulled muscle or something of that nature."
"Diagnosis: Right acromioclavicular joint arthritis History of present illness: This lady had painful right shoulder for over a year, which came on rather suddenly and has been getting worse for the last few months. Apparently she couldn't lift her arm initially for which she had to be off sick for four weeks. However, her symptoms have improved but she doesn't admit to any Paraesthesia in her upper or lower limbs. She has no symptoms related to early morning stiffness, or swelling of her joints. Her personal and social histories are uneventful."
"Physical examination: General and systemic examinations were normal including joints. Examination of the right shoulder revealed acromioclavicular joint arthritis. Investigations: I requested for various blood tests and also x-rayed her hands and feet as they appeared to be slightly swollen at the Map's and Pip's. Management: I have injected the right acromioclavicular joint today and also offered physiotherapy. I have given her an ARC booklet on shoulder pain to educate herself, and I shall review her in four months after she has obtained some physio."
" ..... an injury is significant if the person whose date of knowledge is in question would reasonably have considered it sufficiently serious to justify his instituting proceedings for damages against a defendant who did not dispute liability and was able to satisfy a judgment."
"32 When did she have knowledge that the injury was attributable to her work? This question of attributability also troubles me. Here is a lady who has been treated for an arthritic injury; she is referred to a rheumatologist. Of course she is aware that it is difficult for her to move the cages around and that it causes her pain, but is she aware, or ought she [to] be aware, that the injury itself is attributable to the action of moving the cages? Counsel for the defendant carefully cross-examined her on the basis that she realised there was [a] connection between the injury and her work, to which she readily admitted, but it was not the case, I find, that by such an admission she was or could be saying that she knew that the injury was attributable to the work insofar as there was a cause or connection of some kind ..... 33 The first time she might have been aware of this was at the meeting with the consultant rheumatologist on14 January 1998 . This is curious because the diagnosis is that of arthritis, as may be seen by his report on26 January 1998 . However, the claimant orally recalls him saying it was an overuse injury. She thought that after a couple of months rest it would be okay. How am I to interpret this? It seems to me that the claimant herself had an expectation that the symptoms would go with rest. The documentary evidence indicates an arthritic condition. I can understand a confusion and lack of ability by the claimant to place reliability at this time upon a test of attribution."
"Q ..... When you went to see your GP in August 1997, so when you first go off to see your GP, you are presumably conscious at that stage, as you told us, about the probable connection between the work you are doing and the symptoms you are getting in your shoulder? A Yes. Q And that presumably is something that you would have discussed with your GP? A I didn't discuss it with him. I just told him that I had a painful shoulder, told him what work I did and he gave me the injection for the pain but at that point there was no real diagnosis. Q But you no doubt would have told him what your work was - A Yes. Q - and no doubt what your work involved? A Mm."
"55 To this end it is clear from the report of Mr David Hirschowitz on26 June 2001 , when he says: 'I would expect her to recover to do ordinary shop work' but at the time she has not so recovered. By11 September 2001 he says: 'My view is that Mrs Collins has already recovered to the point where she should be able to cope with ordinary shop work, perhaps on a part-time basis initially, but from a shoulder point of view full-time within a year.' That is by11 September 2002 ."
"Q Is that one of the reasons why you have not worked since February 2001? A No. The main reason why I have not worked is because I have been told that tendonitis, once you have had it, can be recurring, so I don't want to do anything too strenuous and I am not trained for proper office work as such. I only ever worked in shops, so I need to have a re-think."
"A little earlier the judge (I interpolate, that is the judge at first instance in that case): "had spoken of the solicitor's perception that he needed confirmation that there was the relevant causal connection, and a little later he added that the question will, in certain circumstances, be whether a particular injury was caused by an operation or was caused by something else. In my judgment, in all these passages the judge is substituting the much tougher test of proof of causation for the much less rigorous statutory test of attributability, in the sense that the identified injury was capable of being attributed to the identified omission. The test is a subjective one: what did the plaintiff herself know? It is not an objective one: what would have been the reasonable layman's state of mind in the absence of expert confirmation? After all, the policy of Parliament, in these cases which would otherwise be statute-barred, is to give a plaintiff who has the requisite low level of knowledge three years in which to establish by inquiry whether the identified injury was indeed probably caused by the identified omission and whether the omission (identified initially in broad terms) amounted to actionable negligence. The judge's approach would be to stop the three years from even starting to run until a much more advanced stage of the investigation had been completed."