High Court of Ireland Decisions

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[2025] IEHC 216

 

 THE HIGH COURT

[Record No. 2021/5232P]

BETWEEN

MARK KEANE

PLAINTIFF

AND

 

JOHNSON & JOHNSON VISION CARE (IRELAND)

DEFENDANT

 

JUDGMENT of Mr Justice Paul Coffey delivered on the 1^st day of April 2025

1.                  In this case the plaintiff seeks damages for personal injury arising from an accident at work which occurred on 10 September 2018 at the defendant's factory in Limerick when, as a rescuer, he intervened to save a colleague's hand which had become caught in a heavy machine, as a result of which the plaintiff alleges he sustained significant injuries to his right little finger and right shoulder together with PTSD, the cumulative effect of which has been to incapacitate him from work to date with significant vocational implications into the future.

2.                  The defendant has admitted liability but disputes any causal relationship between the trauma of the accident and the plaintiff's current right shoulder condition or his alleged incapacity to work beyond 11 September 2020, when it is alleged that the plaintiff was offered but failed to take up suitable alternative employment which would have accommodated the admitted injury to his right little finger.

Background

3.                  The plaintiff was born in 1981 in Limerick as the second eldest of four siblings and is married to Karen, with whom he has one child. Each of them also has a child from a previous relationship, together forming a blended family of three children. He was a highly accomplished hurler, playing inter-county for Limerick from 2000 to 2006, winning three All-Ireland U.21 medals, and being one of the top scorers in the country, before his career ended. After completing his Leaving Cert in 1999, he trained as an apprentice electrician and worked in the electrical industry, including a period of self-employment, before joining the defendant in August 2014 as a process technician, securing permanent employment in December of 2014. In 2020, he completed a Level 7 Degree in Manufacturing Technology which he had started in 2017 as part of a career development initiative at his workplace. At the time of the accident, the plaintiff was employed as a process technician (Level 21-Band 3). It is agreed that but for the accident the applicant would have been promoted to the position of line leader (Level 22-Band 2) as of the date of trial earning €69,322.16 per annum.

The accident

4.                  The accident occurred on 10 September 2018, at approximately 6am, while the plaintiff was working a night shift on Line 24 in the defendant's factory. In the immediate vicinity, his colleague, Pat Ryan, was working on a pre-cure machine on Line 25 when his hand became trapped under a heavy weight in the machine. Upon hearing the screams of his co-worker for help, the plaintiff immediately intervened as a rescuer to save his colleague's hand. In doing so, he caught his right hand on a metal rail in the machine, forcefully bending his right little finger backwards, causing immediate pain and injury. Despite this, the plaintiff proceeded to position himself in a crouched stance underneath the machine, using his right shoulder to bear the full weight of the heavy load pressing down on his colleague's trapped hand. He maintained this position for thirty seconds to a minute, exerting significant force on his right shoulder, arm and upper body. Eventually, with the assistance of other employees using a crowbar and bottle jack, his co-worker's hand was freed. The cause of the accident was the failure of the machine's safety mechanism, which allowed the heavy weight to descend onto Mr Ryan's upper limb.

The plaintiff's injuries

5.                  The plaintiff's clinical course involved treatment of his right little finger and the subsequent emergence and treatment of symptoms in his right shoulder. The central issue in this case is whether the plaintiff's right shoulder symptoms are causally related to the accident of 10 September 2018.

6.                  Following the accident, the plaintiff was initially of the belief that he had only suffered an injury to his right little finger, which was bent backwards from impact with a metal rail in the machine. He attended University Hospital Limerick that evening, where an x-ray confirmed a fracture to his little finger. He was then referred to Cork University Hospital for further assessment. Under the care of Mr Seán O'Sullivan, a plastic surgeon, the plaintiff was placed in a splint and underwent conservative treatment for several months. However, his condition did not improve and surgery was deemed necessary to correct a flexion deformity that had developed in the extensor tendon of his little finger. On 15 February 2019, he underwent surgery at the South Infirmary in Cork which failed to straighten the little finger. By March of 2019, a possible ulnar compression syndrome was suspected involving pain radiating to his elbow with no documented mention of shoulder involvement. However, the plaintiff gave evidence that he had complained at all times of pain running from his right hand to his right shoulder. As a result of his presentation, the plaintiff was referred for nerve conduction studies, which were performed in June 2019 and reported as normal. By November 2019, Mr O'Sullivan wrote to the plaintiff's general practitioner, Dr Boylan, noting that he was "a bit uncertain (about what exactly was) going on". On 3 December 2019, a CUH clinical note recorded "pain radiating from hand to right elbow/shoulder." This was the first documented note of any shoulder involvement, though no specific shoulder diagnosis was made.

7.                  On 1 December 2020, a physiotherapist treating the plaintiff documented his complaint of increased right arm and shoulder pain after his seven year old daughter had jumped on him. This was the first documented mention of pain coming from the plaintiff's right shoulder.

8.                  As the plaintiff's symptoms worsened, he was referred to Professor Harmon, a pain specialist who arranged for an MRI to be carried out to investigate possible structural pathology in the plaintiff's right shoulder. The MRI was carried out on 20 December 2021 and revealed early degenerative changes and a partial SLAP lesion where the bicep tendon attaches to the top of the labrum.

9.                  Between 2022 and 2023, he received multiple pain management injections to his shoulder and neck, administered by Professor Harmon. In May 2022, the plaintiff was assessed by Professor Cathal Moran, orthopaedic surgeon and shoulder injury specialist. He initially recommended a trial of physiotherapy and an injection to manage the plaintiff's symptoms conservatively. When these treatments proved ineffective, it was decided in mid-September 2022 that arthroscopic surgery was necessary. In September 2022, the plaintiff underwent a shoulder arthroscopy in Santry, Dublin, during which Professor Moran debrided the subacromial space and distal clavicle and performed a bicep tenodesis to restore the anatomy. Four weeks post-surgery, the plaintiff still had an irritable and sensitised shoulder, but the pre-surgery bicep tendon tenderness was no longer present. Professor Moran administered another injection and described the plaintiff's ongoing condition as a sensitised and inflamed shoulder with a tendency towards stiffness or borderline frozen shoulder.

10.              In January 2023, the plaintiff also developed unrelated severe lower back pain, following which an MRI revealed a disc bulge at L3. He was referred to the Mater Hospital where on 30 March 2023, he underwent a lumbar discectomy, which relieved his pain but left residual numbness in his leg.

11.              In addition to his physical injuries, the plaintiff has also suffered from severe anxiety, depression and emotional distress related to his injuries and inability to work. On 22 April 2024, he was assessed by Dr Cian Aherne, a clinical psychologist, who diagnosed him with severe PTSD linked to the trauma of the accident and his ongoing pain. Using the PCL-5 PTSD assessment tool, the plaintiff scored 59 out of 80, well above the clinical threshold of 30-35. His PTSD symptoms include vivid flashbacks, hypervigilance, sleep disturbance, social withdrawal and feelings of helplessness. He is on anti-depressant medication and has undergone multiple psychotherapy sessions, but currently cannot afford the further sessions of therapy that have been recommended to him.

The evidence as to the effect of the accident on family life

12.              The accident has had a profound impact on the plaintiff's psychological wellbeing and family life, leaving him feeling emotionally and mentally devastated. Before the accident, he had overcome alcoholism, rebuilt his career, and was financially stable, but its impact has left him feeling emasculated, helpless and incapable of providing for his family. His wife, Karen, testified that the accident has completely changed him, and she now worries everyday for his wellbeing, especially if he is late returning home. She has had to retrain as a special needs assistant and return to work part-time, adding further strain on the family. Their financial struggles have been exacerbated by the fact that in 2021, they acquired a site and obtained planning permission to build a two-storey, four bedroom house, which was meant to be their family home. However, as his income was incrementally reduced and eventually stopped in November 2022, they were unable to secure a mortgage, forcing them to remain in rented accommodation owned by a relative. The plaintiff described the strain on him as "astronomical" deeply affecting both his relationship with his wife and his mental health, as he struggles with a feeling that he has let his family down and has been abandoned by his employer despite his efforts to save his colleague's life.

The effect of the accident on the plaintiff's work

13.              Since the accident, the plaintiff has been unable to return to his previous role as a process technician, primarily due to the opinion of the defendant's occupational health physician, Dr Madden, that he was unfit to return to his pre-accident work but also due to the plaintiff's own recognition that the manual component of the work would be too painful given his hand injury. In mid-2020, the defendant's business unit manager, Greg Reddin, in consultation with Dr Madden, considered 43 alternative roles within the company, but ultimately identified only one that potentially was suitable based on the plaintiff's hand injury.

14.              On 14 August 2020, the plaintiff attended a meeting with company representatives to discuss trialling the relevant role which was that of inspections coordinator. At the meeting the role was described but not offered to the plaintiff who stated in any event that he would need to discuss it with his GP. However, in November 2020, Dr Madden suspended any return to work pending the completion of further treatment to the plaintiff's upper limb. His salary continued to be paid in full but was incrementally reduced before being stopped completely in November 2022. Following the decision of Dr Madden in November 2020, the plaintiff's return to work was never revisited by the defendant with the result that he was never offered alternative suitable employment within the company.

15.              After November 2022, when the plaintiff's salary payments from his employer ceased, he transitioned to social welfare support. Since May 2023, the plaintiff has been in receipt of Invalidity Pension of €230 per week. Additionally, the plaintiff receives €25 per week for travel expenses from the National Learning Network (NLN), where he is currently enrolled in an IT course aimed at facilitating his return to work in a less physically demanding role. This course, which commenced in 2024, is a two-year program and will provide the plaintiff with a Level 5 qualification upon completion in 2026.

Causation of the plaintiff's shoulder condition

The defendant's case

16.              The defendant contends that there is no medical or factual basis to conclude that the plaintiff's shoulder condition was caused or related to the accident of 10 September 2018, given the significant delay in the onset of symptoms and the absence of any shoulder complaints in his early medical records. The plaintiff's first recorded complaint of shoulder pain was on 1 December 2020, when he reported symptoms to Patricia O'Gorman a physiotherapist, more than two years after the accident. The defendant argues that if the accident had caused a significant shoulder injury, it would have been documented in the immediate aftermath or within a reasonable period following the trauma.

17.              The absence of any shoulder complaints in the plaintiff's early medical records is central to the defendant's argument. The plaintiff attended Cork University Hospital in September 2018, where his right little finger was diagnosed as the primary injury, but there is no mention of shoulder pain in the CUH records. Similarly, the plaintiff's GP, Dr Boylan had multiple consultations following the accident, but recorded complaints only related to the right little finger and hand, without any reference to shoulder symptoms until late 2021, when Professor Harmon referred him for an MRI. Dr Madden, the defendant's occupational health physician, also made extensive notes on the plaintiff's medical condition from 2018 onward and never recorded any reference to shoulder pain in his early assessments. His notes from August 2019 and December 2019 documented pain radiating up the arm, but it was by inference pain originating in the hand, with no reference to shoulder involvement. It was only in November 2020 that Dr Madden recorded that the plaintiff reported pain spreading "all up along his arm". The defendant argues that this evolving nature of the plaintiff's complaints raises serious doubts as to whether the shoulder symptoms were linked to the original trauma, suggesting that they were the result of some other cause.

18.              The defendant also relies on the fact that the plaintiff was examined by Mr Rice, an orthopaedic surgeon, in February 2019 in respect of a previous and unrelated road traffic accident that occurred in 2014 but did not complain of pain in his shoulder at the time. Instead, his complaints related to his neck back and knee with no mention of shoulder discomfort.

19.              The defendant also relies on the expert evidence of Dr Garrett Quin, a consultant in emergency medicine, who emphasised that symptoms of acute trauma, such as a shoulder tear, would normally present either immediately or within days of the injury. Dr Quin testified that the late onset of symptoms, as in this case, would strongly suggest that there is no causal connection between the accident and the plaintiff's shoulder condition. He further noted that had the plaintiff suffered a traumatic shoulder injury during the rescue event, he would have expected it to be recorded in his early medical reports, particularly in his consultations at Cork University Hospital or in the assessments by his GP. The fact that there is no medical record of any shoulder complaints until December 2020 suggests to him that the shoulder injury was not caused by the accident.

20.              Additionally, the defendant points to the plaintiff's physical activities in the summer of 2020, which included multiple long distance cycling sessions, as further evidence undermining any claim that he was suffering from a significant shoulder injury before late 2020. The plaintiff was shown to have completed seven long-distance cycles between June and July 2020, including a 42.7-mile cycle in just over two and a half hours, with substantial elevation gains, requiring the use of his shoulders for climbing. The defendant argues that if the plaintiff had been suffering from ongoing significant shoulder pain relating to the accident, it would have been highly unlikely that he could have engaged in such strenuous activities.

21.              Finally, the defendant relies on the medical opinion of the plaintiff's expert witness, Professor Moran, who could not say whether the MRI findings in 2020 were caused by the accident. Professor Moran also stated that multiple factors including wear and tear, activity levels or genetic predisposition, could have contributed to the plaintiff's shoulder condition. He further noted that shoulder symptoms can develop and worsen over time, even in the absence of trauma. The defendant argues that this uncertainty, combined with the absence of shoulder complaints in the plaintiff's earlier medical records and his extensive physical activity in 2020, makes it more likely than not that the plaintiff's shoulder condition is unrelated to the accident.

The plaintiff's case

22.              The plaintiff contends that his right shoulder symptoms were directly caused by the workplace accident on 10 September 2018, and that while symptoms were not immediately apparent, they progressed as a result of the trauma sustained during the accident. It is argued on his behalf that the absence of symptoms before the accident, the mechanism of the accident, the restricted use of the shoulder post-injury, and expert medical opinion on causation all support the link between the accident and his shoulder condition.

23.              It is not in dispute that the plaintiff had no shoulder symptoms in his right shoulder before the accident or that he was unable to use his right shoulder for extended periods after the accident, which it is contended, explains why symptoms may not have become fully apparent until much later. From the date of injury until surgery in February 2019, his right hand was mobilised in a sling due to the fracture to his little finger and associated pain. Following surgery, he was again in a sling intermittingly and continued to wear a splint on his hand for long periods during his recovery. The plaintiff argues that because his right arm and shoulder were being used less frequently or not at all, it is entirely plausible that the injury went unnoticed initially. It is further contended that as he began to reintroduce movement, particularly after surgery, he started experiencing pain radiating up his arm which was ultimately found to originate in his shoulder.

24.              The plaintiff's GP, Dr Boylan, clarified that although he initially had multiple attendances on the plaintiff, they were for the purposes of certifying his absence from work and not for the purpose of reviewing or treating him clinically. He noted that the shoulder injuries can sometimes develop gradually, particularly when a person is unable to use the limb properly for an extended period. He compared it to a rope fraying overtime, explaining that minor damage to the tendons or structures in the shoulder can worsen as the person begins using the arm again. Dr Boylan further stated that there was no other known injury to the plaintiff's shoulder between the accident and the onset of symptoms, and that he saw no reason to believe that the condition was caused by anything other than the accident itself.

25.              The plaintiff's case was further supported by Professor Harmon, who stated that the plaintiff's right shoulder symptoms originated from the accident, rejecting the argument that they were caused by degenerative changes due to his age.

26.              The plaintiff's case was also supported by Professor Moran. While he acknowledged that multiple factors, including wear and tear, activity levels or a subsequent trauma, could have contributed to the findings on the plaintiff's 2020 MRI, he ultimately concluded that it was reasonable to believe that the accident played a causative role in triggering symptoms in the plaintiff's shoulder.

Assessment of the evidence

27.              On balance, I prefer the evidence that supports a causal connection between the trauma of the accident and the emergence of symptoms in the plaintiff's right shoulder, despite the delay in their documented onset.

28.              An important factor supporting causation is that the plaintiff had no complaints or symptoms relating to his right shoulder before the accident. His medical history is therefore devoid of any reference to previous right shoulder pain, weakness, or dysfunction. This provides the baseline for assessing causation, as any subsequent issue with his shoulder must be explained by an identifiable event or process that occurred after the incident. However, no such event or process was identified in the evidence.

29.              The nature and mechanics of the accident provide a clear and obvious mechanism for the shoulder injury. The plaintiff was attempting to lift the weight of a heavy part of a machine off his colleague's trapped arm, exerting considerable force through his upper limb, particularly his right arm and shoulder. This was not a minor or incidental movement - it involved a sustained and intense force transmission through the shoulder joint. The plaintiff gave unchallenged evidence that in taking the weight of the relevant part of the machine, all the pressure was on his right shoulder while he was positioned under the machine in an awkward position, reaching around Mr Ryan. This is entirely consistent with the type of traumatic force that can either lead to the partial tear that was seen on MRI and/or trauma that was likely to have provoked symptoms in his shoulder, if such a tear or degenerative changes were already present.

30.              It is highly relevant that although the plaintiff did not initially report right shoulder pain, he did so in the context of a prolonged immobilisation of his right shoulder in a sling. This immobilisation likely masked the symptoms of a developing shoulder issue, as he was not engaged in normal activity that would have prompted the recognition of pain.

31.              It is also relevant that after the sling was removed and his hand treatment progressed, the symptoms in his right arm began to emerge. As early as March 2019, symptoms in his right arm began to manifest following which it became increasingly apparent that these symptoms extended beyond his hand and forearm, eventually involving the shoulder. It is also clear from contemporaneous medical records that his treating doctors did not fully understand the nature of his symptoms at the time. This was expressly acknowledged by Mr O'Sullivan in his letter of 14 November 2019 to Dr Boylan, in which he stated he was "a bit uncertain (about what exactly was) going on". This uncertainty strongly suggests that his medical team recognised that his symptoms did not align neatly with an injury to his finger or hand.

32.              The plaintiff's medical records thereafter demonstrated a clear trajectory of worsening pain, eventually involving his right shoulder. On 3 December 2019, a clinical note from CUH references pain radiating from the plaintiff's hand to his right shoulder. On 1 December 2020, a physiotherapy note made by Patricia O'Gorman documented the plaintiff specifically complaining of right arm and shoulder pain with an upward-facing arrow, though it was linked to an incident where his daughter jumped on him. Such an arrow beside a complaint of pain usually means that the pain has worsened or increased in severity which prima facie suggests that the pain was already present and therefore not caused by the incident of 1 December 2020. This was confirmed by Ms O'Gorman, who stated in her evidence that the incident increased muscle spasm in the back of his shoulder, in which the plaintiff had already reported pain on 17 November 2020. By November 2021, when assessed by Professor Harmon, the plaintiff's shoulder was such that an MRI scan of the right shoulder was ordered for 20 December 2021, which disclosed degenerative changes and a partial tear of the labrum. This suggests the evolution of symptoms, consistent with a progressive shoulder injury triggered by the accident but masked by prolonged immobilisation and a focus on his hand injury.

33.              Although he could not definitively attribute the abnormalities seen on MRI to the trauma of the accident, Professor Moran acknowledged the "second hit" phenomenon, where an injury elsewhere on the limb, in this case the hand, can sensitise the shoulder and tip it into symptomatology. He further acknowledged that injuries can take time to reach the level that would prompt a referral to a clinician. He also found it "logical" and "reasonable" to conclude that the accident "was likely to have aggravated a tear that was already there, or a tear caused in the accident" and said it was "reasonable" to conclude that the accident played a role in the "gradual progression of symptoms".

34.              I find it significant that the opinion of Professor Moran is independently supported by the opinions of Professor Harmon and the plaintiff's GP, Dr Boylan. Professor Harmon was unequivocal in stating that the plaintiff's right shoulder symptoms were directly attributable to the accident and categorically rejected the argument that they were caused by degenerative changes due to age. However, I found the evidence of Dr Boylan particularly helpful because of his long history of treating the plaintiff and his familiarity with the progression of the plaintiff's symptoms. He also provided a clear and credible explanation as to why the plaintiff's shoulder symptoms may not have been immediately apparent but were nonetheless causally linked to the accident. Dr Boylan emphasised that shoulder injuries can sometimes manifest gradually, particularly when the limb is immobilised for an extended period, as was the case here. He likened the nature of the plaintiff's injury to a rope fraying overtime whereby minor, undetected damage to the tendons or joint structures can progressively worsen as the limb is reintroduced to movement and function.

35.              Having considered the counter-arguments, advanced with considerable force and skill by senior counsel for the defendant, I am satisfied, on the balance of probabilities, that the accident was not only a contributing factor but a crucial and necessary link in the chain of causation of the plaintiff's shoulder condition.

General Damages

36.              As the accident giving rise to these proceedings occurred in 2018, I am required to have regard to the 2016 edition of the Book of Quantum when assessing general damages. As this case involves multiple injuries, I am further required to adopt a structured two-stage approach in assessing the overall award for general damages. First, I must determine appropriate compensation for each injury to ensure that the plaintiff is properly compensated for each injury to which I must assign a value that is both fair to the parties and proportionate to the maximum of €450,000 and equivalent awards available in the Book of Quantum for injuries of similar gravity. Second, I must not simply mathematically aggregate the assigned values but rather must step back and, if necessary, adjust the overall award to ensure that it is itself proportionate to the maximum and equivalent awards available so that the final award neither overcompensates nor undercompensates the plaintiff, having regard to his overall injury profile. Typically, this is done to ensure that there is non-duplication of compensation where, for example, injuries have overlapping effects on daily life, work, or long-term prognosis.

Right little finger/hand

37.              In addition to his pain and suffering to date, the plaintiff continues to experience ongoing pain and functional limitations in his right hand, which impact both his daily activities and ability to engage in physical tasks. He reports that pain intermittingly travels up and down his hand, particularly when it is in a locked position for a prolonged period. Additionally, he experiences vibration sensitivity which prevents him from fully engaging in activities he once excelled at, such as coaching hurling. While he can verbally instruct players, he is unable to physically demonstrate techniques due to pain. The plaintiff also finds jogging and running difficult, not because the condition prevents him from doing so entirely, but because the vibration from the impact can leave him in pain for days afterwards.

38.              Professor Harmon stated that the plaintiff still experiences symptoms in his hand, as well as in his shoulder and neck, with ongoing pain and limitation of movement. Mr Colin Riordan, hand and plastic surgeon, assessed the plaintiff's condition and determined that the impairment and disability in his hand equated to approximately 3% loss of function. He stated that no further late complications were expected in relation to the hand. However, he confirmed that the plaintiff's right little finger has a permanent 40° flexion deformity, meaning that the joint remains permanently bent and unable to fully extent. Accordingly, while his overall function and impairment is considered minor from a clinical standpoint, the pain and sensitivity he experiences continue to significantly impact his ability to engage in activities acquiring fine motor skills, grip strength, or repetitive movement.

39.              Applying the principles of fairness and proportionality with due regard to the Book of Quantum, I characterise the injury as one that straddles the divide between 'moderately severe' and 'serious and permanent conditions' and assign to it a value of €50,000.

Right shoulder

40.               Over and above his pain and suffering to date, the plaintiff continues to experience persistent pain and functional limitation in his right shoulder, requiring ongoing pain management injections. His last round of injections occurred before Christmas 2024, and he is due for further treatment. While the injections provide some relief, they do not restore movement or eliminate pain completely. He experiences pain "all the time" and suffers from significant sleep disturbance, stating that he only manages two to three hours of sleep per night due to discomfort and a fear of rolling onto his right side and waking up in pain.

41.              Professor Dominic Harmon emphasised that the plaintiff's primary physical impact is in his shoulder, elbow and neck rather than his hand. He described the condition as an evolving issue and estimated the plaintiff would require pain management treatments three times per year for at least 3-5 years. He acknowledged that symptoms could change over time, with further evolution of pain and functional limitations possible. Dr Boylan stated that while the plaintiff has regained significant use of his shoulder, he remains at risk of developing future problems if he engages in heavy lifting or repetitive movements. He advised that the plaintiff should avoid occupations that involve physically demanding shoulder use, such as lifting, pulling, or repetitive manual labour.

42.              Professor Moran last examined the plaintiff in March 2023 and described his shoulder as "irritable" and "somewhat sensitised", behaving like a borderline frozen shoulder. He stated that while certain symptoms, such as tenderness over the bicep tendon, had improved following surgery, the shoulder remains sensitive. He warned that shoulder function is heavily influenced by the rotation of cuff tendons, and that bit by bit, the shoulder could become more dysfunctional over time. However, he does not anticipate that the plaintiff will require a joint replacement or major surgical intervention in the future. Instead, ongoing physiotherapy and occasional injections will likely be necessary to manage pain and inflammation. Professor Moran is hopeful that based on the average outcomes for similar cases, the plaintiff will eventually rehabilitate to a level where he could live a somewhat normal life. However, this would not mean a full recovery and he would likely continue to experience some limitations.

43.              Applying the relevant legal principles set out above, I characterise the injury to be at the upper end of 'moderate' in its gravity and assign to it a value of €55,000.

PTSD

44.              Although a pain specialist, Professor Harmon is also a qualified psychologist. Both he and Dr Cian Aherne, clinical psychologist diagnosed the plaintiff with PTSD. Professor Harmon and Dr Aherne rejected the defence argument that the plaintiff's PTSD resulted from frustration over physical injuries. Dr Aherne catalogued the plaintiff's symptoms as including flashbacks, avoidance behaviour, emotional distress and social withdrawal. His evidence was that the plaintiff suffers from chronic anxiety and feelings of depression, at times expressing feelings of helplessness about his future and describing a deep sense of isolation due to his condition.

45.              Dr Aherne emphasised that PTSD significantly impacted on the plaintiff's ability to return to work, particularly in high-stress or unpredictable environments. He stated that PTSD is "very disabling" in the workplace and that the plaintiff would need a benign work environment and an understanding employer. His evidence suggests that the plaintiff may be able to work in a structured, low-stress setting but that he would still face challenges related to anxiety and social withdrawal. Dr Aherne recommended that the plaintiff transition into employment through a structured, supportive programme, such as his current IT course with the NLN. Professor Harmon also highlighted that PTSD symptoms made it difficult for the plaintiff to work in a conventional employment setting and added "another layer of difficulty" to his ability to function at work, at least in a high-pressure environment. Professor Harmon also noted that PTSD can affect concentration, stress tolerance and emotional stability in the workplace. His evidence makes clear that while the plaintiff may be capable of working in a structured, low-stress role, PTSD remains a significant barrier to employment.

46.              Dr Aherne emphasised that PTSD is not just about whether a person can perform tasks - it also affects how they handle stress, deal with workplace dynamics, and maintain focus. He indicated that many PTSD sufferers can struggle with consistent employment due to the unpredictability of symptoms. He accepted that while he may be competitive for some roles in the future, PTSD will likely continue to affect his job options and workplace performance. The evidence of Dr Aherne further suggests that his prognosis depends on the success of treatment, the type of job he pursues, and the level of employer support. Professor Harmon indicated that while some improvement was possible, it depends on treatment, the work environment, and personal resilience. The evidence suggests that the plaintiff's PTSD is likely to persist for years, possibly indefinitely, if not well-managed and that it will continue to be a barrier to employment, particularly in high-stress roles. Accordingly, even if his physical injuries improve, PTSD will still affect his work capacity.

47.              The Book of Quantum does not provide guidance on the appropriate range of damages for PTSD. However, it is agreed that the 2021 edition of the Personal Injuries Guidelines offers relevant guidance in its absence. In this case the plaintiff's PTSD is undoubtedly severe and, in many ways, serves as the defining feature of his presentation to the court, conveying very clearly that his life has been profoundly affected, if not turned upside down by the trauma of his workplace accident. I therefore classify his PTSD as severe, while acknowledging that his prognosis is not so bleak as to preclude even the probability of meaningful recovery with sustained professional intervention. Applying the principles of fairness and proportionality, I assign a value of €65,000 to his psychiatric injury.

Overall award for general damages

48.              Having assigned values to all the plaintiff's injuries, I must now step back and assess whether the cumulative award requires adjustment to ensure that the final award is itself both fair to the parties and proportionate. In carrying out this review, I note that the injuries have had to varying extents overlapping effects on all aspects of the plaintiff's life and his prognosis. To avoid overcompensation and to measure a final award that is fair and proportionate, I will adjust the mathematical aggregate of all the assigned values to measure an overall award for general damages of €135,000.

 Special damages

Claim for loss of earnings and pension rights to date

49.              The plaintiff claims damages for loss of earnings (together with interest) and pension rights to date in the sum of €154,605, on the basis that his injuries have rendered him unable to work, and that his inability to return to employment is due to the defendant's failure to reintegrate him into alternative suitable employment and not any failure on his part to mitigate his loss.

50.              Mr Colin Riordan, hand surgeon, assessed the plaintiff on behalf of the defendant on 22 August 2023 and gave an explicit opinion that the plaintiff was fit to return to work as a process technician, however, his opinion was not grounded on any examination of the physical or functional demands of the role. Although the plaintiff remains formally employed by the defendant, he has never, despite multiple assessments, been certified by the defendant's occupational health physician as fit to resume his pre-accident duties as a process technician. In June 2020, and at a time when he was understood to have a hand injury alone, the defendant assessed 43 roles within the company but ultimately found that only one was potentially suitable for the plaintiff - inspections coordinator. The plaintiff attended a meeting in August 2020 to discuss this role, during which he raised concerns about typing due to pain in his right little finger and moving pallets with a pallet truck due to his ongoing pain. He indicated he would consult his GP, but before he could do so, the defendant's occupational doctor, Dr Madden in November 2020 unilaterally halted the process following which the defendant made no attempts to re-integrate the plaintiff.

51.              It is clear from the foregoing that the plaintiff could not have returned to his previous role without medical clearance, which was never granted. Although the defendant identified a role that it was prepared to trial, Mr Martin McKenna who attended the meeting with the plaintiff in August 2020 confirmed "nobody offered him a job there and then on the spot". Although the plaintiff applied for jobs outside the defendant in 2023 and 2024, these applications were unsuccessful. The defendant suggested that this showed a failure to mitigate his loss, but the plaintiff justifiably countered that seeking external options did not absolve his employer of its failure to re-engage with him.

52.              The medical evidence of Dr Boylan, Dr Aherne, Professor Moran and Professor Harmon supports the plaintiff's incapacity for work to date due to a combination of physical and psychological impairments. Given the lack of formal job offers, the absence of medical clearance, and ongoing medical and psychological limitations, I am satisfied that the plaintiff's claim for loss of earnings and pension rights to date is fully justified.

The plaintiff's claim for future loss of earnings

53.              The plaintiff claims damages for future loss of earnings on the basis that his injuries prevent him from returning to his pre-accident employment and will significantly impact his earning capacity going forward. The evidence in support of this claim comes from rehabilitation consultant Ms Elva Breen, the plaintiff, and the medical experts called on his behalf.

54.              Ms Breen assessed the plaintiff on two occasions, May 2021 and May 2024. On both occasions she used the DASH method of evaluating the impact of the plaintiff's injuries on his capacity for manual work, finding each time that he had consistently high scores of incapacity. She concluded that his injuries significantly impair his ability to perform manual work or any role involving repetitive hand use, heavy lifting, or prolonged physical exertion. In 2021, when only his hand injury was known, she determined that he could not return to his pre-accident role as a process technician and that he was fit, in effect, for only light sedentary work. By 2024, following his shoulder deterioration and PTSD diagnosis, she assessed his overall work capacity as further diminished. She recommended that the plaintiff transition to a less physically demanding career, suggesting a phased return to work in an administrative data entry or customer service role, each offering a salary range of approximately €25,000 to €35,000 per year. She also agreed with Ms Sinéad Vine, the defendant's rehabilitation consultant, that he may be competitive for administrative roles, work which would command similar income levels. She emphasised that he will be 45 years old by the time he completes the IT course that he is currently doing with NLN in 2026, having been out of competitive employment for eight years, which will affect his ability to secure well-paid employment.

55.              The plaintiff gave evidence that he intended to work with the defendant until retirement at age 66. It is agreed that but for his accident the plaintiff would have been promoted to Level 22-Band 2 by February 2025, so that his gross pay as of March 2025 would have been €69,322.16. He now faces a drastic reduction in earning potential, as the roles identified for him pay significantly less than what he would have earned had he remained with the defendant. He feels that he will never regain the level of financial stability he previously had, as he can no longer work in his trade as an electrician or any physically demanding role.

56.              The plaintiff's medical experts unanimously agree that the plaintiff is unfit for physically demanding work. Dr Boylan recommends that the plaintiff avoid any role requiring heavy lifting, pulling, or repetitive shoulder movements. Professor Moran noted that while the plaintiff has regained some function, his shoulder remains irritable and prone to further dysfunction over time, requiring continued physiotherapy and pain management. Professor Harmon emphasised that the plaintiff will require ongoing pain treatment for at least 3-5 years, and that his symptoms will persist, limiting his physical capabilities. Dr Aherne diagnosed PTSD, which adds another layer of difficulty to re-entering the workforce, as he will require a supportive work environment with minimal stress triggers.

57.              In assessing the plaintiff's claim for future loss of earnings, I accept the unchallenged evidence of the rehabilitation consultant that the plaintiff is only capable of engaging in non-physically demanding sedentary work, with an expected salary range of €25,000 to €35,000 per year. I am further satisfied that the plaintiff will experience an ongoing reduction in his competitive earning capacity until his anticipated retirement age of 66. While I accept that the plaintiff's capacity to earn will be significantly reduced in the short term, at least until he completes his IT course in 2026 and makes further progress in his overall rehabilitation, I am also satisfied that having regard to his previously strong work record, evident resilience and clear intelligence, that he is likely to re-enter the workforce and achieve earnings that will approximate to the equivalent of €30,000 per annum from now up to the age of 66. Accordingly, I consider it appropriate to reduce the capital value of the plaintiff's future loss of earnings by applying an average earnings figure of €30,000.

58.              Mr Tennant, actuary, has calculated the full actuarial value of what the plaintiff would have earned to retirement but for his injuries, using the appropriate multiplier and discount rate, as amounting to €988,758. From this sum, it is necessary to deduct the actuarial value of the plaintiff's residual earning capacity, assessed on the basis that he is likely to earn the equivalent of €30,000 per annum over the same period, resulting in a net future loss of earnings of €481,110.

59.              In assessing the plaintiff's likely future loss of earnings, I must also apply a deduction in accordance with the principles set out in Reddy v Bates, to reflect both the general vicissitudes of life and the specific uncertainties to which this particular plaintiff is exposed. While he has, to his great credit, successfully managed his alcoholism to date, it remains a potential risk factor for future employment stability. Additionally, his history of lower back and hip problems, introduces a variable that could impact his ability to work, irrespective of the injuries sustained in the accident. However, it is also relevant to acknowledge that the plaintiff was in secure employment with a reputable multinational in a relatively senior position, supported by trade and Level 7 qualifications. Balancing these considerations, I consider that a 15% reduction of €72,166.50 should be applied to the plaintiff's net future loss of earnings to reflect the realistic possibility that, even in the absence of the accident, his career trajectory may have been subject to some degree of disruption or limitation due to these pre-existing vulnerabilities. This yields a net future loss of earnings of €408,943.50

60.              To these figures must be added the sum of €24,567.96 for miscellaneous special damages to date, €141,780 for future loss of pension right to the date of retirement, €67,320 for future loss of medical insurance benefits previously paid by the defendant and €11,858 for future pain management procedures which I will allow for three years.

61.              Aggregating all the above, the total award amounts to €943,074.46, comprised as follows:

(1)   €135,000 for general damages;

(2)   €154,605 for loss of earnings (together with interest) and loss of pension rights to date;

(3)   €24,567.96 for miscellaneous special damages to date;

(4)   €408,943.50 for future loss of earnings;

(5)   €141,780 for future loss of pension rights to retirement;

(6)   €67,320 for future loss of employer-paid health insurance to retirement;

(7)   €11,858 for future pain management procedures.

62.              There will therefore be judgment against the defendant for €944,074.46.