This case study is an anonymised composite based on publicly reported commercial insurance claim patterns. It is not actual Apex client data and does not constitute legal or insurance advice. Names, locations and identifying details have been changed. Apex Insurance Brokers Limited is authorised and regulated by the Financial Conduct Authority, FRN 724952.
A private physiotherapy and rehabilitation clinic operating from a converted ground-floor unit in a small commercial parade in the South West, around eight treating clinicians (physiotherapists, sports therapists and a part-time consultant musculoskeletal physician), turnover £820,000. The clinic is registered with the Health and Care Professions Council as employer of the registered physiotherapists, and the clinical lead is registered with the General Medical Council. Insurance includes medical malpractice cover at £3m, public liability at £5m, employers’ liability at £10m, and standard material damage and BI cover.
An 82-year-old patient attending the clinic for post-surgical rehabilitation following hip replacement surgery sustained a fall in the reception area while waiting to be called for her physiotherapy appointment. The patient had been walking with a stick following her recent surgery and was familiar with the clinic environment, having attended seven previous appointments over the preceding three weeks.
The fall occurred when the patient attempted to navigate around a small portable display stand that had been placed in the reception area approximately ninety minutes earlier by a clinical equipment supplier representative meeting with the clinical lead. The display stand had been placed by the supplier in a position close to the patient seating area without the clinical lead’s specific knowledge of its location. The reception staff had not raised the placement as a concern with the supplier or the clinical lead. The patient caught her stick on the base of the display stand, lost her balance and fell heavily, fracturing her wrist and sustaining bruising and soft-tissue injuries.
Emergency services were called immediately. The patient was taken to hospital where the wrist fracture was managed with surgical fixation. The patient’s recovery was complicated by her age and the recent hip surgery; her return to independent mobility was delayed by approximately fourteen weeks compared with the expected recovery trajectory had the fall not occurred.
The clinic’s incident reporting protocol was followed. The display stand was removed by the supplier immediately on being informed of the incident. The patient continued her physiotherapy at the clinic during her recovery, with the wrist fracture managed by her NHS team.
A claim was intimated by the patient’s solicitors approximately ten months after the incident, pleaded at approximately £120,000: special damages including additional care during the extended recovery period, additional equipment (a wheeled rollator frame for the extended use period), additional NHS-charged costs not recoverable directly, and general damages for pain, suffering and loss of amenity on a JC Guidelines basis for a moderate wrist fracture in an elderly claimant at approximately £42,000.
The pleading advanced liability under the Occupiers’ Liability Act 1957 section 2, with the clinic as occupier of the premises and the patient as a lawful visitor. The pleading also advanced liability against the equipment supplier as a separate co-defendant, on the basis that the supplier had introduced the display stand into the reception area and bore responsibility for the consequences of its placement.
The clinic’s defence position was that it bore some occupier responsibility but that the patient’s age, prior knowledge of the clinic environment, and use of a walking stick should be taken into account in the contributory negligence assessment. The equipment supplier’s defence position acknowledged that the supplier had placed the display stand but contested the assertion that the placement was a breach of the standard of care expected of a visitor to commercial premises.
The public liability section of the combined healthcare clinic policy responded to the occupier liability claim. Notification was made within five working days of the incident even though the formal claim did not arrive for ten months — a proactive circumstance notification preserving the cover in force at the date of incident.
The insurer instructed claims-handling specialists with healthcare premises experience. The defence position addressed contributory negligence robustly: the patient’s age and her use of a walking stick, while not in themselves grounds for reducing the occupier’s duty, were relevant to the assessment of the standard of care that the occupier owed in respect of vulnerable visitors and to the question of whether the patient could have taken reasonable steps to avoid the obstacle.
The pleading against the equipment supplier as a co-defendant generated a contribution analysis under the Civil Liability (Contribution) Act 1978. The supplier’s combined liability insurer engaged on the contribution question. After extended negotiation between the two insurers, the parties agreed an 80/20 split between the supplier and the clinic, reflecting the supplier’s primary responsibility for the placement of the display stand and the clinic’s secondary responsibility as occupier for the configuration of the reception area at the time of the incident.
The matter settled at mediation approximately fifteen months after the incident at £75,000 plus claimants’ costs of £28,000. The settlement reflected an assessed contributory negligence by the patient of approximately 25%, the supplier’s 80% liability share and the clinic’s 20% share. The clinic’s PL insurer paid approximately £15,000 of the settlement plus a 20% share of the claimants’ costs. The clinic’s own first-loss exposure was the £500 standard excess.
The medical malpractice policy was put on notice but did not engage substantively — the incident was a premises matter rather than a treatment matter.
The clinic implemented a revised visitor protocol requiring all suppliers, equipment representatives and other commercial visitors to obtain reception sign-off for any equipment, display materials or items brought onto the premises, with a documented list of locations where such items may be placed and a maximum duration for placement. The combined healthcare clinic policy renewed with a modest 8% premium increase reflecting the relatively small claim quantum and the clinic’s response.
The Health and Care Professions Council was notified as a service-quality matter (in respect of the clinical lead’s responsibilities) but no professional regulatory action followed. The Care Quality Commission registration was not engaged as the patient’s injury was a premises matter rather than a treatment matter.
The equipment supplier subsequently introduced its own corporate procedure for representative visits to clinical premises, requiring documented coordination with the host clinic and minimum standards for the placement of display materials.
Premises liability claims in healthcare settings have a particular profile because the patient population is often older, more medically vulnerable or less mobile than the general population, and the standard of care expected of the occupier is correspondingly higher. First, the Occupiers’ Liability Act 1957 duty to take reasonable care to ensure visitor safety is calibrated to the foreseeability of the type of visitor; healthcare premises must anticipate visitors with reduced mobility, sensory impairment and cognitive impairment. Second, visitor protocols for suppliers, representatives and other commercial visitors are essential and should be embedded in the reception staff’s induction; the absence of such protocols substantially weakens any defence. Third, contributory negligence in respect of elderly or vulnerable claimants is a more constrained defence than for the general population, and settlement strategies should reflect this. Fourth, contribution arguments under the Civil Liability (Contribution) Act 1978 can be a meaningful recovery pathway where a third party is materially responsible for the incident, and should be pursued through the insurer’s contribution mechanism. Fifth, the medical malpractice cover and the public liability cover are distinct and should be benchmarked separately at renewal; a single combined limit can create coverage compression on combined incidents.
We would have reviewed the visitor protocol at the previous renewal as part of a structured healthcare premises risk review, and would have specifically discussed the management of supplier and representative visits. At notification, we would have supported the proactive circumstance notification and would have ensured the insurer engaged a defendant-side claims handler with healthcare premises experience. The contribution analysis against the supplier is a workstream we would have driven from the earliest stage, recognising the value of a contribution claim in keeping the clinic’s own loss exposure to a minimum.
For the underlying cover, see our Healthcare clinic insurance hub.
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