Investigations in Cumulative Back Injury Claims

In edition 246 of BC Disease News (here), we focused on investigations conducted during the course of NIHL claims. This week, we move on to consider investigations conducted during the course of cumulative back injury claims.


Back pain is one of the most common conditions that affects adults of working age, leading to both short and long-term disability. It has been reported that around 52-60% of low back pain patients claim that their pain is work related.

Approximately 40% of all work-related injuries are relate to the back and approximately half of these are reported as being caused by manual handling.

Although the majority of claims for back injuries caused by manual handling relate to one off accidents or incidents, there is a growing trend for claims to be pursued for cumulative back injuries caused by repeated manual handling.

The HSE categorise back injuries within the general umbrella description of Musculo-Skeletal Disorders (MSDs) which also includes upper limb disorders and lower limb disorders.

Anatomy & Structure of the Spine

In short, the back is made up of the following component parts:

  • The spine – The vertebral column that travels from the base of the skull to the pelvis and contains the spinal cord;
  • The spinal cord – Contains the nerves that leave through openings to receive sensations in the skin and control muscle movements;
  • Facet joints – Small joints linking the vertebrae which help to direct and limit movements of the spine;
  • Intervertebral discs – Act as ligaments between the vertebrae to allow slight movement of each vertebrae; and
  • Muscles, tendons and ligaments – Provide movement and stability and support the spine.

Back injuries are often referred to as lumbar, thoracic or cervical depending on the section of the spine to which they relate. There are 33 vertebral bones within the spine. The cervical spine consists of the top 7 vertebrae, the thoracic spine consists of the next 12 vertebrae and the lumbar spine consists of the next 5 vertebrae. The remaining vertebrae are fused and contained in the Sacral and coccyx at the bottom of the spine.

As can be seen from the below figure, cervical injuries are injuries to the neck area, thoracic injuries are injuries to the area between the shoulder blades and lumbar injuries are injuries to the lower back, just above the waist line.


(Source: Wikimedia Commons)

Lumbar spinal injuries are by far the most common as this is the section of the spine which is the most flexible and bears the most weight.

Typical Back Conditions

The back is a very complex structure and there are a number of disorders which can be diagnosed by medical experts. The following are the most common found in cumulative back injury cases:

  • Low back pain – A non-specific disease which can be caused by minor muscle problems such as sprains and strains but is often a symptom of other disorders;
  • Degenerative disc disease – A non-specific disease referring to symptoms of pain due to intervertebral disc degeneration over time;
  • Spinal disc herniation – When a tear in the fibrous ring of an intervertebral disc allows the central soft portion to bulge beyond the outer segment. Widely referred to as a ‘slipped disc’;                               


(Source: Wikimedia Commons)

  • Spinal Stenosis – An abnormal narrowing (stenosis) of the spinal canal that may occur in any region of the spine. This narrowing causes a restriction to the spinal canal, resulting in neurological problems;
  • Radiculopathy – Damage or disturbance of nerve function that results if one of the nerve roots near the vertebrae being compressed. Also known as a ‘pinched nerve’;
  • Sciatica – A set of symptoms such as pain caused by compression of one of five spinal nerve roots of each sciatic nerve or compression/irritation of either of the sciatic nerves. It is a specific form of lumbar radiculopathy, which is only classified as sciatica due to the type of symptoms it elicits (pain starting in the lower back and going down the leg) rather than a diagnosis of what is causing the nerve irritation;


(Source: Wikimedia Commons)

  • Spondylosis - Degenerative osteoarthritis (cartilage loss and breakdown) of the joints between the spinal vertebrae; and
  • Spondylolysis – A defect or fracture of one or both wing-shaped parts of a vertebra, a specific part of the facet joint called the pars interarticularis. Spondylolisthesis is the actual slipping of a vertebral body forward, backwards or to the side. Spondylolysis is the most common cause of spondylolisthesis.


(Source: Wikimedia Commons)

The above disorders are closely related, with degenerative disc disease being the link.


Back injury symptoms can include the following:

  • Back pain;
  • Pain when moving or with particular postures e.g. sitting;
  • Difficulty performing certain movements;
  • Stiffness;
  • Tightness;
  • Sharp pains;
  • Muscle spasms;
  • Neck pains;
  • Aching; and
  • Burning sensation.

Duration, Prognosis, Treatment & Effects on Work


Most patients with most disorders will find non-surgical treatment effective. When improvement is seen with non-surgical treatment, its continued use is often encouraged.  Recovery times range from a few weeks to almost a year, though most will tend to be at the lower end of this time scale.  In most disorders, surgery is only considered after a number of months of unsuccessful non-surgical treatment, in cases where symptoms are severe, or in cases where there is a risk of major neurological damage.

Medical Causation

Numerous studies have been conducted in relation to the causes of spinal disorders, with the main focus on degenerative disc disease, as this can lead to a number of other disorders, as set out above. Traditionally, it has been believed that age, general health (particularly smoking status and weight), physical loading and ‘wear and tear’ are the main risk factors in spinal disorders and back pain.

The Industrial Injuries Disablement Benefits (IIDB) scheme allows individuals with work related conditions and diseases to be receive state benefits.  Around 75 diseases are acknowledged by the scheme as being caused by work.  In order for a condition to be added to the list of ‘prescribed diseases’ in the IIDB scheme it needs to have diagnostic features that are defined and can be clearly demonstrated. 

There are no disorders of the back on the IIDB list.  In 2007, the Industrial Injuries Advisory Council, which advises Government on prescribed diseases, published a report on back and neck pain which did not recommend their addition to the scheme for the following reasons:

  • ‘Back and neck pain are sometimes disabling. However, in most cases symptoms resolve relatively quickly and without prolonged disability. Many people experience recurring episodes of back and neck pain over their lifetime, but only a minority become chronically disabled
  • IIAC has identified significant barriers to prescription, including problems with diagnosis. Back and neck pain are symptoms, and not diseases. The pathological and anatomical origins of back and neck pain tend to be unclear in all but a few specific cases. Poor correlations exist between symptoms of back and neck pain and pathological changes found on X-rays and MRI scans of the spine. For these reasons, objective diagnosis and verification of back and neck symptoms is difficult in many cases’.

Features of occupational tasks that are typically considered to be connected to back disorders include repetition, force, duration of exposure, awkward posture, the working environment, psychosocial factors and individual differences. These are described below.


Work is repetitive when it requires the same muscle groups to be used over and over again during the working day or when it requires frequent movements to be performed for prolonged periods.


(Source: Pxhere)


Force can be applied to the muscles, tendons and joints of the spine by handling heavy objects, performing tasks such as pushing and pulling, fast movements or as a result of excessive force generated by the muscles of the body.


(Source: Flikr)

Duration of Exposure

Duration refers to the length of time for which a task is performed. It includes the length of time that the task is undertaken in each shift, plus the number of working days the task is performed (e.g. four hours per day, five days per week). Short exposures are unlikely to create significant risk of injury, except where the task is exceptionally demanding and/or the worker has not been allowed to build up to its demands over a period of time. This can occur after returned to work from holidays always an increase in the work pace.

Working Posture

Working postures can increase the risk of injury when they are awkward and/or held for prolonged periods in a static or fixed position. An awkward posture is where a part of the body is used well beyond its neutral position. A neutral position is where the trunk and head are upright, the arms are either side of the body, forearms are hanging straight or at a right angle to the upper arm, and the hand is in the handshake position. Static postures occur when a part of the body is held in a particular position for extended periods of time without the soft tissues being allowed to relax.


(Source: Wikimedia Commons)

Working environment

This includes factors such as vibration, cold and lighting.  Exposure to cold and resulting decreased blood flow, decreased sensation dexterity, decreased maximum grip strength and increased muscle activity. The visual demands of the task are an important consideration since the workers posture can be largely dictated by what they need to see.

Psychosocial Factors

Examples include workers who have little control over their work and work methods, where work demands are perceived to be excessive or there is a payment system in place which encourages working too quickly or without breaks.

Individual Differences

Examples include new workers who may need time to acquire the necessary skills and/or rates of work, differences in competence and skill, workers of varying body size (weight, height, reach), vulnerable groups (older workers, younger workers, expectant mothers), health status and disability, individual attitudes or characteristics.

Evidence of Work as Cause?

Recent studies involving twins suggest that previously considered risk factors may have little or no causal association and the risks are largely down to genetic predisposition.

Twin studies are a powerful tool for assessing the relative contributions of genetic and environmental factors to the appearance of conditions or disorders.  As twins, particularly identical twins, share almost 100 % of their genes and most likely many socio-economic parameters (wealth of parents, etc.), differences between twins (weight, intelligence, health conditions etc.) are generally due to lifestyle factors such as eating habits, hobbies, work activities and smoking. Twin studies have found very few differences in disc degeneration between pairs of twins that have had major differences in occupational and leisure-time activities, smoking, whole-body vibration and previous trauma.  The leading twin study concludes “Most of the specific environmental factors once thought to be the primary risk factors for disc degeneration appear to have been very modest effects, if any.” (Battié et al 2009).[i]

There are numerous academic reviews that suggest relationships between occupational risk factors and back pain and comments on the amount of evidence for association vary from limited to strong.

Recent reviews (Roffey et al 2010[ii]; Roffey et al 2010 [iii]; Roffey et al 2010[iv]; Roffey et al 2010[v]; Wai et al 2010 [vi]; Wai et al 2010[vii]; Kwon et al 2011;[viii] Ribeiro et al 2012[ix]) suggest the following are all unlikely to be associated with back pain:

  • Bending and twisting;
  • Awkward postures;
  • Sitting;
  • Standing and walking;
  • Carrying;
  • Pushing and pulling;
  • Lifting; and
  • Assisting patients.

However, one review suggests lifting between 25kg and 35kg is likely to be associated with low back pain (Wai et al 2010[x]).

Considering the above, claimants in many cumulative back injury claims may struggle to prove that their work caused their condition on the balance of probabilities and there is little academic support that work can accelerate symptoms. However, arguments that work has led to an aggravation of symptoms are likely to be more successful depending on individual circumstances.

Guidance for Employers on Manual Handling & Back Injuries

The HSE provide employers a variety of guidance on manual handling risks at work through publications such as Manual Handling at Work, INDG143 2012, and the Manual Handling Assessment Charts (the MAC tool).

Most claims for cumulative back injuries are pleaded under the Manual Handling Operations Regulations 1992 as amended (MHOR).

However, Section 69 of the Enterprise and Regulatory Reform Act 2013 (ERR Act) amends section 47 (2) of the Health and Safety at Work Act 1984 so that claims for accidents occurring after 1st October 2013 can no longer be brought based upon allegations of breach of statutory duty under health and safety Regulations, except in very few cases, for example under Regulation 16 of the Management of Health and Safety at Work Regulations, which specifically relates to the safety of new or expectant mothers.

Claims after 1st October 2013 will be pleaded in common negligence. However, many of the duties owed by employers at common law mirror those under health and safety Regulations. Equally, failure to adhere to the regulations and associated guidance will be relied upon as evidence of negligence. Within the context of most cumulative back claims the ERR Act will not make a material difference.

Firstly, it must be considered whether the MOHR apply.

The MHOR apply to ‘manual handling operations’ which include transporting or supporting of a load (such as lifting, putting down, pushing, pulling, carrying or moving) by hand or by bodily force. A ‘load’ includes any discrete moveable object including any person or animal

They do not apply where the load is a tool used for its intended purpose (HSE’s Guidance note L23).

Under MHOR there is a hierarchy of duties requiring employers to do the following:

  1. Avoid the need for hazardous manual handling operations, so far as is reasonably practicable;
  2. Assess the risk of injury from any hazardous manual handling operations that can’t be avoided; and
  3. Reduce the risk of injury from hazardous manual handling operations, so far as is reasonably practicable.

Has manual handling been avoided?

Employers need to have considered whether operations can be automated or removed from the work completely.

Are the risk assessments adequate?

If manual handling cannot be avoided employers need to have assessed the risk of injury arising from the operations carried out.

Regulation 4(1) (b) of MHOR sets out the duties regarding assessment of risk. There has to be a ‘suitable and sufficient’ risk assessment, taking account of the following:

  • The task;
  • The load;
  • The work environment;
  • Individual capability and physical suitability of the employee;
  • Whether movement or posture is hindered by personal protective equipment or by clothing;
  • Knowledge and training of the employee; and
  • Results of any relevant risk assessments or health surveillance (under the Management of Health and Safety at Work Regulations 1999 (MHSWR 1999)) and whether the employee is within a group identified by the assessment as being especially at risk.

Where a risk assessment is required a general company/area risk assessment which assesses all of the workplace risks may suffice as ‘suitable and sufficient’. However, often a task specific detailed manual handling risk assessment will need to be carried out.

The HSE’s guidance on manual handling states that:

‘A full assessment of every manual handling operation could be a major undertaking and might involve wasted effort. To enable assessment work to be concentrated where it is most needed, Appendix 3 gives numerical guidelines which can be used as an initial filter. This will help to identify those manual handling operations which need a more detailed examination’.

There are separate guidelines for lifting and lowering, carrying, pushing and pulling and handling while seated.

Numerical Guidelines for Lifting and Lowering

  • The guidelines for lifting and lowering relate to the image below. If the weight lifted/lowered exceeds the figure for a particular box a detailed manual handling risk assessment should be carried out.


(Source: HSE)

  • If the handler’s hands enter more than one box during the operation, then the smallest weight figure applies. An intermediate weight can be chosen if the hands are close to a boundary between boxes.
  • Where operations are repeated more than once every two minutes the weights should be reduced as follows:
    • 30% for once or twice per minute;
    • 50% for five to eight times per minute; and
    • 80% more than twelve times per minute.
  • Where operations involve twisting and are repeated more than thirty times per hour or once every two minutes a detailed manual handling risk assessment should be carried out. Where operations involve twisting and are repeated less than thirty times per hour or once every two minutes the weights should be reduced as follows:
    • 10% for a 45 degree twist; and
    • 20% for a 90 degree twist.
  • A detailed manual handling risk assessment is also required in the following circumstances:
    • The operation takes place outside of the box zones;
    • Other conditions apply e.g. a pregnant handler;
    • The operation cannot be done quickly;
    • The load is not easy to grasp with both hands;
    • Working conditions are unreasonable;
    • The handler’s body position is unstable;
    • The handler does not control the pace of the work;
    • Pauses for rest are inadequate or there Is no chance of carrying out another task providing an opportunity for the use of different muscles; and
    • The handler supports the load for any length of time.

Numerical Guidelines for Carrying

  • The guidelines for carrying are the same as for lifting and lowering but a detailed manual handling risk assessment is required in the additional following circumstances:
    • The load is not held against the body;
    • Carrying for more than 10 metres except where the load is carried on the shoulder with no lift involved; and
    • The hands are below knuckle height or above elbow height.

Numerical Guidelines for Pushing and Pulling

  • The guideline figure for stopping or starting a load is 20kg of force for men and 15kg of force for women. The guideline figure for keeping a load in motion is 10kg for men and 7kg for women. The amount of force to be applied to move a load is around 2% of the load weight (i.e. a 500kg load is equivalent to 10kg of force). If the figures are exceeded a detailed manual handling risk assessment should be carried out.
  • A detailed manual handling risk assessment should also be carried out in the following circumstances:
    • The force is not applied between knuckle and shoulder height;
    • The load is pushed/pulled over 20 meters; and
    • The conditions are sub-optimal (e.g. there are uneven floor surfaces confined spaces, trapping hazards etc.).

Numerical Guidelines for Handling While Seated

  • The guidelines for handling while seated relate to the image below. If the weight handled exceeds 5kg for men and 3kg for women a detailed manual handling risk assessment should be carried out.


(Source: HSE)

  • A detailed manual handling risk assessment should also be carried out if the handling is beyond the indicated box zone.

Are there suitable control measures in place?

The purpose of carrying out a ‘suitable and sufficient’ risk assessment, under Regulation 4(1) (b) of MHOR, is to identify areas of concern and control measures that can be put in place to reduce the risk.

The control measures to be adopted will be specific to the operations carried out but in cumulative back injury claims normally the most effective control measures and those that Courts look for are adequate rest breaks and adequate task rotation, which allow sufficient time for the back to recover.

Tasks/operations which are more ergonomically demanding should be rotated with tasks/operations which are less ergonomically demanding. The HSE has developed a MAC risk assessment to help employers identify high risk tasks. However, the MAC assessment does not constitute a detailed manual handling risk assessment. There is also a RAPP tool to assess risks from pushing and pulling.

Other Relevant Legislation?

In addition to MOHR, there are other Regulations which may be relevant to the issue of manual handling. The relevant duties on employers in this respect are set out below:

  • Management of Health and Safety at Work Regulations 1999
    • Assess all significant risks, and keep a written record of the risk assessment where there are 5 or more employees;
    • Identify preventive or protective measures in the risk assessment;
    • Take particular account of risks to new/expectant mothers and young people;
    • Arrange for effective planning, organisation, control, maintenance and review of health and safety, to include health surveillance where identified by an assessment as appropriate; and
    • Provide comprehensive and relevant training to all employees on health and safety, including information on the risks involved and preventive / protective measures.
  • Provision and Use of Work Equipment Regulations 1998
    • Ensure that the work equipment provided is suitable for use, and for the purpose and conditions in which it is to be used;
    • Maintain work equipment in a safe condition for use so that health and safety is not at risk; and
    • Inspect equipment in certain circumstances to ensure that it continues to be safe for use.
  • The Workplace (Health, Safety and Welfare) Regulations 1992
    • Workplace and equipment must be maintained in good condition; and
    • There are specific provisions covering matters such as ventilation, temperature, lighting, space, workstations, floors and traffic routes.
  • Personal Protective Equipment (PPE) at Work Regulations 1992
    • Provide suitable PPE when the risk cannot be controlled by other means, which must be appropriate to the risks involved, the work done, ergonomic factors and the state of health of the user, and must fit the user;
    • Take steps to ensure that the PPE is properly used;
    • Ensure that PPE is maintained in good repair, cleaned / replaced as often as necessary, and stored effectively when not in use; and
    • Provide staff with information, instruction and trainingon the risks the PPE is intended to avoid, the use of the PPE and steps the employees are expected to take to use it as directed, maintain it and report any loss/damage.


Detail any preliminary enquiries made with the insured, setting out what information the insured has provided to date. Then concisely summarise what else needs to be investigated / clarified by identifying the main issues in dispute which require further investigation. For example:  

Lay Evidence

The Claimant

  • What was / is the claimant’s ( C ) job role and periods of employments?
  • What site(s), departments, lines, operations & processes does / did the C work at with relevant dates for the same?
  • What was C’s days and hours of work, including any regular overtime?
  • What were his / her rest breaks-formal and informal-including frequency and duration of the same?
  • Obtain a broad timeline of what happened. When did C first:
    • Start the work complained of?
    • Raise any problems concerns regarding his work?
    • Develop symptoms?
    • Go absent from work?

[Further details on complaints and absences etc. requested below]

  • Did C have any particular requirements at material time-e.g. new or expectant mother, disability and / or health problems, migrant worker with poor communication skills in English? Any physical or learning disability?

Manual Handling Operations

  • Is it accepted that the work carried out by C involved manual handling?
  • Is it accepted that this was manual handling work to which the Manual Handling Operations Regulations 1992 as amended (MHOR) would apply?

[Note: The MHOR apply to ‘manual handling operations’ which include transporting or supporting of a load (such as lifting, putting down, pushing, pulling, carrying or moving) by hand or by bodily force. A ‘load’ includes any discrete moveable object including any person or animal. They do not apply where the load is a tool used for its intended purpose.

Under MHOR there is a hierarchy of duties requiring employers to do the following:

  • Avoid the need for hazardous manual handling operations, so far as is reasonably practicable;
  • Assess the risk of injury from any hazardous manual handling operations that can’t be avoided; and
  • Reduce the risk of injury from hazardous manual handling operations, so far as is reasonably practicable].

Avoiding the Manual Handling Operations, As Far As Reasonably Practicable

  • Have the insured considered avoidance of the manual handling operations, such as through automation or use of mechanical handling aids such as a conveyor, pallet truck, electric hoist, lift truck etc.?
  • If so when and how was this considered and by whom?
  • What was the conclusion reached and why?
  • Why was it not reasonably practicable to avoid the operations?

Risk Assessment

  • Have the insured carried out risk assessments regarding the operations / process and in particular the manual handling operations?
  • If so when and how were these risk assessments carried out and by whom?
  • Where the risk assessments suitable and sufficient? Did they consider the factors listed in Schedule 1 to the Manual Handling Operations Regulations (i.e. the task itself, the loads, the work environment, individual capability and physical suitability of the employee, and other factors such as whether movement or posture is hindered by personal  protective equipment or clothing).
  • Have the insured followed the manual handling risk assessment flow chart in the HSE Guidance to the MOHR? Have the insured used the HSE’s risk assessment filter and/or incorporated the Manual Handling Assessment Charts (MAC tool) and/or the Risk Assessment for Pushing and Pulling (RAPP tool) as part of their assessments? Obtain full details.
  • If the risk assessments were not suitable explore reasons / why not?
  • How often were risk assessments reviewed and why?
  • Details of insured’s general Health and Safety structure and policies and procedures.

Control Measures

  • What control measures were identified by the risk assessments to reduce the risk of injury?
  • Have these been implemented? If not, why not?
  • If they have been implemented when were they implemented, how and by whom?
  • Obtain details of the existing control measures currently in place and throughout the C’s employment and reasons for any changes such as availability of mechanical lifting aids, any system of rotation (e.g. whether written or verbal, how it is implemented, the frequency/duration of tasks in the work schedule, and the extent of opportunity for rest/recovery in addition to formal rest breaks) or training programme for manual handling.

The Work

[Note: Some of these questions may overlap with the above.]

  • Please take a video of the work carried out by C-ideally of someone the same height, weight and gender. Obtain relevant measurements and photographs.
  • Obtain full details of the nature and extent of the manual handling work as follows:

The Load / The Task

  • What are the loads?
  • The weight of the loads?
  • The size and shape of the loads?
  • Are the loads an awkward shape or bulky making them difficult to handle?
  • Are the contents of the load able to move or move unpredictably (like animals) and make it difficult to handle?
  • Are the loads easy to grip? Do they have handles or handholds? Do they have loose parts enabling comfortable grip?
  • Hot or cold or sharp?
  • How many people handle the load? (See also below)
    • Does the task require and large vertical movements?
  • Does the task require unusual capability-above average strength or agility?
    • Is the task complex?
    • Does the task require special information or training for its safe performance?

For Lifting Operations

  • What height is the load lifted from and to (e.g. from knuckle to elbow height)?
    • What is the proximity of the load to the body (e.g. held close to the body or with arms outstretched)?
    • Is the handler’s body position stable?
  • Is any lifting carried out whilst seated?
  • What is the hand distance from the lower back-see figures below[xi]?

17.png(Source: HSE)

  • What are the hand positions during course of lift-see figures below? Obtain details.


(Source: HSE)

  • Is there are twisting of the torso or sideways bending-see figures below? Obtain details;


(Source: HSE)

For Carrying Operations

  • What height is the load carried at / where are the hands located (e.g. hands held at elbow height)?
    • What is the proximity of the load to the body (e.g. held close to the body or with arms outstretched)?
  • What is the distance over which the load is carried?
    • Is the handler able to walk normally?
    • Does the load obstruct the handler’s view?
  • Is the load supported on the shoulder?
  • Is there any twisting of the torso during carrying?
  • What is the horizontal distance between the hands and the lower back? See figures below?


(Source: HSE)

  • What is the carrying position adopted? Are the load and hands symmetrical in front of the body? Or are they asymmetrical? Or is there one handed carrying to the side? See figures below.


(Source: HSE)

  • Are there any obstacles on route? Is there any need to go up a steep slope or steps or closed doors or around / over any tripping hazards or up ladders etc.? Obtain full details.

For Team Handling Operations

  • What is the horizontal distance between each person’s hands and lower back? See figures below.


(Source: HSE)

  • What is the position of the hands during the course of the lift? See figures below.


(Source: HSE)

  • What is the distance over which the load is carried?
  • Is there any twisting of the torso during lifting / carrying?
    • Are operatives able to communicate effectively to handle the load?

For Pushing/Pulling Operations

  • How is the force applied to the load (e.g. with the hands or shoulder)?
  • Is the torso largely upright or inclined and the level of the incline?
    • Is the torso bent or twisted and the level of this?
    • If the hands are used where are the hands held to support the load (e.g. between hip and shoulder level)?
    • What distance is the load pushed or pulled?
  • Are there any obstacles on route? Is there any need to go up a steep slope or steps or closed doors or around / over any tripping hazards or up ladders etc.? Obtain full details.
    • How is the load moved e.g. rolled, churned, dragged/slid
    • What equipment is used to carry out the pushing/pulling? Is it suitable and well maintained?
    • How do the hands grip the load? See figures below:


(Source: HSE)

Handling Aids & Equipment

  • Are any handling aids used? What are these and when implemented?
  • Are these aids correct for the task?
  • Are the wheels on the aid suited to the floor surface?
  • Do the wheels run freely?
  • Are there any brakes? Do they work?
  • Are the aids properly maintained and serviced?
  • Any reported problems with aids?
  • Are the aids freely available or difficulties in obtaining these?

Duration & Frequency

  • How frequently are breaks taken from manual handling?
  • Are there natural breaks in the work and the extent of the natural breaks (e.g. 10 seconds every few minutes)?
  • The frequency of the handling carried out per minute / hour / over the course of a working day;
  • The duration of each individual task;
  • The cumulative duration of manual handling in a working day;
  • An estimate of manual handling work as a proportion of a working day;
  • How many days per week the manual handling work is carried out-daily and regular task / weekly and irregular etc?
  • Details of any formal job rotation between different tasks and a description of what the other tasks in the work schedule involved (including the extent of any manual handling) and the frequency/duration of each task in the rotation schedule;
  • Details of any natural variation of duties within the work and the frequency/duration of the variation;
  • Is the work rate imposed by a process and / or targets?
  • Is the work difficult to keep up with?
  • Is there sufficient rest or recovery time between handling?
  • Any seasonal variations in work-full details;


  • Can manual handling be carried out without hindrance? Are there any space restrictions? Do these cause restricted postures to be adopted?
  • What is the floor surface? Is it dry and clean and in good condition? Is it worn or uneven? Is it wet or slippery or unstable? Is it flat or sloping? Are there variations in floor levels, steps, closed doors or ladders to negotiate?
  • Are there any extremes of temperature (hot or cold)?
    • Do gusts of wind or strong air movements hinder handling?
  • Is handling carried out in extreme lighting conditions (dark, bright or poor contrast)?
  • Any tools or PPE used and any whether this has any impact on the work;


  • Please detail the training provided to the C in relation to the work generally and the tasks carried out in department;
  • Details of any induction and/or refresher training provided to the claimant in relation to the risks of manual handling. What exactly did the training cover-for example:
    • Weight of loads handled
    • Presence of risk factors
    • How injuries can occur
    • How to avoid injuries
    • How to carry out safe manual handling
    • How to use aids safely and correctly,
    • When and how to report any accidents and health problems and seek medical advice & assistance?
  • When, how and who carried out the manual handling training and what qualifications/experience did they have?

Complaints / Occupational Health

  • Obtain details of the insured’s system relation to injury complaints;
  • Identify whether C made any complaints about the nature of the work and/or his injury to managers/supervisors/ other employees;
  • If complaints made then when and to whom and nature/gist of the same?
  • How were C’s complaints were dealt with-when and by whom-and what was the outcome? Did C carrying on with work complained of?
  • Details of the insured’s occupational health arrangements / policy;
  • Was C referred to Occupational Health-if so how, when and by whom?
  • What was done following the referral including the occupational health advisor’s recommendations and whether these were followed);
  • Were there any previous complaints about work or accidents / injuries from or others? If so when, from whom, to whom, nature / gist and what happened as a result / what action taken?

Absences & Returns to Work

  • Dates of absences from work and reasons?
  • Any assessment of capability for work on return?
  • Graduated return to work / any restrictions imposed / different work carried out?
  • Did C return to same work-if so when?
  • Were there any subsequent complaints by C after the injury / absence? If so when and to whom and nature / gist of the same? How was this dealt with and what was the outcome?
  • Identify in retrospect whether anything could have been done differently.
  • Was C’s employment terminated? If so when and for what reason(s)?
  • Was C placed on different work which effected income? Obtain full details.


This Checklist is intended only to be a guide and it is not exhaustive.


The Injury

  1. Accident Book entry for the claimant’s injury and any other relevant incidents.
  2. Form F2508/ F2508A (submitted to the Health & Safety Executive). Any other documents completed for the purposes of RIDDOR 2013.
  3. Any HSE investigations or correspondence in relation to the claim, any other similar incidents or the system of work in general.
  4. Any other investigation reports or forms, including any statements taken or memos sent.
  5. First Aid/Treatment Book entry.
  6. Sick Notes submitted by the Claimant.
  7. Documents relating to any other similar claims or Accident Book entries etc.

Manual Handling

  1. In relation to the period about which the claimant is complaining, documentation to show:
    1. The claimant’s Day Work Sheets (including details of basic hours worked and any overtime);
    2. A breakdown of the claimant’s daily activities and frequency rate of manual handling;
    3. The claimant’s performance targets and actual achievement/production levels;
    4. Average speed of the process (e.g. in terms of units per minute, per hour or per shift);
    5. If the Claimant was above or below average, documents to show this (e.g. statistics or a comparator employee’s Day Work Sheets etc.);
    6. The weight, size and shape of the loads;
    7. Duration and frequency of manual handling.

Risk Assessments & Health & Safety Records

  1. Health & Safety Committee Meeting Minutes which refer in any way to the subject matter of this claim.
  2. The Company’s Health & Safety Policy.
  3. Any other relevant internal health and safety documents, including memos and e-mails, relating to manual handling.
  4. Maintenance, inspection and/or repair records for all relevant equipment, plant or tools used by the Claimant.
  5. Risk Assessments — for the period of the Claimant’s employment and also one year before and to date, in relation to:
    1. Manual Handling Operations Regulations;
    2. Management of Health & Safety at Work Regulations;
    3. Provision and Use of Work Equipment Regulations;
    4. Workplace (Health, Safety and Welfare) Regulations;
    5. Personal Protective Equipment regulations
    6. Any re-assessments following changes (e.g. to the work station, to the system of work or following any accidents or health surveillance);
    7. Any other relevant risk assessments undertaken.
  6. Documents showing any other sources of information obtained, such as:
    1. Any independent health & safety reports commissioned;
    2. Time-in-motion studies; work surveys; ergonomic assessments;
    3. Documents obtained from HSE, trade associations, health & safety industry journals.

Control Measures

  1. Documents showing what steps have been taken, if any, to reduce, eliminate or avoid risk of injury. In particular:
    1. Rotation;
    2. Rest Breaks;
    3. Shared manual handling;
    4. Tools and equipment;
    5. PPE;
    6. Ergonomic layout of the workstation/work area;
    7. Provision of training where appropriate;
    8. Complaints systems;
    9. Referrals to occupational health;
    10. Any documents showing systems of review, maintenance or testing regarding the above;
    11. Any documents which explore the possibility of the above or other control measures.
  2. Documents showing what mechanical assistance was available to the claimant, in particular:
    1. Manufacturers’ specifications (e.g. catalogues, marketing information);
    2. Any manuals in respect of the use of the equipment;
    3. Maintenance and repair records.

Training and Enforcement

  1. Health & Safety Handbook/Manual — preferably the copy signed and dated by claimant to acknowledge receipt.
  2. Documents showing all training, instructions and warnings (e.g. training certificates, course notes, course registers, internal memos, publicly displayed warning notices, handbooks/booklets, notes of guidance and any other literature etc.) given to the Claimant in respect of relevant matters such as:
    1. Safe manual handling techniques;
    2. The hazards of repetitive work;
    3. Other risk control measures;
    4. Recognition of symptoms;
    5. The need to report symptoms and seek medical assistance.
  3. The Claimant’s Training Records for all aspects of the work and, in particular, for manual handling
  4. Information provided to the claimant regarding the weight of the loads.
  5. Documents relating to enforcement procedures, including warnings given and disciplinary procedures taken against employees (particularly the claimant) for failure to follow manual handling procedures and health and safety policies generally.

Health Surveillance

  1. Documents detailing any system of health surveillance (e.g. undertaken by who, when, how often and in respect of what). Complaints or comments and action taken
  2. Documents relating to any written or oral complaints or comments by the claimant or any other employees about symptoms or the system(s) of work.
  3. Documentation detailing the Company’s response to any such complaints or comments and what action was taken, if any.
  4. All correspondence passing between the Company and the Health & Safety Executive regarding this incident or any other similar matters.

Wages, Benefits and Absences

  1. Details of the claimant’s net weekly pre-absence earnings for a period of 13 weeks.
  2. Details of all payments made to the claimant during any periods of absence (from work due to the alleged injury-SSP/CSP/Holiday and bonus payments /PHI if PHI scheme fully funded by insured).
  3. The Claimant’s Absence Record (including all absences due to sickness, holidays, training etc.).
  4. If the claimant was moved to alternative work:
    1. Details of the pay in the new job compared with the old job (including differences in shift allowances and bonuses).
  5. If the Claimant’s employment was terminated:
    1. The date on which the employment ceased;
    2. All letters and documentation relating to the termination.
  6. If the Claimant was made redundant:
    1. All documents relating to the redundancy, including the selection procedure, details of payments made etc.
  7. Pension details, if applicable:
    1. Pension handbook;
    2. Pension statements;
    3. Copy correspondence confirming details of how the pension would be affected (if the Claimant’s employment was terminated or made redundant).

Confidential records

[Forms of authority from C required]

  1. Works’ Medical Records/Occupational Health Records.
  2. Full Personnel File (including Contract of Employment and job description).


[i] Battié, M. C. et al. The Twin Spine Study: Contributions to a changing view of disc degeneration†. The Spine Journal 9, 47–59 (2009).

[ii] Roffey, D. M., Wai, E. K., Bishop, P., Kwon, B. K. & Dagenais, S. Causal assessment of awkward occupational postures and low back pain: results of a systematic review. The Spine Journal 10, 89–99 (2010).

[iii] Roffey, D. M., Wai, E. K., Bishop, P., Kwon, B. K. & Dagenais, S. Causal assessment of occupational pushing or pulling and low back pain: results of a systematic review. The Spine Journal 10, 544–553 (2010).

[iv] Roffey, D. M., Wai, E. K., Bishop, P., Kwon, B. K. & Dagenais, S. Causal assessment of occupational sitting and low back pain: results of a systematic review. The Spine Journal 10, 252–261 (2010).

[v] Roffey, D. M., Wai, E. K., Bishop, P., Kwon, B. K. & Dagenais, S. Causal assessment of occupational standing or walking and low back pain: results of a systematic review. The Spine Journal 10, 262–272 (2010).

[vi] Wai, E. K., Roffey, D. M., Bishop, P., Kwon, B. K. & Dagenais, S. Causal assessment of occupational bending or twisting and low back pain: results of a systematic review. The Spine Journal 10, 76–88 (2010).

[vii] IWai, E. K., Roffey, D. M., Bishop, P., Kwon, B. K. & Dagenais, S. Causal assessment of occupational lifting and low back pain: results of a systematic review. The Spine Journal 10, 554–566 (2010).

[viii] Kwon, B. K., Roffey, D. M., Bishop, P. B., Dagenais, S. & Wai, E. K. Systematic review: occupational physical activity and low back pain. Occup Med (Lond) 61, 541–548 (2011).

[ix] Ribeiro, D. C., Aldabe, D., Abbott, J. H., Sole, G. & Milosavljevic, S. Dose–response relationship between work-related cumulative postural exposure and low back pain: A systematic review. Ann Occup Hyg mes003 (2012). doi:10.1093/annhyg/mes003

[x] Ibid at Wai.

[xi] All figures within this schedule reproduced from HSE Guidance Manual Handling Assessment Charts (the MAC tool), INDG383, (rev2), June 2014