Secondary victim claims: psychiatric illness after witnessing an accident

Seeing someone you love badly hurt or killed can cause lasting psychiatric illness. The law recognises that, but only within tight limits, and those limits were restated by the Supreme Court in 2024. This guide explains who counts as a secondary victim, the tests the courts apply, what the Paul decision changed for medical negligence cases, how the position differs in Scotland and Northern Ireland, the evidence you need and the time limits. If you were yourself in physical danger, you may be a primary victim instead, and the tests on this page do not apply in the same way: see our guides to psychological injury claims and PTSD claims. We are an independent information service, not a law firm.

Primary and secondary victims

The distinction comes from the House of Lords in Alcock v Chief Constable of South Yorkshire Police (1992), which arose from the Hillsborough disaster. As the Supreme Court explained in Paul, Lord Oliver separated people involved in an event as participants from those who were no more than the passive and unwilling witness of injury caused to others, and called the second group secondary victims. In a later Hillsborough case, Frost, the House of Lords held that the category of primary victims is limited to people exposed, or who perceived themselves to be exposed, to physical danger.

In every case the claimant needs a medically recognised psychiatric illness. As the Supreme Court recorded, no damages are awarded in English law for grief or sorrow caused by a person's death, but damages are recoverable for a recognisable psychiatric illness. NHS guidance describes post-traumatic stress disorder (PTSD) as an anxiety disorder caused by very stressful, frightening or distressing events. A diagnosis from a doctor, and usually an independent psychiatric report, is needed.

The Alcock tests

In Frost, the House of Lords summarised the requirements from Alcock, and in Paul the Supreme Court said that summary was accurate and authoritative. In Lord Hoffmann's words:

• the claimant must have close ties of love and affection with the victim, which may be presumed in some cases, such as spouses or parent and child, but must otherwise be established by evidence;
• the claimant must have been present at the accident or its immediate aftermath; and
• the psychiatric injury must have been caused by direct perception of the accident or its immediate aftermath, not by hearing about it from someone else.

Alcock itself shows how strictly these are applied. Two claimants who were at the ground, one of whom lost two brothers and the other a brother-in-law, failed because a close enough tie could not be presumed from the family relationship and had not been proved. Relatives who saw a body in the mortuary to identify it were held not to be within the aftermath, and claims based on seeing the disaster on television failed because those images were not treated as equivalent to being there.

Paul also settled two points in claimants' favour. There is no separate requirement that the illness was caused by a sudden shock to the nervous system. And a claimant who was present at the accident or its immediate aftermath only has to show a causal connection between witnessing it and the illness, not the mechanism by which the illness was caused.

Medical negligence: what Paul changed

On 11 January 2024 the Supreme Court decided three appeals together: Paul v Royal Wolverhampton NHS Trust, Polmear v Royal Cornwall Hospitals NHS Trust and Purchase v Ahmed. In each, close relatives had witnessed the death of a family member, or its aftermath, from a medical condition the defendant had allegedly failed to diagnose and treat. The majority held that a claimant cannot recover damages as a secondary victim unless they witnessed an accident, or its immediate aftermath.

The court described an accident as an unexpected and unintended event which causes injury, or a risk of injury, by violent external means. It is an external event, not the injury it causes. A medical crisis from an untreated illness is not an accident in that sense, and the majority said it could not accept that a doctor's responsibilities extend to protecting a patient's close family from the traumatic experience of witnessing the death or manifestation of disease or injury in their relative. Lord Burrows dissented and would have allowed the appeals.

In practice, secondary victim claims now depend on an external event such as a road accident, a fall or an industrial accident. Where a relative dies because of negligence, the family may still have other claims: in England and Wales, the Fatal Accidents Act 1976 allows claims where death is caused by a wrongful act, neglect or default, including a fixed bereavement award of £15,120 for a spouse or civil partner, a cohabiting partner who meets the Act's conditions, or in some cases the parents of an unmarried child under 18. See our fatal accident claims guide.

Scotland and Northern Ireland

Paul was decided on English common law. Lord Carloway, one of the seven judges who heard the appeals, said the decision is likely to have considerable persuasive influence on Scots law in similar circumstances, and that had Scots law been applied the same result would have been reached for those claimants. Scots law also has a separate, long-standing route for close relatives after a death: under section 4 of the Damages (Scotland) Act 2011 relatives can be compensated for distress and anxiety in contemplation of the deceased's suffering, for grief and sorrow caused by the death, and for the loss of the deceased's society and guidance. That is a different claim from a secondary victim claim for psychiatric illness. For the Scottish process, see making a claim in Scotland.

The Supreme Court describes itself as the final court of appeal in the UK for civil cases, and that includes civil appeals from Northern Ireland. A Northern Ireland solicitor can advise how the Alcock tests and the reasoning in Paul are applied by the courts there; see making a claim in Northern Ireland.

Evidence for a secondary victim claim

• Medical evidence of a recognised psychiatric illness: GP records, referrals and treatment notes, and usually a report from an independent psychiatrist or psychologist.
• Evidence you were there: where you were, what you saw or heard, and when; statements from others at the scene; photographs, dashcam or CCTV footage if it exists.
• Evidence of the relationship: for spouses and for parents and children the close tie may be presumed; for others, such as siblings, grandparents or close friends, evidence of how close the relationship was.
• Evidence of fault for the accident: police or accident reports and witness details, as in any accident claim.
• Records of your losses: time off work, treatment costs and the effect on your daily life.

The Supreme Court acknowledged that the lines drawn can seem hard: a mother who learns in a telephone call that her child has been killed in a road accident may suffer an illness no less severe than a mother who saw it happen, yet only the second can claim as a secondary victim. An early, honest assessment of the evidence saves time and cost.

Time limits

Psychiatric illness counts as personal injury for limitation purposes: the Limitation Act 1980 defines personal injuries as including any disease and any impairment of a person's physical or mental condition. In England and Wales, the claim must usually be started within three years of the accident or, if later, your date of knowledge: when you first knew the injury was significant and attributable to the act or omission alleged, and who the defendant is. For a child, the three years usually run from their 18th birthday.

In Scotland the period is 3 years, running from when you became aware, or could reasonably have become aware, of the relevant facts, and Northern Ireland uses three years from accrual or the date of knowledge. Courts in all three jurisdictions can allow a late claim where it would be equitable, but that is discretionary.

The checker gives a first indication only. A psychiatric diagnosis can come some time after the event, so the date of knowledge needs care: take advice early.

Frequently asked questions

Related guides: psychological injury claims, PTSD and trauma claims, fatal accident claims, road traffic accident claims, making a claim in Scotland and making a claim in Northern Ireland.

Official sources used for this guide: Paul v Royal Wolverhampton NHS Trust [2024] UKSC 1; Limitation Act 1980, s.38; Fatal Accidents Act 1976, s.1A; Damages (Scotland) Act 2011, s.4; NHS: post-traumatic stress disorder; The Supreme Court. This guide is general information about the law in the UK, not legal advice; the law can change, so check your own position with a regulated solicitor.