Combined Breach & Causation Reports
A single integrated cardiology opinion addressing both breach and causation, used where the two questions are tightly linked or where proportionality favours one report rather than two. CPR Part 35 compliant.
- Integrated opinion
- Proportionate
- Claimant & defendant
Resolve breach and causation
in one report
A combined report is used where the two questions are too closely linked to separate, or where claim value makes two reports disproportionate. The breach finding and the causation analysis sit in one document, each given full treatment and clearly separable.
Each report is prepared under CPR Part 35 and Practice Direction 35, with a CPR 35.10 statement of truth and the expert’s overriding duty owed to the court.
- Tightly linked questions where the breach is itself the causative mechanism — a missed diagnosis followed by progression of the underlying disease, for example.
- Lower-value claims where two reports would be disproportionate, particularly under fixed recoverable costs or LAA funding.
- Pre-action protocol stage where a single integrated opinion supports the letter of claim and the response without separate instructions.
- Court direction where a single report covering both issues has been directed, particularly on the small claims or fast track.
What the report covers
A combined report addresses breach and causation in one document, but each section retains the rigour of a standalone report. The scope of each section mirrors the equivalent standalone instruction.
Breach and causation
- A breach section identifying the standard of care and applying Bolam and Bolitho, referenced against contemporaneous NICE and society guidance.
- A causation section — the factual counterfactual, the balance of probabilities, and material contribution where the evidence supports it.
- Cross-references where the breach finding feeds directly into the causation analysis.
- Whether the records are sufficient for a conclusive opinion, or what further disclosure is required.
- A signed CPR Part 35 statement of truth and declaration of duty to the court, covering both sections.
Not covered
- Condition and prognosis, quantum or life expectancy — that requires a separate condition and prognosis report.
- Examination of the claimant, unless specifically agreed in the instructions.
- Cases where the questions are too separate or complex to be addressed proportionately in one document — there, two reports are the better option.
Where we are regularly instructed
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Missed diagnosis
Delayed identification of aortic dissection
Chest pain attributed to musculoskeletal causes; aortic dissection identified eighteen hours later. The breach is the missed diagnosis; the causation question is the additional injury caused by the delay. The two are tightly linked and naturally addressed in one report.
Often paired with: Aortic dissection
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Anticoagulation failure
AF stroke with documented failure to prescribe
Lower-value claim where the breach (failure to anticoagulate documented AF) and the causation (the resulting embolic stroke) are uncontroversial in cardiology terms and the case turns on quantum. A combined report keeps the liability work proportionate.
Often paired with: Condition & Prognosis Atrial fibrillation
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Procedural complication
Pacemaker lead displacement
Pacemaker lead displaced shortly after implantation, requiring revision. The breach (technique or post-procedure assessment) and the causation (the revision and its consequences) are tied to the same procedural events.
Often paired with: Pacemaker & ICD complications
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Inquest follow-on
Cardiac event following missed admission
After an inquest has clarified the cardiac contribution to death, a combined civil report addresses both the alleged breach in the days before death and the causation question on the timing and inevitability of the event.
Often paired with: Inquest & Fatal Cardiac Sudden cardiac death
Report format, length and turnaround.
Combined reports typically run to twenty to thirty pages, reflecting the dual scope. Standard instructions are returned within four to six weeks. Where a hearing date, limitation deadline or court direction requires it, an expedited timetable of two to four weeks is available subject to capacity.
Fixed fee where the records bundle is contained; the combined report is structured to cost less than two standalone reports while delivering the same weight on each question. Larger or complex matters are quoted on an indicative basis with a cap. LAA rates and deferred payment terms available — full fee schedule.
Need a combined breach & causation report?
Submit case details today and receive a same-working-day quotation. For urgent matters, call using the phone number below.
Same-working-day quotation Fixed fee where the bundle allows LAA rates available