Erb's palsy affects one arm, causing weakness, reduced movement, or in serious cases complete paralysis from shoulder to hand. When it results from negligent care during labour and delivery, an Erb's palsy claim can be brought on behalf of the child to recover the compensation needed to fund treatment, therapy, and any long-term support.

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What is an Erb's palsy claim?

An Erb's palsy claim is a clinical negligence claim brought on behalf of a child who suffered a brachial plexus injury during delivery caused by a failure in the standard of care. The brachial plexus is a network of nerves running from the spinal cord through the neck and shoulder to the arm, controlling movement and sensation from shoulder to fingertip. Erb's palsy specifically involves damage to the upper brachial plexus, primarily the C5 and C6 nerve roots, and results in the characteristic pattern of weakness affecting the shoulder, upper arm, and elbow.

The most common mechanism is shoulder dystocia: a delivery complication in which the baby's head is delivered but the shoulder becomes impacted behind the mother's pubic bone. If excessive or incorrect traction is then applied to the baby's head to complete the delivery, the brachial plexus nerves can be stretched, torn, or in severe cases avulsed from the spinal cord. The birth injury section of this site covers the broader range of maternity-related injuries.

Not every case of Erb's palsy involves negligence. Some degree of brachial plexus stretch can occur even in well-managed deliveries. The legal question is whether the care fell below the standard a competent clinician would have provided, and whether that failure caused or materially contributed to the injury.

What constitutes Erb's palsy negligence?

Erb's palsy negligence arises in two distinct situations: failure to anticipate shoulder dystocia and take preventive action before delivery, or negligent management of shoulder dystocia when it occurred during labour.

As explained in guidance from GadsbyWicks, the negligence categories are:

Failure to recommend or offer Caesarean section. In pregnancies where identifiable risk factors make shoulder dystocia a foreseeable risk, a competent clinician should discuss the risk with the mother and offer a planned Caesarean section. Risk factors include maternal diabetes, foetal macrosomia (estimated large birth weight), a previous delivery complicated by shoulder dystocia, and certain maternal anatomical characteristics. Failure to raise these factors in antenatal care and offer a surgical alternative can constitute negligence if shoulder dystocia then occurs and causes a brachial plexus injury.

Failure to honour a Caesarean request. Where a mother specifically requests a Caesarean and is refused without adequate clinical justification, and shoulder dystocia then follows causing injury, the refusal may itself be the negligent act.

Negligent management during delivery. Applying excessive downward traction on the baby's head, twisting or rotating the head inappropriately, or failing to apply the recognised manoeuvres in the correct sequence can each constitute a breach of duty. The negligence is not that shoulder dystocia occurred, but in how it was handled.

What is the standard of care when shoulder dystocia occurs?

When shoulder dystocia occurs, the clinician is required to follow the structured protocol set out in the RCOG guideline on shoulder dystocia. The guideline sets the standard against which any Bolam analysis of the delivery team's conduct is measured.

The first-line response is the McRoberts manoeuvre: the mother's legs are hyperflexed against her abdomen by two attendants to rotate the pelvis and increase the available space, while a third applies suprapubic pressure above the pubic bone to dislodge the impacted shoulder. This combination resolves the majority of cases without injury. If the McRoberts manoeuvre and suprapubic pressure fail, internal manoeuvres are attempted: the Rubin II manoeuvre (rotating the posterior shoulder forward) and the delivery of the posterior arm.

The RCOG guideline records the incidence of shoulder dystocia at 0.58 to 0.70% of deliveries. The NHS Litigation Authority data cited in that guidance found that 46% of shoulder dystocia injuries were associated with a poor standard of care. Deviation from the protocol, application of fundal pressure (which can worsen impaction), or excessive lateral traction on the head are the most commonly identified failures in claims.

Does the Montgomery ruling apply to Erb's palsy claims?

Yes. The Supreme Court decision in Montgomery v Lanarkshire Health Board [2015] UKSC 11 applies directly to antenatal consultations in pregnancies with recognised shoulder dystocia risk factors.

Montgomery established that a doctor must disclose any risk that a reasonable patient in their individual position would consider significant when deciding whether to proceed with treatment. The standard is patient-centred, not clinician-centred: the Bolam test does not govern what risks must be disclosed. In Erb's palsy claims, this principle means that where a patient's clinical picture included identifiable risk factors for shoulder dystocia, the consulting clinician was required to raise the possibility, explain the risks, and discuss the option of elective Caesarean section, even if the absolute probability of shoulder dystocia was not high.

A failure to have that conversation can be the standalone negligent act that grounds the claim, separate from any question of how the delivery itself was managed. If the patient was not warned and would have chosen an elective Caesarean section had she been properly advised, the causation argument flows directly from the consent failure.

Severity, recovery, and the impact on your claim

Erb's palsy varies considerably in severity, and the clinical prognosis at the early assessment stage is one of the most important factors in determining the likely value of a claim.

At the less serious end, neuropraxia involves bruising or stretching of the nerve without structural rupture. In these cases, spontaneous recovery within three to six months is common, and the child may regain full or near-full function. Further along the spectrum, nerve rupture or avulsion (where the nerve root is torn from the spinal cord) produces permanent deficit that cannot fully recover through natural healing. Surgical intervention, including nerve grafting or tendon transfer procedures, may improve function but cannot restore it to normal.

Severity is assessed by neonatal clinical examination, electromyography and nerve conduction studies, and MRI imaging of the brachial plexus. These investigations establish both the extent of the injury and the likely trajectory of recovery. In a legal claim, the medical evidence on severity and prognosis directly shapes both the general damages assessment and the scope of the special damages schedule.

How much Erb's palsy compensation can you claim?

The total amount of Erb's palsy compensation depends on the severity of the injury, its permanence, and the financial losses it has caused. NHS Resolution data from 2022/23 records the average total settlement for an Erb's palsy negligence claim at £809,485, reflecting a combination of general damages and special damages across cases ranging from partial to permanent injury.

General damages are assessed against the Judicial College Guidelines, which contain brackets for brachial plexus injury by severity level. The brackets range from modest figures for temporary injuries with substantial recovery, through to significantly higher figures for permanent complete paralysis of the arm. The 18th edition of the Guidelines was published in April 2026 with an approximate 8.26% RPI uplift from the previous edition; the specific brachial plexus brackets should be confirmed with a specialist solicitor, as they were not reproduced in the public sources reviewed for this article.

Under the CFA Order 2013, the 25% success fee cap applies only to general damages and past financial losses. Future losses, including future therapy costs, surgical costs, adaptive equipment, and any projected loss of earning capacity, are fully protected and paid in full.

Special damages in an Erb's palsy claim

Special damages in an Erb's palsy claim are built from evidence of actual and projected financial losses. In cases involving temporary injury with full recovery, the special damages schedule will be limited: primarily physiotherapy costs and any earnings lost by a parent who took time off work to care for the child.

In permanent cases, the schedule expands considerably. Physiotherapy and occupational therapy are typically ongoing. Nerve grafting or tendon transfer surgery may be required, with associated hospital, rehabilitation, and recovery costs. Adaptive equipment and modifications to support independent living add further items. Where the injury affects the dominant arm and the child's future earning capacity is materially reduced, an employment expert and actuary will project the lifetime loss. These future losses are calculated individually and can substantially exceed the general damages award.

In the most serious permanent cases, total Erb's palsy compensation can run well above the NHS Resolution average of £809,485 cited above, particularly where a child faces multiple surgeries, ongoing therapy, and a significant reduction in career options.

How long do you have to make an Erb's palsy claim?

A child's own three-year limitation period does not begin until their 18th birthday, under section 28 of the Limitation Act 1980. This gives until age 21 to issue proceedings in the child's own right. A parent or litigation friend can bring the claim on the child's behalf at any time before that, and acting earlier is strongly recommended.

Early instruction matters for practical reasons. Delivery records, CTG traces, and maternity notes are more complete when requested promptly. The clinicians involved have clearer recollections of their decisions. Expert witnesses with direct experience of brachial plexus birth injury litigation are easier to identify and instruct. Where liability is admitted or becomes clear from an early evidential review, an earlier instruction also enables an application for interim payments, providing funds for therapy and surgical costs without waiting for a final settlement.

For maternal injuries sustained during delivery, the standard three-year rule applies from the date of the injury or date of knowledge, whichever is later.

Starting an Erb's palsy claim

If you believe your child's Erb's palsy was caused by negligent care during delivery, the first step is a specialist assessment of the records and the circumstances. Liability in Erb's palsy claims requires careful expert analysis of the delivery records: whether the risk factors were identified antenatally, whether the correct manoeuvres were applied and in the correct sequence, and whether any excessive or incorrect traction is documented.

AAA Solicitors handles all categories of birth injury claim in England and Wales on a no win no fee basis. Erb's palsy claims are funded through a Conditional Fee Agreement: no upfront costs, no fees if the claim is unsuccessful, and the 25% success fee cap protects the majority of your award. Legal aid is not available for Erb's palsy claims alone, but does apply where a child also suffered a severe neurological brain injury. The CFA funding guide on this site explains both routes in full.

The initial assessment at AAA Solicitors is free and commits you to nothing. You can check your claim using the online form, or call to speak with a specialist directly. The claims process guide covers every stage from first instruction to settlement.

The only cost of not calling is not knowing where your child stands.