What is a medico-legal report?
A medico-legal report is a document in which a doctor gives a medical opinion for use in a legal process. It is most often needed in personal injury claims, for example after a road traffic accident or a fall at work, and in clinical negligence claims, where someone believes their medical care fell below an acceptable standard.
The report sets out the relevant history, the findings of an examination and any tests, a review of the medical records, and the expert's opinion on the questions the court needs answered. It is written so that lawyers, insurers and judges, who are not doctors, can follow the reasoning.
This guide is for solicitors, claimants and insurers who want a plain-English overview. It is general information, not legal advice, and the details of any case should be discussed with a solicitor.
Who can write a medico-legal report?
In principle, any registered doctor can write a letter or report about a patient. For an independent expert report used in court, however, the author needs specialist expertise in the area in question, enough clinical experience to give a reliable opinion, and an understanding of the rules that govern expert evidence.
In practice, that usually means a consultant or senior specialist who is on the GMC specialist register in the relevant field, keeps up to date clinically, and has training in writing expert reports. The right expert depends on the questions: an orthopaedic surgeon for a fracture, for example, or a clinical neurophysiologist where nerve function is in question.
Treating-doctor reports and independent expert reports
A treating doctor, such as your GP or the consultant who looked after you, can write a factual report about the care they provided and what they found. That can be useful, but treating doctors are not usually asked to give an independent opinion on causation or prognosis, because their relationship with the patient could be seen as affecting their impartiality.
An independent expert has not been involved in the person's care. They are instructed specifically to examine the evidence and give an objective opinion to help the court. In most significant claims it is this kind of independent report that the court relies on.
The expert's duty is to the court
In England and Wales, expert evidence in civil cases is governed by Part 35 of the Civil Procedure Rules and its Practice Direction. A central principle is that an expert's overriding duty is to help the court on matters within their expertise. That duty comes before any obligation to the person who instructs or pays them.
This means an expert must be impartial whether they are instructed by a claimant's solicitor, a defendant, an insurer or jointly by both sides. The report must be the expert's own independent view, must state the facts and assumptions it relies on, and must say clearly where an opinion is qualified or outside the expert's field. An expert cannot be asked to support one side's case.
What a neurophysiology expert covers
A Consultant Clinical Neurophysiologist specialises in measuring how nerves and muscles work. In medico-legal work, this provides objective evidence that does not rely only on a person's description of their symptoms. Dr Arvin Rodrigues, Consultant Clinical Neurophysiologist at Bridge House Clinic in Rossett, near Chester, prepares independent expert reports in this field.
Typical questions include whether a nerve has been injured, where along its course the damage lies, how severe it is and what recovery may be expected. Nerve conduction studies and EMG can be carried out as part of the assessment where appropriate, and earlier results can be reviewed.
Cost and timescales
There is no single price for a medico-legal report. Fees depend on the questions asked, the volume of medical records, whether an examination and nerve tests are needed, and any later work such as answering written questions or attending court. Fees are quoted per instruction, so the instructing party knows the terms before work begins.
Timescales are agreed at instruction too. They depend on how quickly records are available, the appointment for any examination or testing, and the complexity of the case. If you are a claimant, your solicitor will normally arrange the instruction. If you have new or worsening symptoms in the meantime, please see your GP or call NHS 111, and call 999 in an emergency.
Common questions
Who instructs a medical expert? +
Usually a solicitor acting for the claimant or the defendant, an insurer, or both parties jointly as a single joint expert. Whoever instructs, the expert's overriding duty is to the court.
How much does a medico-legal report cost? +
Fees vary with the scope of the work, including the records to review and whether an examination and nerve tests are needed. Fees are quoted per instruction before work begins.
Do I need to be examined for a medico-legal report? +
Often, yes. Many reports involve an appointment with the expert to take a history and carry out an examination. In neurophysiology cases this may include nerve conduction studies and EMG. Some reports are based on medical records alone.
Can my own doctor write the report? +
Your treating doctor can provide a factual account of your care. For an independent opinion on causation and prognosis, courts generally rely on an expert who has not been involved in your treatment.
Will the expert be on my side? +
No expert is on either side. Under the Civil Procedure Rules the expert must give an impartial opinion to help the court, whoever has instructed or is paying them.
