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When did Medical Expertise in PI become Industrial? - Dr Mark Burgin

23/07/19. Dr. Mark Burgin BM BCh (oxon) MRCGP tells the story of how Medical Expert Witnesses in Personal Injury lost their way with quality as the main casualty.

There are good reasons why solicitors instruct PI medical experts who have an industrial approach to the work as they have experience, effective systems and availability.

There are problems with industrialisation that MedCo was created to deal with, links between experts and solicitors or MROs and cutting corners.

To understand why MedCo’s efforts to improve the quality of PI medical reports have largely been ineffective we have to return to the origins of industrialisation in the year 2000.

Solicitors were looking for a way of increasing the supply of PI medical expert reports because orthopaedic surgeons were not able to keep up with demand.


General Practitioners

General Practitioners were seen at the time as a cheap alternative and had the added benefit of being less aware of the legal issues than their orthopaedic colleagues.

MROs were able to draft in large numbers of GPs and after some initial resistance it was recognised that GP have experience in soft tissue injuries and psychological symptoms.

GPs were happy to diagnose acute stress reaction (F43.0) anxiety disorder, unspecified (F41.9) adjustment disorders (F43.2) or even PTSD (F43.1). (1)

Solicitors were pleased with the improvement in PI quantum and the much faster turnarounds although the lack of training meant that GP reports were often light on details.


Industrialisation of Medical reports

Some MROs were concerned about the quality of PI reports and their quality improvement teams would analyse the reports and give feedback on how to improve quality.

GP expert response was patchy with some GPs engaging with the process but others focused on improving industrialisation by reducing the time and costs of producing reports.

Increasing pressure to deliver reports within a timescale and for lower cost led to MROs side-lining and then disbanding their quality improvement teams.

Medical experts were given a clear message from all parties that their main task was producing PI reports as rapidly and cheaply in a ‘pile them high sell them cheap’ approach.


Quality becomes a dirty word

The claimant solicitors and their associated MROs were busy taking each other over and building huge bases of operations and for a time largely outclassed the defendant solicitors.

Even courts were unable to provide any balance and the part of the problem was that expert witnesses had a long-standing immunity to being sued.

Although judgments critical of medical experts were reported they had little effect because few PI cases go to court and judges who reported good practice were ignored. (2, 3, 4)

In 2011 the Supreme Court shocked the industry by finding for the first time that an expert could be sued but despite further adverse judgments little actual change has occurred. (5)


Fighting the Machine

Bond Solon led the way by developing training courses for expert witnesses with Cert CPR for expert witnesses in 2011 and Cardiff Law School Foundation Certificate in 2015.

They developed the MedCo accreditation training and now continuing professional development CPD for medical experts working in soft tissue injury RTA cases.

MedCo have used the ‘rapid and cheap’ standards and added ‘near and often’ which only high-volume experts working in cities can deliver and thus erodes quality.

MedCo’s randomisation system has become subverted by large (Tier one) MROs who can ensure that the solicitor gets the expert of their choice but there has been some progress.

Finding the Way Back

David Pearce has been a leader in the field creating IT systems Corex and then Nephex which reduced the costs of high-quality reports and offers real randomisation.

I have developed the MERA audit report that provides an independent assessment of the CPR compliance, function of the report and recommendations of how to improve. (8)

The judges have sanctioned Dr Grace Kerali and Dr Asif Zafar for weak methodologies and MedCo has organised more training for experts. (6) (7)

I have written over 30 articles on the art of PI medical report writing covering aspects such as range of opinion in prognoses and susceptibility to injury. (8)

Conclusions

PI medical experts whose reports are bespoke and detailed are responsible for only a minority of the reports and the industrial model based on a GP report is here to stay.

The main components of high-quality report are time to assess the claimant, time to write the report, access to material records and feedback with relevant training.

There is considerable resistance from the solicitors on MedCo, MROs and even experts themselves against taking the steps necessary to improve the quality of PI medical expert reports.

The present standards of ‘rapid and cheap’ and ‘near and often’ with poorly focused training are likely to worsen rather than improve judges view of the quality of these reports.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

  1. ICD 10 https://icd.who.int/browse10/2016/en#F40.0

  2. MacDonald v. Bruce [2008] ScotSC 21 (08 August 2008)

  3. Sara Buxton v Direct Line Insurance 29 Dec 2010

  4. Dominique Mullen v Churchill 14 Feb 2012

  5. Jones v Kaney [2011] UKSC 13

  6. [2019] EWCA 392 (Civ)

  7. https://www.lawgazette.co.uk/law/whiplash-doctor-sues-for-libel-over-insurers-guilty-claim/5059107.article

  8. Burgin 2015 to 2019 http://www.pibriefupdate.com

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