PI Brief Update

Audit on Amendments to PI reports - Dr Mark Burgin

28/10/23. Dr Mark Burgin explores the pressure on the PI reporting industry from amendment requests and considers the options available.

A large MRO brought the issues in this audit to my attention and provided a list of cases. The MRO has also helped with some of the analysis and understanding and has indicated that the workload associated with these challenges is unsustainable. There is a clear risk that MROs may choose to only use less independent experts who give more favourable opinions.

Of the five groups of requests, the first two are simple amendments and reviews of additional records provided, and both are reasonable. Amendments asking what physiotherapy is for and where the report is already correct are decreasing in number as training improves. However, breach of CPR35 guidelines represents almost 10% of all instructed cases and over a quarter of amendment requests are problematic.

Breach of CPR35 guidelines mainly involved attempts to get a whiplash injury reclassified as non-whiplash or to ask the expert to change their opinion. The proportion of non-tariff cases is rising rapidly. Several methods were used to achieve this, such as stating that an injury had been missed, instructing the expert to change their opinion, or saying that the report was not clear.

The solicitors involved in these breach of CPR35 requests typically refused to provide a statement of truth, medical records, or engineering evidence. They would often follow up a statement that something was unclear with a further letter clarifying that they were really just disagreeing with the opinion. This behaviour is only present in less than 10% of instructed cases, but it causes significant stress and costs to MROs.

Request for simple amendment

1. time off work - He was off work due to the previous RTA - I would not normally comment on the reasonableness of time taken off for previous RTAs.
2. Amended to expand on entries based on new information.
3. request for simple amendment.
4. request for simple amendment.
5. request for simple amendment.
6. request for simple amendment.
7. simple amendment request.

Additional records provided

1. request to review MRI scan.
2. medical records added.
3. request for records review.
4. request for records review.
5. CCTV reviewed and added.

What is physio for?

1. ‘you have recommended 4 sessions of physiotherapy but have not advised what injuries they are for’ Amended to state that the treatment was for the physical injuries.
2. Please specifically state which injuries you are recommending treatment for. Amended to state that the treatment was for the physical injuries.
3. Can you please ensure that you specify what injuries you are recommending treatment for within your reports? Amended to state that the treatment was for the physical injuries.
4. you have recommended the client to undergo 4 sessions of physiotherapy but have not stated for which specific injury - - Amended to state that the treatment was for the physical injuries. Second amendment – add injuries – already in the report.
5. you have not stated what injuries further physiotherapy - As the only injury is neck pain radiating to the shoulders, both upper arms, upper back and associated headaches the physiotherapy is to treat that injury.
6. you have advised that you have recommended the client have 6 sessions of physiotherapy but have not stated for what injury this is in regards to - Amended to state that the treatment was for the physical injuries
7. you have advised for further sessions of physio but have not stated for what type of injuries this is required for - Amended to state that the treatment was for the physical injuries.

Report already correct

1. Exceptional circumstances not mentioned -- Exceptional circumstances do not apply unless whiplash has been diagnosed
2. Please clarify ‘incapacity’. No amendment made.
3. Report already contains the required information on the front page no amendments.
4. No mechanism provided for each injury, please note the mechanism for all injuries. Report stated mechanism was whiplash – no amendment.
5. The report already contains the requested information – detailed list of the 7 relevant entries in a reply.
6. Whiplash? This case is not classed as an RTA under the court rules - no whiplash - fall out of taxi.
7. Could you state if the client was wearing a seatbelt? The information is already in the report:
8. No mechanism provided for any of the clients injuries, please note we require all injuries to have a mechanism noted within the report. Report stated mechanism was whiplash – no amendment.
9. No mechanism provided for any of the clients injuries, please note we require all injuries to have a mechanism noted with the report. Report stated mechanism was whiplash – no amendment.
10. There is no difference between the requested amendment and the report = no amendment can be made – 5 attempts to get expert to use the solicitor’s words rather than accept the expert’s wording.
11. Whether the medical expert believes the injuries are classed as a tariff whiplash injury or a non-tariff injury – report already contains the information – reply given.
12. No mechanism provided for any of the clients injuries, please note we require all injuries to have a mechanism noted with the report. Report stated mechanism was whiplash – no amendment.

Breach of CPR35 guidelines

1. Multiple challenges from inappropriate requests for amendments, instructing the expert to change their opinions by the solicitors and the claimant.
2. Claimant states the expert lacks expertise and challenges the opinions of the expert about pre-existing problems, associated losses and recovery times. Expert recommended review of the medical records, to have a chat with the solicitor (no charge) and gave a detailed written reply to the comments.
3. Request to remove material evidence about what was said at the time of the examination - no amendments.
4. The solicitor stated that the opinion was of ‘soft tissue injury whereas the report stated that the bruising was due to direct trauma - no amendments.
5. Request to change opinion and refer for psychologist and orthopaedic opinions rather than review of records. Review of records confirmed significant pre-existing problems and the prognoses were safe.
6. Please change the opinion from whiplash to non whiplash and extend prognoses – reply given to explain that this is not appropriate.
7. Instructed to extend prognoses, reply indicating that medical records review would be required.
8. Request to extend injury prognosis. Reply to explain that this is not appropriate.
9. Request to add injuries that the claimant denied and were not in the instructions.
10. Request to change injuries opinion on whiplash to non whiplash.
11. Request to change injuries opinion on whiplash to non whiplash.

Discussion of results

There was a total of 42 requests for amendments out of 132 reports and 12 resulted in amendments. Each failed request was addressed with a reply, many were full written replies and others were emails. The addition of records and answering the breach of CPR35 guidelines amendments took the longest time to reply.

Many of the amendment requests appear to have been based upon the introduction of MedCo audit criteria being followed by case handlers without the necessary training. The case handlers are raising less and less of these amendments as they become familiar with the structure of the medical expert report. There is also concern that case handlers do not have access to effective supervision.

The MRO raised some other concerns related to this audit, there can be requests for amendments if the expert provides a correct date of birth or accident which is different than the one on file. ‘If a solicitor does not understand a report then it must be amended because clarity is essential’. ‘All experts on the panel are happy to give opinions on the correct interpretation of the Civil Liability Act 2018’.

These are fair points as increasing numbers of claimants are not legally represented and someone will need to address the legal aspects. The problem is however where the solicitors (not the claimants) state that they want the expert to provide legal advice to understand the report. This is only a small number of the instructing solicitors.

 My experience suggests that the compensators do not have any problems with correctly interpreting reports. They also appear to have no difficulty with the Civil Liability Act 2018 and how to interpret it. I do not believe that claimants will be better off without solicitors and the actions of a small minority should not taint the excellent work of the vast majority.

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

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

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