A medico-legal report is a written opinion from a medical expert, prepared for a legal claim or proceedings. It explains a person's injuries or condition, what caused them and what the future is likely to hold, based on their medical records and usually an examination. In civil claims in England and Wales the report is expert evidence under Part 35 of the Civil Procedure Rules, and the expert who writes it owes their duty to the court, whoever pays the fee. This guide explains the main types of report, what goes into one, and how it is used as a claim moves forward.
The practical bottom line
- What it is. An independent medical expert's opinion for legal proceedings, covering diagnosis, causation and prognosis, and in clinical negligence the standard of care.
- Who it serves. The expert's duty is to the court, above any obligation to the party instructing them (CPR 35.3).
- What it contains. Practice Direction 35 sets the minimum contents, ending with a statement of the expert's duty and a statement of truth.
- How it is tested. Through written questions, discussions between experts and, occasionally, cross-examination at trial.
What does medico-legal mean?
Medico-legal describes work where medicine and law meet. Medico-legal work covers the doctors and other clinicians who give expert evidence, the solicitors and medical reporting organisations who instruct them, and the records, reports and hearings in between. The medico-legal report is the central document in that work.
Who writes a medico-legal report?
A medico-legal report is written by a medical expert in the specialty relevant to the issue: an orthopaedic surgeon for a fracture, a psychiatrist for post-traumatic stress, a GP for a delayed diagnosis in general practice. The expert is usually independent of the person's treating team. Treating clinicians can give evidence of fact about what they saw and did, and an independent expert gives the opinion.
Instructions usually come from a solicitor, sometimes through a medical reporting organisation (MRO) that finds the expert and manages the records and appointments. Whoever instructs, the duty under CPR 35.3 is the same: to help the court on matters within the expert's expertise, above any obligation to the person paying.
What types of medico-legal report are there?
- Condition and prognosis. The most common report in personal injury. It describes the injuries, whether the accident caused them, the current condition and the likely recovery.
- Breach of duty. In clinical negligence, a report on whether the care fell below the standard of a responsible body of practitioners in the same field, judged under the Bolam test.
- Causation. Whether the substandard care caused the injury, and what would have happened with proper care. See our guide to factual and legal causation.
- Quantum reports. Reports used to value the claim, covering future treatment, care and assistance, aids and equipment, and sometimes life expectancy.
- Psychiatric and psychological reports. Diagnosis, causation and prognosis for conditions such as depression, anxiety and post-traumatic stress disorder.
- Whiplash and MedCo reports. In road traffic claims for soft tissue injuries in England and Wales, the first medical report must be obtained through MedCo, the system that allocates accredited experts. Since the whiplash reforms of May 2021, lower value claims of this kind run through the Official Injury Claim service.
- Immigration and asylum reports. Reports that document injuries, scars and psychological effects and assess how consistent they are with the account given, usually following the Istanbul Protocol, the UN manual on documenting torture.
What does a medico-legal report contain?
Paragraph 3 of Practice Direction 35 sets the minimum, and our guide to CPR 35 has the full checklist. In practice most reports follow a similar order:
- A summary of the conclusions.
- The instructions and the questions the expert was asked.
- The expert's qualifications and experience.
- The records and documents reviewed, with dates.
- The history, as given by the person examined and as recorded in the notes, with any differences between the two.
- Examination findings and the results of any tests.
- A review of the medical records, often set out as a chronology.
- The opinion on diagnosis, causation and prognosis, with reasons and any range of opinion.
- Answers to the specific questions asked.
- The statement of the expert's duty to the court and the statement of truth.
For how to write each section, see our structure-first guide to writing an expert witness report.
How is a medico-legal report used in a claim?
Before proceedings, a report helps the claimant's solicitor decide whether the claim has merit and what it is worth. In a personal injury claim, a medical report on the injuries has to be served with the particulars of claim. Once proceedings start, the court decides which experts each side may rely on, and the other side can put written questions to an expert within 28 days of receiving the report. Where both sides have experts in the same field, the court usually directs them to discuss the case and produce a joint statement of what they agree and disagree on; our joint statement checklist covers that stage. Most claims settle on the strength of the reports. Where they do not, the expert may be cross-examined at trial.
How long does a medico-legal report take?
It depends on the records more than the writing. A straightforward condition and prognosis report can follow within weeks of the examination. A clinical negligence report on breach or causation can take months, because the expert needs complete GP, hospital and imaging records before an opinion is safe. Missing records are the most common cause of delay; our guide to what an expert should do when the disclosure has gaps covers how to handle them.
Who pays for a medico-legal report?
The party who instructs the expert pays the fee, and a successful claimant usually recovers it from the other side as a disbursement, subject to the court's control of expert costs. For a single joint expert, the instructing parties are jointly and severally liable for the fee unless the court orders otherwise. Who pays has no bearing on the expert's duty: the opinion should be the same whichever side instructs.
What makes a good medico-legal report?
Solicitors and courts look for the same things: a clear answer to each question, reasoning that can be followed, and facts that can be checked against the records by page number. A good report says what the expert cannot tell as plainly as what they can, and it acknowledges the range of opinion on each disputed point. Our piece on what instructing solicitors actually want from an expert report goes into more detail.
The first thing the other side's expert does with a medico-legal report is check the page references. A report that survives that check has done most of its work.
How ALLDOQ fits
ALLDOQ is built for the work behind a medico-legal report. Records arrive in a secure document hub, the expert reviews them with medical record review tools and an in-browser radiology viewer, and the chronology and report builder keep every fact linked to its source page. Book a walkthrough to see it on a live instruction.
