• Read this resource to: Understand the claims environment in the medicolegal field
• Access tailored advice and key recommendations to help you reduce risks in the future

Medicolegal experts play a key role across a diverse range of cases, including civil, criminal, coronial, and regulatory proceedings. One of the concerns about undertaking medicolegal work is the possibility of being criticised – so it is important you understand the types of issues that might arise and how you can reduce the risks.

As a Medical Protection member, you benefit from more than 130 years of experience protecting doctors and other healthcare professionals. That isn’t just a number – it’s more than 13 decades of specialist expertise that we use to protect you long into the future.

The team at Medical Protection have reviewed selected cases faced by medicolegal experts to identify different scenarios which might lead to a claim or complaint. Their analysis aims to keep you informed about current trends and provide useful insights to help you to protect yourself throughout your career.

Introduction

Medicolegal experts occupy a pivotal position in civil, criminal, coronial, and regulatory proceedings. Their views can heavily influence how a case progresses, particularly where legal teams may not have in-depth clinical understanding. The implications are considerable: for patients and families, poor-quality expert evidence can cause distress, delay, and unnecessary escalation; for clinicians, negative opinions may carry serious professional or even criminal consequences.

These concerns were previously echoed in the Williams and Hamilton reviews of 2018 and 2019 commissioned following the case of Dr Bawa-Garba, and the resulting concerns this raised amongst the medical community. These reports highlighted variability in the quality and consistency of expert evidence and emphasised the need for appropriate training, accreditation, and adherence to clear professional standards.

Given the level of influence a medicolegal expert may have on a case, expert evidence must be thorough, impartial, and firmly rooted in the standards of practice at the relevant time, taking into account applicable guidance and system pressures.

Several barriers deter clinicians from undertaking medicolegal work, including time constraints, unfamiliarity with legal frameworks, and concern about potential criticism. Consequently, many experts are further on in their careers and may no longer be in active practice, which can introduce risk if opinions do not fully reflect current clinical environments. By contrast, those in active practice are often better placed to provide contemporaneous and relevant insight, although they must carefully balance this work with clinical responsibilities and contractual obligations.

The risks associated with medicolegal work are significant. Among these is the possibility of criticism. Where reports or oral evidence are found to be deficient, whether due to factual inaccuracies, lack of objectivity, stepping beyond a person’s expertise, or insufficient analysis, this may result in formal judicial or inquiry challenge. Such findings can, in turn, lead to claims of professional negligence.

Regulatory scrutiny is another important consideration. The General Medical Council (GMC) may investigate concerns about an expert’s conduct, particularly where there is an obligation to self-refer following criticism in legal or coronial settings. Concerns may also be raised by instructing solicitors or other parties dissatisfied with the quality of the work. In more serious cases, this can progress to fitness to practise proceedings and the imposition of sanctions.

Independence remains a fundamental safeguard. Experts must provide objective, unbiased opinions and avoid acting as advocates for those instructing them. Offering views outside one’s area of expertise or failing to engage with alternative perspectives can significantly damage credibility, especially under cross-examination.

In many respects, medicolegal practice carries risks comparable to, or greater than, those encountered in clinical work. Reports must be capable of withstanding detailed legal scrutiny. As such, careful preparation, ongoing training, and appropriate professional indemnity are essential. Access to specialist medicolegal advice and support can also play a crucial role in managing risk and responding to concerns.

Feedback from members highlights that involvement in medicolegal cases can be highly stressful. At Medical Protection, we aim to share our knowledge and experience to provide meaningful professional support when it is most needed.

Medical Protection offers members access to advice and assistance in the event of medicolegal concerns, including support from specialist advisers and, where appropriate, legal representation.

Case report

From efficiency to error: The hidden dangers of template reporting

This case is based on a real scenario, with some facts altered to preserve confidentiality.

Dr T, a Consultant, maintained a private medicolegal practice alongside his NHS work. He provided medicolegal expert reports, primarily in relation to personal injury claims, and produced a significant number of such reports every year.

Having been instructed by solicitors acting for Miss L, he provided a report in relation to alleged injuries she sustained in a road traffic accident.

The report written by Dr T stated that Miss L had been driving her car when another vehicle emerged from a side street at speed, colliding with her as she was passing the entrance to the side road. It set out the examination performed and the findings, including that the symptoms following the accident had lasted for a month before resolving.

Subsequently, Miss L raised concerns to the solicitors that the report was inaccurate. She had been a passenger in the car, not the driver, and her symptoms were ongoing at the time of consultation with Dr T. Further, in two places in the report, Miss L was referred to as Mr D.

The instructing solicitor recalled that they had also recently instructed Dr T to provide a report on another individual, Mr D, who had also been involved in a separate road traffic accident. They compared the two reports and found that many of the paragraphs were identical, including in relation to the symptoms reported by the claimant, the examination conducted, and the findings on examination. The solicitor then went on to look at other reports that Dr T had been instructed to produce, as he was an expert they often approached and who was known to provide reports quickly.

On review of twelve expert reports provided by Dr T in relation to personal injury claims over the last two years, the same or very similar paragraphs, usually relating to examination, findings, and symptoms, appeared in all of them. In four of the reports, the description of the accident itself was identical.

The solicitor was concerned about this and approached Dr T, who set out that he did use a template for his reports and may have accidentally copied and pasted information from one report into another. He offered to re-write Miss L’s report at no charge, but the solicitor declined and informed Dr T that they preferred to approach another expert instead.

The solicitor was genuinely concerned about Dr T’s approach to writing medicolegal reports, and referred the matter to the GMC for consideration, including providing a copy of all twelve reports.

The GMC opened an investigation and wrote to Dr T to inform him of this. Dr T consequently contacted Medical Protection for assistance.

Dr T discussed the case with a Medical Protection medicolegal consultant. He set out that his NHS work meant he did not have the time to devote to his medicolegal practice, but he needed the money from the reports to fund ongoing divorce proceedings. He acknowledged that he did not spend sufficient time reviewing patients and producing the reports, and that he did copy and paste parts of previous reports to make the process quicker. He did not, however, think that this was particularly problematic, given that many of the cases were very similar anyway.

Medical Protection’s medicolegal consultant highlighted the requirements of the GMC’s Good medical practice and Providing witness statements or expert evidence as part of legal proceedings guidance, as well as the expectations by the courts in relation to Dr T’s practice as a medicolegal expert. Dr T initially resisted these discussions, but after a period of reflection acknowledged that he had not acted in line with his obligations to both the court and the GMC.

The GMC sought an expert opinion of their own, which concluded that Dr T’s practice fell significantly below the expected standard. Following this, the GMC provided formal written allegations to Dr T.

Dr T’s medicolegal consultant at Medical Protection instructed a solicitor to represent Dr T and draft a response to the allegations, and the three individuals met to review the case in detail and discuss ongoing reflections and remediation. Dr T was advised that the case was unlikely to be closed after the GMC received his response and would instead likely be referred to a Tribunal, given the nature of the concerns and the number of reports involved.

The matter indeed progressed to a Medical Practitioners Tribunal, and a barrister was instructed to represent Dr T. In the lead-up to the hearing, Dr T continued his reflection and remediation, ensuring he was fully familiar with the requirements of a medicolegal expert and able to clearly explain where he had fallen short of these standards and the GMC’s guidance. While this process was ongoing, he was not offered any further new instructions for medicolegal work, but he resolved that should his practice recommence following the Tribunal, he would only accept a small number of instructions to ensure that he had appropriate time to dedicate to these. Dr T also accepted that while the divorce proceedings and need for money had been a driver in his actions, this was in no way a mitigating factor and he fully accepted he had made a grave error in judgement.

At the hearing, the Tribunal found that Dr T’s actions amounted to misconduct and his fitness to practise was impaired. The GMC argued for a sanction of erasure, but the arguments put forward by Dr T’s representative at Medical Protection, his own oral evidence, and the remediation bundle provided, meant that the Tribunal imposed a sanction of suspension rather than erasure.

This was a good outcome for Dr T, given there had been a very real possibility of erasure in this case.

Case report – When boundaries blur: Failure to provide a chaperone

This case is based on a real scenario, with some facts altered to preserve confidentiality.

Dr Y, a doctor with a medicolegal practice specialising in injury assessments, contacted Medical Protection following a formal complaint made by a patient, Mrs C which included a reported referral to both the GMC and the police. The complaint concerned allegations of inappropriate examination during an injury assessment.

The patient had been in a car crash and saw Dr Y as part of her claim for compensation. Dr Y understood she had suffered musculoskeletal injuries to her arm, however during the consultation she reported abdominal scarring from a seatbelt injury and chest pain when breathing in.

Dr Y examined the chest and abdomen of Mrs C in his clinic room noting that she had some linear marks that may be consistent with a seatbelt on both her chest and abdomen. He reported no abdominal tenderness, organomegaly or other injury of note. He auscultated the chest and recorded equal air entry bilaterally.

Dr Y advised that the consultation lasted 15 minutes and the patient did not express any concerns at the time.

Mrs C had approached NHS England to make a complaint the day after seeing Dr Y and claimed that she had been inappropriately touched during the examination which was conducted without a chaperone. She alleged that his hand had touched her breast when examining the chest and her groin.

Dr Y contacted Medical Protection very distressed, and reflected that his medicolegal work was conducted in an office setting where chaperone availability was not guaranteed. His usual NHS practice was to always use a chaperone and he had been involved in a chaperone policy at the Practice. Dr Y spoke with a medicolegal consultant at Medical Protection, who explained the possible processes that could occur as a result of the complaint, and the support available through his Medical Protection membership. He was also given resources for support, including access to a confidential counselling service, available to Medical Protection members.

Dr Y described his examination technique and explained that, on this occasion, he recalled his hand brushing the top of the breast while auscultating the chest. He said he apologised to the patient at the time of the examination. He also noted that, in the absence of an available chaperone, he auscultated with the patient clothed, placing the stethoscope inside her clothing.

Dr Y denied touching the groin but recalled the bruising having been below the trouser line and the patient having moved her trousers to show him this. He admitted that early in his career as a doctor he had previously had a complaint regarding examination without a chaperone, which was why he had been so careful in his practice subsequently.

NHS England requested a meeting with Dr Y, and he attended this meeting alongside a Medical Protection medicolegal consultant. NHS England explained the concerns and explored what had happened in the consultation. They requested that Dr Y provided detailed reflections and remediation to present to the Professional Standards Group (PSG). They also requested that Dr Y sign voluntary undertakings not to examine female patients without a chaperone during the investigation. Dr Y agreed to this undertaking and decided to suspend his medicolegal practice for a period, to consider the setting and chaperone availability.

Dr Y subsequently received correspondence from a police officer investigating the allegations, and Medical Protection instructed a solicitor to attend a voluntary interview with Dr Y. The interview was conducted under caution and lasted a few hours. Whilst Dr Y felt supported, the experience had an impact on his wellbeing and he was signed off work with stress. During this time, his marriage failed and Dr Y made contact with Practitioner Health for support with his mental health.

The police confirmed that they were not charging Dr Y, although the GMC had also been made aware and opened an investigation, alongside the NHS England process.

Dr Y returned to work and complied with his undertakings whilst attending courses and reflecting on the case and the chaperone concerns. Dr Y attended two courses relating to chaperones and a professional boundaries course. He reflected on how his medicolegal practice had deviated from his NHS practice and the reasons behind that. He was able to collate a range of positive feedback from both colleagues and patients and wrote a reflective statement for NHS England. This included his learnings from the courses, and the steps he had taken in preparation for returning to medicolegal practice, such as changing the premises for his consultations and employing a nurse as a chaperone. His reflections were detailed and provided to NHS England and the GMC as part of his rule 7 response at the same time, on the advice of his legal team at Medical Protection.

The whole process took six months due to Dr Y having a period where he was unwell. The PSG noted the reflections and the remediation and the fact that Dr Y clearly had extensive knowledge of the GMC guidance and writing and implementing chaperone policies. The voluntary undertakings were removed. The GMC however issued Dr Y with a warning due to the fact that he had previously had a GMC case regarding chaperones, and had not taken sufficient care in his medicolegal practice to mitigate the risk.

Dr Y accepted the warning as he acknowledged that his medicolegal practice had not sufficiently considered the safeguards required. Dr Y expressed gratitude for the support, provided by Medical Protection throughout the investigation, which helped him navigate a highly challenging and stressful period.

Top tips to avoid risk in medicolegal work include:

Please note this is not an exhaustive list of recommendations, but key learning points

from our analysis.

• Ensure you have sufficient time to devote to any medicolegal case you accept. Poor or hasty work may result in referral to your regulatory body or even a claim for professional negligence.
• While you may wish to use a standard template for the structure and format of your reports, ensure that you are conducting a full review of the documents and the patient in each case.
• Ensure you are aware of, and adhere to, the expectations and obligations set out by the courts and the GMC. Do not forget that, ultimately, your duty is to the court.
• Do not accept instructions where you do not have the appropriate knowledge or expertise to opine.
• The same standards apply to medicolegal practice as general medical practice.
• Chaperone availability should be considered in line with the GMC’s Good Medical Practice.
• Ensure you have adequate indemnity for your full scope of practice, including medicolegal work.

To get advice or seek support, Medical Protection members can contact our medicolegal advice line on 0800 561 9090, available Monday to Friday, 08.30–17.30 (excluding bank holidays), with a 24/7 service for emergencies and urgent medicolegal queries.