Modern Medical Evidence Donald Fowler – Premex Group Stuart Sheehy – Premier Medical Group 3 rd May 2012

1. Modern Medical Evidence Donald Fowler – Premex Group Stuart Sheehy – Premier Medical Group 3rd May 2012

2. Current position…. • Policy makers need to be clear about current processes…and unfortunately they are not • Premex and Premier deliver c350,000 medical reports p.a. • Represents c50% of total market requirement • Both organisations operate panels of NHS doctors with strict vetting & report QA criteria in operation • There are calls for independent panels of experts – this is exactly what MROs such as Premex and Premier already provide

3. Whiplash….. • Latest scientific and medical opinion presented at LD International Conference on Whiplash (April 2012) • Considerable research based evidence presented that whiplash is a mechanism of injury that can cause range of injuries, even at low speeds • ABI and Jack Straw in attendance – their opinion is seemingly unchanged despite the latest research presented • In the absence of definitive tests or scans, sound expert medical opinion is necessary to assess “does it all fit together” • Current medical evidence processes have been shaped enormously by solicitor and insurer requirements around speed and cost

4. Current MRO processes…. • Current medical evidence processes have been shaped enormously by all solicitor and insurer requirements around speed and cost. • Shift to mainly GP reports in RTA space • Default position is no review of medical notes by GPs • Standardised content to facilitate electronic transfer of data • Move towards electronic integration with quantum valuation tools • MROs such as Premex & Premier have brought significant benefits to the claims process • Independence – independent buffer and removal of “hired gun” evidence • Speed – appointments, let alone reports themselves, used to take months • Cost - successful operation of fixed cost regime with insurers • Innovation – report writing software and “real time” appointment booking system

5. Lord Justice Jackson • The MRO model was considered by LJ Jackson, who said…… • “Having considered the evidence with the assistance of my assessors, I am persuaded that the intervention of MROs has had the overall effect of controlling the costs of obtaining medical evidence in personal injury cases”

6. Myth #1 …. • “Doctors are in the pay of CMC’s and solicitors” • MRO’s act as a buffer between the solicitor or insurer and the medical expert • No one wants a return to the partisan “hired gun” evidence of “the old days” • We are instructed by both claimant and defendant organisations – simply would not happen if this statement was accurate • Single expert panel and instruction/report process used regardless of whether client is a solicitor or insurance company

7. Myth #2 …. • “Doctors’ income is dependent upon outcome of the case” • Our experts are paid “win, lose or draw” • We have NO arrangements where the expert is incentivised to write a claimant friendly report • Our banking facilities allow us to pay our experts on fixed credit terms, significantly ahead of when we receive payment of our invoice • This practice is essential in demonstrating the experts’ independence

8. Myth #3 …. • “Doctors simply write what the claimant tells them” • GP’s clinical experience of treating patients over long periods of time is essential to the process • The expert needs to assess “does it all fit together?” • Claimant’s demeanour • Relevant medical history • Accident details • Resultant injuries and symptoms described • Impact on their day to day life • Each expert signs a statement of truth and is fully aware the report is addressed to the court • Each expert is aware he might be called to court and be challenged on it

9. Myth #4 …. • “Routine prolonged prognosis periods for minor injuries” • Analysis of 50,000 GP reports involving neck and back injuries • 75% of all injuries assessed had a prognosis period of < 9 months • Only 3% had a prognosis period > 18 months

10. Myth #5 …. • “Medical evidence is provided by 3rd rate doctors” • Over to Stuart ……

11. I Love Claims Conference Stuart Sheehy Managing Director Medico Legal 3rd May 2012

12. Medical Experts – Current Position • PMG & Premex have developed similar processes to vet medical experts and ensure that quality standards are met • Recruitment: • Review CVs • GMC registration, professional accreditations and indemnity insurance • Interviews if appropriate. • Literature provided on Civil Procedure Rules and training in IT procedures • Formal contracts to meet professional standards and SLAs • Probationary periods to ensure quality standards are met • If quality standards are inadequate, experts are removed from the panel • System is self-regulating, the best thrive, poor experts will not be selected

13. The Reporting Process • Tickbox or a fast, efficient reporting process • WARP and Xport software provides Quality Assurance • Expert time is spent on the client not on paperwork • Not a medical but an assessment of injuries for a claim

14. Certificate in Medico Legal Reporting • Desire for objective evidence that the experts possess the required level of knowledge • To adopt and disseminate the latest available research and literature on Whiplash and Spinal Injury • Civil Procedure Rules to provide understanding of the Expert’s role in reporting • E learning modules and online articles and guidance • Online questionnaire provides verification of understanding

15. Cert MLR – Benefits for all • Providing experts with the most up to date analysis on injuries • Can help identify training needs • Objective evidence of relevant knowledge • Right first time reports and quicker case closure

16. What Next? • Launch date 1 September at latest • Not mandatory initially • Further modules where medical clarity supports the claim process • Modules developed collaboratively with all parties