Who is your Medico Legal Expert?
In normal course of events, he is a medical doctor of many years experience in the field, either as a trauma surgeon or an orthopaedic surgeon. The main person examining you will be a trauma or orthopaedic surgeon and at their discretion other specialists’ opinions may be recommended.
Who arranges the appointment?
After a meeting with your solicitor, arrangements are put in place for you to be assessed with the purpose of obtaining a medico legal report, either from your GP or the medico legal expert, depending on the complexity of the case, and how the serious the personal injuries.
When the appointment is obtained you are notified of the date, time and venue. If the arrangement does not suit you, you should notify your solicitor, who informs the medico legal expert. Failure to do this on your part may attract a non-attendance fee; you usually pay this before another appointment can be scheduled, and there could be a long wait for another appointment to come through.
When you receive details of the appointment from your solicitor, you should organise to bring with you all the documents including the photographs of the accident site or relevant photographs that you may have featuring your injuries arising from the accident. These documents form an integral part of the evidence, so make a special effort to gather them and bring them with you on the day of the interview. The expert reviews these documents when compiling the medico legal report.
Preparation Prior to the Visit
Prepare a document file for visit
Before the visit for medico legal assessment, prepare a file for yourself for easy reference. This file should have the details of the events surrounding the accident. The expert will ask you some important questions in order to compile the report. Do not be taken aback when these questions are asked, as the instructing solicitor may not have provided all the necessary information.
There are many types of injuries arising from the accidents the medico legal expert deals with, the most common being road traffic accidents, slip and fall injuries, industrial accidents, accidents at home, assaults and so on. There are certain common factors that are observed in the most of these accidents, such as a lapse in safety and standards, negligence, a lack of, or even absence of, training, lack of warning signs such as road works, uneven slippery surfaces, wet floors, paths under repair, etc.
Some points to note concerning road traffic accidents
Try and be concise and make the notes to these points. Write legibly and keep one copy for yourself and one for your solicitor. The circumstances at the time of the impact provide a vital clue in the assessment of your physical and psychological injuries.
Your location the vehicle
Where were you sitting in the car at the time of the accident?
If in a multi-person vehicle, please define your exact location, your seat location has an important bearing on the assessment.
Were you wearing a seatbelt, or just a lap belt?
If the passenger was a baby or young child, was the passenger strapped in the baby seat?
Level of alertness
At the time of the accident, were you fully alert? Did you see the vehicle approaching just before the crash? Did you hear any unusual noises such as the screeching of tyres and brakes from behind? Did you look through the side view mirror and see vehicle approaching from the rear? If so, as a reflex action did you suddenly turn your head or torso when startled?
Awareness that an accident is just about to happen will give you a chance to be ready to take the impact, to brace yourself, such as putting your hands forwards to prevent forward surge or grabbing the door handle, the arm rest or the seat itself, and stiffening your body.
Awareness is important to note. For example, in the rear end shunt you are restrained by the seat belt holding your back and torso with the lap and shoulder straps; however the head, neck and upper torso are not restrained fully. If you have a chance to restrain yourself when holding onto the steering wheel, some of the force from the impact is taken by the wrists, forearms and shoulders as the head is violently jerked forwards and backwards, whereas if there is no bracing involved, the whole upper torso, neck and head are thrown forwards into the windscreen, steering wheel or the dashboard, depending on the severity of the impact from behind. Awareness thus can result in somewhat different patterns of injury.
Prior to and at the time of the accident
How fast were you travelling?
Were you slowing down, intending to stop, or changing direction?
Were you in control of the vehicle or was the vehicle non-responsive for a number of reasons?
Were you stationery in traffic, at a crossroads, in a filter lane, at a T junction, entering a major road form a side road (or vice versa) or negotiating a bend in the road?
Did you have clear visibility?
Did you make an emergency stop and why?
If your vehicle was rear-ended did you see the vehicle approaching from behind? Did you take or could you take any evasive action or was there no time? Did you brace yourself to take the brunt of the impact from the rear, or was the impact completely unexpected?
Sudden jolts, jerks or shunting at the impact
At the impact, were you thrown forward, sideways and did you twist your torso? Did you come off the seat or were you physically lifted off the seat? This is particularly important if the passenger is not wearing a seatbelt. The person can be thrown off the seat, flung forwards from the back seat and hit the console or fall in the foot well. There are recorded incidents of this actually happening, especially were unrestrained children are concerned. If unaware of the impending impact were you looking to the one side or the other? What way was your torso turned or which way were you leaning? At impact were you jolted, jerked or even thrown off the seat?
Was your seat damaged from the mounting?
Was the upright of the seat damaged and were you thrown back in the rear seat of the vehicle?
Was the airbag deployed? Did you make contact with the side window, steering wheel, windscreen, sun visor or even the steering column or glove compartment?
Did you head the back of the seat in front of you if you were a rear seat passenger?
Exit from the vehicle
Were you able to come out of the vehicle yourself unaided? Could you open the door yourself or was the door jammed, and if so did you exit from some other door, or did someone assist you in exiting the vehicle?
State of mind
Obviously there would be a level of shock realising what has happened, and it is quite natural not to experience any pain at the time of the accident. Please make this known to your expert examiner along with describing how you were feeling in the immediate aftermath.
Physical complaints of the time
Did you feel any pain, stiffness, weakness of limbs, tingling or numbness in the peripheral areas such as fingers or toes?
Did you feel sick or vomit at the time? Did you feel dizzy, lose control of bowels or bladder? Did you sustain any cuts or bruises? If so, where did you suffer the cuts? Was there any specific patterns of bruising, such as in the line of the seat belt across the chest, over the lower abdomen and across the pelvis, commonly described as lower stomach?
Did you have a shortness of breath, more commonly described as being ‘winded’?
Did you notice any obvious deformity of the limbs? Were you able to put full weight and walk on your legs? Did you notice or feel any lumps, called haematomas, especially in the scalp?
Of course if you were rendered unconscious you would have very little or no recollection of the actual events of the accident. However you may remember the events just before the crash such as hearing the screeching the brakes, bright light shining in your face and so on. You may remember a vehicle pulling out in front of your vehicle, or making a U-turn in front of your path or perhaps coming directly head on towards you, or a fellow passenger shouting out the warning of an impending accident. All of these points have a significant bearing on the assessment of your injuries.
If you were unconscious at the time or severely dazed, stunned or concussed, try to remember where you regained consciousness. Make a note of the visible injuries such as cuts, abrasions, friction burns or swelling or even obvious deformity of part of the lower or upper extremity.
Some point to note in slip and fall incidents
What were the contributing factors to the fall? A wet slippery surface, uneven surface, a dip or hole in the ground, lip of a shore, rise on the road, open drains, improperly closed manholes, whether there were warning signs, was the area well lit?
How did you fall? Did you fall forwards, and did you break the fall by putting out your hands? Did you fall twisting the torso or did you fall backwards as your feet went from under you and you landed on your lower back or coccyx? Did you hit your face or the back of your head?
Were you dazed? Could you get up of the ground yourself or were you helped up?
Make a note of any cuts, wounds, bruises, swellings, and deformity of the limbs, your ability to walk and move your arms and legs, and the region most painful.
On the day, be on time and collect all the relevant documents such as x-rays, reports, and any other specialists’ reports that you may have.
The expert asks specific questions to retrieve information to understand the circumstances surrounding the accident. Make sure you understand the questions put across to you by the expert before your answer. The expert is not trying to pry into your private affairs. If you are not happy about a question put to you, don’t be angry, withdraw or withhold the information. Simply state that you are not happy to respond to the question or at least ask the expert to clarify the question. Based on the information available they will compile a medico legal report. If some information is held back, intentionally or otherwise, your report will not represent all facts and can affect the outcome of proceedings.
For a comprehensive report, your expert has to recreate the scenario from the beginning to the present. This can be boring or even very distressing, bringing back all the memories of the accident you want to put behind you. In most cases the expert is given an account of the accident in the form of ‘particulars of the injury’ and a ‘copy of the Personal Injury Summons’.
This information may not be sufficient for a comprehensive report as some facts may not be represented or may be misinterpreted. Your version of the events surrounding the accident is of significant value in compiling the comprehensive medico legal report.
The expert will ask you relevant questions. Disclose all the details you know about the accident. Also give a history of any previous accidents, injuries, incidents or similar complaints as they may have significant importance in assessing your injuries from the present injury and help the court to award compensation for damages from the subject accident. If you have suffered any further injury since the subject accident, be sure to declare it during the interview, otherwise your credibility would be jeopardised. It is possible that on the day you may not have all the necessary information with you. Do not fuss or give inaccurate vague information. Simply state that you are not sure and will respond later on, but do not use this as an excuse as it raises the doubt of your credibility and honesty of your account.
What is a Medico Legal Report?
It is a document correlating the history of the injury with clinical findings, including investigations, with a view to giving an opinion and long term future prognosis of the outcome from the injury resulting from the accident.
The report takes into consideration the relevant information on the circumstances surrounding the incident responsible for causing the personal injury, and correlates this with the medical evidence. To generate the report, the expert takes into account a detailed history of the physical and psychological state of the person at the time of the incident. The report attempts to connect the history and clinical findings with the relevant investigations, submitted documents such as shared reports, hospital notes and GP notes, and other specialists’ opinions. The report takes into account any previous accidents or any other injury that may have occurred since the subject injury. This also includes the implication of any pre-existing adverse factors such as degenerative changes, and certain medical conditions such as diabetes and hypertension.
These factors have a significant bearing on the rate of quantum of recovery, taking into account how these adverse factors would have affected the plaintiff’s life style if such an accident did not occur.
The report finally concludes with an Opinion and Prognosis. This is the foundation stone of the medico legal report. This is the opinion of the expert. The expert does not advocate. The report aims at answering the following issues:
On the balance of probability
Could the accident result in such an injury?
Has the victim been thoroughly assessed?
What would be the extent of recovery and the approximate time frame of such recovery to occur from the time of the accident?
What is the prospect of the victim returning to their original lifestyle, including original occupation?
What is the forecast for any future lasting complication, disability and effect on lifestyle and occupation?
What suggestions can be made to improve the victim’s quality of life?
Of these various issues it is the extent of recovery that is important, as it directly affects the future lifestyle once the condition is static and there is no prospect of any further recovery to take place.
Recovery- long-term future prognosis
Is the injury attributable to the accident, no matter how trivial or serious the injury?
What is the impact of the injury on the victim’s ability to return to their pre-injury occupation?
Will there be full or partial recovery?
In the case of partial disability, what would be the prospect of an alternative employment?
Would there be a total disability to engage in any occupation?
What level of support would the victim need for the remainder of their life?
What would be the impact on lifestyle, including family, social and leisure activities?
Review your Report
Your solicitor usually forwards a copy of the report along with any supplementary reports. You should go through the report in detail paying attention to the following:
The date of injury
Nature of the injury
Details of the accident
Where you were removed to after the accident
Sequence of development of physical and stress-related complaints in chronological order
Occupation at the time
Dates of sick leave
Details of your return to work
Treatment received, has everything been included?
Past history of relevant surgery, illness, accidents, injuries. Have your overlooked disclosing any injury that may have occurred since the subject injury?
Finally, does the report reflect your history and your complaints and do you agree with the contents of the report? If there are issues in the report you would like to discuss write to your solicitor point by point, outlining where there is disagreement. The solicitor will write to the expert and seek explanation and perhaps a corrected version of the report may be issued. This is why it is strongly recommended that you prepare a document before visiting the expert and during the interview please give all the facts in the order they are put across to you; the reason being the expert is asked to follow a defined format for the report to maintain uniformity of the system.
Remember the expert may recommend investigations and management. Usually the expert is not involved in actual treatment, unless he or she is the person who first attended to you and you are the patient under their care, for example your GP or the hospital consultant you initially attended for the said injury.
Having agreed with the report, read through carefully the Opinion & Prognosis section. The medico legal expert may recommend opinions from appropriate specialists. He is not obliged to arrange these tests or the referral appointments. Your solicitor or GP will help you in this regard.
In more complex claims, there may be more than one report and assessment. This situation varies from claim to claim. However, the basic foundation is the same.
All the final results are forwarded to the expert. On reviewing the results and reports from other specialists, the expert will communicate with your solicitor, discussing the final opinion and prognosis relating to the injury. It will detail any remaining disability or your ability to return to your work and what effect, if any, the injury has on your lifestyle, including your work and leisure activities.
This will probably be the final report in most of the cases. Having read all the facts your solicitor will arrange a meeting with the barrister acting on your behalf, and the defendants, with a view to concluding your claim.
Remember the medico legal expert cannot advocate. He cannot judge your claim. His function is to assist the court in assessing the extent of your injuries, a guideline of management and a forecast of the interim and long-term future prognosis of recovery from the injury.
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