Closed consultation

Revisions to the Medical Reporting Process for Road Traffic Accident Claims

Published 18 July 2023

Foreword

The Government remains committed to engaging with interested stakeholders from across all sides of the PI and medico-legal sectors and the publication of this consultation document is an important part of that engagement.

The medico-legal sector has continued to change and evolve over the years since 2014 in response to Government reform. However, since the introduction of the most recent measures to tackle the number and cost of whiplash claims in May 2021, there has been both a reduction in claims volumes and changes in claimant behaviour.

These changes are attributable not just to the whiplash reforms but also to the societal impacts of the Covid-19 pandemic and associated lockdown measures. Those operating in the sector have adapted to these pressures and altered their working practices over the last two years. This has resulted in better customer service operations and greater use of technological solutions to reduce the operational costs associated with the processing of medical reports.

The industry continues to provide services to both represented and unrepresented claimants seeking good quality medical reports in support of their claims through the Official Injury Claim (OIC) service. However, the Government understands that there have been increasing financial pressures on the sector over the last two years following the implementation of the whiplash reforms and the more recent wider economic conditions.

Therefore, we have decided that it is an appropriate time to consult on a number of medico-legal reporting issues related to the MedCo process, fixed cost medical reports and the implementation of the OIC service. This consultation seeks input, submissions and evidence on these important issues from all stakeholders with an interest in the provision of good quality independent medical reports.

Lord Christopher Bellamy KC

Parliamentary Under Secretary of State for Justice

Executive Summary

The Government first implemented fixed recoverable costs for medical reporting in 2014 and this was followed by the establishment of the MedCo process in 2015. In late 2019 MoJ confirmed changes to the MedCo process^{[footnote 1]} to ensure that all those who chose to provide medical reports to both represented and unrepresented claimants following the implementation of the whiplash reforms were competent to do so.

MedCo’s remit was expanded to encompass the provision of all medical reports for RTA-related personal injury claims up to a value of £5,000. New qualifying criteria and rules for Medical Reporting Organisations (MROs) and Direct Medical Experts (DMEs) wishing to provide medical reports to unrepresented claimants were also introduced. These changes were designed to ensure that medical report providers were efficient and well-run, with effective and transparent consumer protection policies and procedures.

Further changes restricted the provision of medical reports for unrepresented claimants to physiotherapists, GPs and Accident and Emergency consultants only. Additionally, the fixed cost medical report (FCMR) regime was extended to cover all medical reports for RTA-related personal injury claims up to a value of £5,000 (although no changes were made to the level of the available FCMRs).

Finally, a new MedCo ‘offer’ was developed and implemented for unrepresented claimants seeking a medical report via the new OIC service. These changes to MedCo’s scope, along with the new offer, were important in ensuring that the provision of medical reports following the implementation of the whiplash reforms continued to be dealt with in an efficient and effective manner.

In addition, on 31 May 2021, as part of its commitment to tackling the continuing high number and cost of whiplash claims, the Government also implemented the measures in Part 1 of the Civil Liability Act 2018^{[footnote 2]}. These important reforms introduced a fixed tariff of compensation for whiplash injuries and a ban on the use of pre-medical offers to settle such claims. An additional measure to increase the small claims track limit for road traffic accident (‘RTA’) related personal injury (‘PI’) from £1,000 to £5,000 was also taken forward at this time.

The Government also worked with industry to develop the OIC service which provides a platform which enables claimants to take forward their claims following the implementation of the Government’s whiplash reforms. The OIC is operated on behalf of the Ministry of Justice by the Motor Insurers’ Bureau (MIB) and enables claimants to start, progress and settle their own claim with or without professional representation. OIC is a free service which is also open to represented claimants whose claims are progressed on OIC by professional users.

This consultation seeks input from interested stakeholders on several areas related to the implementation of these various reforms and on the impacts of other wider societal and economic factors affecting the medico-legal sector.

Ministry of Justice

18 July 2023

Introduction

We are seeking stakeholder input on several issues of relevance to those who commission and/or provide medical reports used in support of RTA related PI claims valued up to £5,000.

In support of this, MoJ has considered feedback and data from a range of stakeholders, including MedCo and OIC, and have reviewed several different aspects of the existing medico-legal reporting process. This consultation document sets out these areas and proposes updates and revisions to established parts of the system as well as seeking input on solutions to issues identified since implementation of the reforms. Specifically, we are seeking views on:

• revised MRO qualifying criteria and DME rules;
• the MedCo ‘offer’ for both represented and unrepresented claimants;
• use of administration agencies by DMEs and how this can be effectively overseen;
• the level of the fixed cost medical report regime; and
• changes to improve the quality of medical reports and how medical reports for represented claimants are sourced.

A list of key consultees is attached at Annex A. This list is not exhaustive, and responses are welcome from all stakeholders with an interest in the development of good quality independent medical evidence. Revised MedCo MRO qualifying criteria tables are attached at Annex B and updated rules for DMEs are attached at Annex C of this document.

This consultation will close at midnight on 10 October 2023 and a response and next steps document will be published in January 2024.

Changes to MedCo Qualifying Criteria

1. The Government remains committed to the provision of good quality independent medical evidence for road traffic accident (RTA) related personal injury claims valued up to £5,000. Ensuring that those who provide medical reports to both represented and unrepresented claimants are competent, efficient and have well run, transparent consumer protection procedures in place is key to this commitment.

2. The MedCo Qualifying Criteria (QC), therefore, remain as important as ever as they ensure that medical reporting organisations (MROs) already registered, as well as those wishing to register, with MedCo are properly constituted businesses. This means that MROs have satisfactory systems and sufficient resources in place to operate to the minimum required standards for both business-to-business operations and, where applicable, as an MRO to unrepresented claimants.

3. These QC were last reviewed and updated in 2020 prior to the implementation of the whiplash reform programme in May 2021. The changes were to review and refresh the drafting of the existing QC and to add a new set related to providing medical reports to unrepresented claimants. Now that these reforms have had time to bed in, and data on monthly claims volumes has settled, it is helpful to review the QC again to ensure they remain up to date for the post-reform landscape.

4. MoJ has considered the current QC and have recommended revisions all three sets i.e., for both tier 1 and tier 2 MROs, the specific QC tier 1 MROs^{[footnote 3]} and the additional QC for all MROs undertaking unrepresented claimant work. Most of these changes are minor amendments to update links to guidance and to tighten the drafting of the existing QC and in general are not materially different to the previous version.

5. However, the tier 1 QC does contain requirements which directly relate to claims volumes and the numbers of experts required to cope with such. These are areas which have been impacted by Covid-19 and the implementation of the whiplash reforms, and so it is sensible to review these. Between April 2019 to March 2020 (pre pandemic) the average number of claims registered on Claims Portal was around 56,000^{[footnote 4]}; this compares to the current combined level of Claims Portal and OIC claims of around 32,000 per month.

6. MoJ has considered this point and propose that this reduction in claims volumes is reflected in the appropriate QC where it is relevant. Therefore, in reviewing the QC we have proposed some more significant updates to QC 2.2 in Table 2 in relation to the requirements to be a tier 1 MRO. These QC relate to the capacity to deal with high case volumes and to the number of active medical experts on an MROs panel.

7. Currently, the QC require tier 1 MROs to demonstrate the capacity to process 40,000 medical reports PA and to have 225 active experts on their panel. Having looked at the claims volume data and completed some additional scenario modelling MoJ is of the view that this figure should be reduced. However, these QCs are designed to be challenging and any revised figure needs to be robust enough to ensure market integrity and protect against distortion in the tiers.

8. Therefore, taking all relevant factors into account, MoJ proposes that the volume of reports QC be revised down from 40,000 to 28,000 and that the number of active experts QC be revised down from 225 to 175.

9. Like the claims volume and number of experts issues (paragraphs 7-8 above), there is an argument that the requirement to have contracted medical experts in 80% of postcodes (QC 2.2) should also be amended downwards. However, postcode data is used to denote national or regional coverage, therefore MoJ is not convinced it is appropriate to also amend this, but we are interested in feedback on this point.

10. We are interested in the views on these specific proposals and respondents should therefore review the revised QC set out in Tables 1, 2 and 3, attached at Annex B of this document. All changes made to these QC have been highlighted in the annex for ease of reference. However, the key changes are summarised below:

Summary of changes to Qualifying Criteria Table 1 (All MROs): QC 1.1, 1.3, 1.6, 1.7, 1.8, 1.9, 1.14, 1.15 and 1.16 - Drafting changes have been made to update the links to guidance provided and to tighten up drafting. For example, the wording relating to the use of ‘shell companies’ and the definition of an MRO in QC 1.1 has been clarified.

Summary of changes to Qualifying Criteria Table 2 (Tier 1 MROs): QC 2.2 - Drafting change to tighten up drafting and proposed change to the required capacity to process 40,000 medical reports per annum to 28,000. Proposed change to the number of contracted, active medical report providers from 225 to 175. QC 2.7: Drafting change to update links to guidance.

Summary of changes to Qualifying Criteria Table 3 (Unrepresented Claimant Work): QC 3.2, 3.3, 3.4, 3.5, 3.7 and 3.8 - Drafting changes have been made to update the links to guidance provided and to tighten up drafting. For example, the wording on widening the scope of MedCo in QC 3.4.1 has been updated to reflect the implementation of the reforms.

Question 1

The wording and/or the rationale of QCs 1.1, 1.3, 1.6, 1.7, 1.8, 1.9, 1.14, 1.15 and 1.16 have been revised. Do you agree with the proposed changes, and do you have any suggestions to further update and improve these QCs?

Please explain your reasoning.

Question 2

We have considered the required capacity included in QC2.2 for MROs seeking to apply for high volume national status and propose it is reduced from 40,000 medical reports per annum to 28,000. Do you agree, and if not, at what alternative level do think this should be set?

Please explain your reasoning.

Question 3

We have considered the number of active medical experts required by MROs seeking to apply for high volume national status which is included in QC2.2 and propose it is reduced from 225 to 175. Do you agree, and if not at what level do think this should be set?

Please explain your reasoning.

Question 4

MoJ believe the requirement for a tier 1 MRO to have an active expert in 80% of regions should remain unchanged. Do you agree?

Please explain your reasoning.

Question 5

The wording and/or the rationale of QCs 3.2, 3.3, 3.4, 3.5, 3.7 and 3.8 have been revised. Do you agree with the highlighted changes, and do you have any suggestions to further update and improve these QCs?

Please explain your reasoning.

Answer these questions online

Amended DME Rules

11. The QC were developed to ensure that MROs are well run organisations with the resources, processes and customer service capability to provide medical reports. However, MROs are not they only source of medical report provider and claimants may also source reports from Direct Medical Experts (DMEs).

12. In line with the new criteria for MROs (detailed at paragraph 7 above), we believe it is important that the MedCo rules for DMEs undertaking work for unrepresented claimants are also revised to ensure consistency with the standards applied to MROs working for them. MoJ have, therefore, also reviewed and enhanced these rules to reflect, where appropriate, the revised MRO Table 3 QC. These rules will ensure that DMEs continue to operate to a good standard consistent with the requirements which apply to MROs.

13. Most of these changes update links to guidance and to tighten and enhance the drafting of the existing rules. The revised rules for DMEs are attached at Annex C to this document. All changes made to the rules have been highlighted in the annex for ease of reference. However, the key changes are summarised below:

Summary of changes to DME Rules: Unrepresented Claimant Work:

Rules 1, 2, 3, 4, 5 and 6:

Drafting changes have been made to all rules to tighten up drafting of the rules and include additional rationale. The links provided to helpful guidance have been checked and updated where necessary and additional links to useful information have also been added. For example, a link to applying for basic DBS certification has been added to help DMEs who need to undertake this process.

Question 6

Do you agree with the proposed changes and/or additions to DME rules 1 to 6, and/or do you have any suggestions to further update and improve these rules?

Please explain your reasoning.

Answer this question online

Review of the MedCo ‘Offer’

14. The term ‘offer’ is used to describe the number and mix of MROs or DMEs presented to authorised users of the MedCo service when searching for a medical report provider. The number of MROs or DMEs presented for selection via the ‘offer’ is set by the Government. There are currently two ‘offers’ in operation, one for represented claimants and one for unrepresented claimants.

15. The current ‘offer’ for represented claimants was revised on 6 April 2020 and is set at two x tier 1 and five x tier 2 MROs or seven DMEs. A new offer for unrepresented claimants was introduced on 31 May 2021 as part of the whiplash reform programme implementation and is set at two x tier 1 and two x tier 2 MROs or five DMEs.

16. It has been three years since the represented ‘offer’ was last reviewed and approaching two years since the ‘offer’ for unrepresented claimants was introduced. Therefore, MoJ has decided it is now an appropriate time to review both ‘offers’ to take account of the impact on the market of the implementation of the whiplash reforms on 31 May 2021.

17. In assessing the ‘offer’ there are two overriding considerations to keep in mind. The Government’s overarching policy intention to enhance and maintain independence in the provision of medical reports must be balanced against the competition requirements for a functional market.

18. Since the represented claims ‘offer’ was last reviewed in 2020, when there were 11 tier 1 and 40 tier 2 MROs, there has been a decline in the number of MROs registered with MedCo. This means that as of 31 March 2023, there were 10 tier 1 and 28 tier 2 MROs authorised and operational on MedCo. Of these, 8 tier 1 and 18 tier 2 MROs have also opted to provide medical reports to unrepresented claimants making claims via OIC.

19. In reviewing the ‘offers’ MoJ has considered data in several areas including, but not limited to, the number of MROs in each tier, their geographical coverage and the impact this has on presentation and selection over a period of time. Data on the geographical spread of the registered MROs was compiled using declared postcode data. Considering current tier volumes and whether they operate nationally or regionally, MoJ analysts have considered the available data and have calculated appropriate alternative offer ratios.

20. Having considered all the relevant data, including the reduction in the number of MROs currently operational in the market, MoJ proposes that the ‘offer’ for represented claimants should be amended as shown below. Revising the ‘offer’ as proposed ensures that there continues to be fair competition both within and between each MRO tier and that a sufficient choice of DMEs is available for selection by claimant representatives.

Proposed ‘offer’ for represented claimants:

• two tier 1 MROs; and

• six tier 2 MROs; and

• seven DMEs.

21. In addition, having reviewed the available data, MoJ has concluded that there have been no material changes to the market in this area and proposes that no changes are made to the current MedCo offer for unrepresented claimants and it should remain as shown below.

‘Offer’ for unrepresented claimants:

-two tier 1 MROs; and

• two tier 2 MROs; and

• five DMEs.

Question 7

Do you agree with the proposed change to the MedCo offer for represented claimants as set out at paragraph 20?

If not, please explain what you believe the offer should be set as along with your reasoning for this and any supporting evidence.

Question 8

Do you agree with the proposal not to change the MedCo offer for unrepresented claimants as set out at paragraph 21?

If not, please explain what you believe the offer should be set as along with your reasoning for this and any supporting evidence.

Answer these questions online

Use of Administration Agencies by Direct Medical Experts

22. MedCo became aware of the use of Administration Agencies (AAs) by DMEs in late 2019. Since then, the number of DMEs utilising the services of AAs has increased, particularly following the implementation of the whiplash reforms on 31 May 2021.

23. These changes required DMEs to adhere to new rules^{[footnote 5]} on back-office support when providing medical reports to unrepresented claimants. To meet these new requirements, which are tested through an audit interview with MedCo, some DMEs decided to engage the services of an AA.

24. AAs are being used to support DMEs in producing both MedCo and non-MedCo related medical reports, and they are likely to have been operating prior to the launch of MedCo in 2015. The services provided by AAs can vary considerably with many providing clients with help on straightforward secretarial tasks. However, others may be effectively operating as unauthorised MROs and there is no specific framework in place which can be used to audit the services and assess the quality, robustness or appropriateness of the business models being utilised.

25. MedCo have subsequently analysed the data available to them to help identify AAs operating in the sector and several types have been identified. These AAs appear to be offering different types of service including organisations which:

• deal with all types of general administrative and/or secretarial work across various sectors (not just medical reporting);
• were formally registered MROs – some of which have been suspended/terminated from MedCo after failing audits;
• initially planned to register as MRO but decided to scale back the services they provide to reduce costs; and
• provide bespoke software and IT support.

26. MedCo has undertaken work to understand the operation of AAs in the medico-legal market, identifying several practices which are of particular concern. These include:

• payments being made to the AA rather than directly to the DME;
• AAs performing specified MRO activities such as validation, quality assurance and direct contact/liaison with claimants and/or solicitors;
• Medical report instructions being received centrally by an AA and then being allocated to DMEs;
• AAs conducting financial transactions using factoring arrangements; and
• AAs becoming directly involved in the writing of medical reports.

27. Taken together, these concerns can lead to the conclusion that some AAs may in effect be operating as unauthorised MROs. If they are in fact operating in this way, logic also dictates that they should be held to the same standards and criteria as existing MROs registered on the MedCo system.

28. MedCo’s inquiries into this area have highlighted individuals offering administration services working with small groups of experts. However, without an agreement in place with, or audit by, MedCo, ensuring that such individuals and/or AAs are operating in accordance with the guidelines is difficult. Confirming that the AA/DME arrangement is properly controlled by the DME can also be challenging.

29. Additional data could be obtained by auditing all registered DMEs to identify those using AAs and then seeking information from them on how they operate. Consideration would, though need to be given to the MedCo resources required to implement this solution and an audit fee would also be payable by those audited.

30. Despite this, MedCo have taken several steps to tackle this issue, including the production of best practice guidance on interacting with AAs. They have also identified DMEs who utilise AAs and sought explanations of the arrangements in place, along with copies of any formal agreements made. This has enabled MedCo to undertake fact finding visits and make a reasoned assessment of how some of the AAs involved are operating in practice and to identify any areas of concern.

31. MedCo have noted an increase in the use of AAs since the implementation of the whiplash reforms on 31 May 2021, particularly by DMEs registering to provide medical reports to unrepresented claimants. With this uptick in use by DMEs we agree that the area of third-party administrative support requires investigation.

32. Given the concerns set out above, MoJ would like to seek evidence and input from stakeholders in relation to the use of AAs. This includes on the following options to tackle the highlighted concerns in this area. We would be interested in stakeholder views on these options, which are:

• Option 1 - auditing by MedCo of all registered DMEs to identify those using AAs and how they operate, before action to tackle any concerns is taken;
• Option 2 - AAs entering voluntary agreements with MedCo to allow fact finding visits and audit interviews (subject to the payment of an audit fee);
• Option 3 - require all AAs to register on MedCo and be audited against a new set of QC for indirect service providers (subject to payment of appropriate membership/audit fees); and
• Option 4 – do nothing at the current time and continue to monitor to assess whether there is an impact on the quality of service provided to claimants from those DMEs choosing to work with an AA.

33. As noted above, option 1 (auditing all active DMEs) would generate useful information on the administration arrangements of DMEs and the operating practices of AAs. However, this would likely be resource intensive for both MedCo and for the DMEs to carry out. It would also take a lengthy period to schedule and complete audit interviews for the circa 450 operational DMEs, meaning any action required to address the concerns identified could be significantly delayed.

34. Option 2 is reliant on good will and co-operation from AAs. This would likely result in good organisations co-operating and adjusting their business models to fit with MedCo requirements. However, AAs wanting to exploit the process would likely not engage with a voluntary scheme and so overall this option would be of limited help.

35. Option 3 provides the most certainty that active AAs would operate correctly to a good standard. However, it would be imperative to get the QC correct and set the membership fee at an appropriate level. The potential consequences of changes to the market and/or behaviours of MROs following any change would also need to be considered. Feedback from respondents on such consequences would be welcome.

36. There is also option 4 - do nothing at this stage and continue to monitor the impact AAs are having on the market. This would require MedCo to continue to investigate and interview DMEs utilising the services of an AA, and to monitor the quality of reports provided to ensure they remain at a satisfactory level. However, doing nothing would also preserve the status quo and could leave some DMEs at a disadvantage as compared to those using AAs.

37. If either of options 2 or 3 are taken forward, amendments to the DME rules and new audit/qualifying criteria will be required to implement them. Restricting DMEs to only contracting with MedCo approved AAs would also be a necessary requirement. In addition, a new set of QC would also be needed to audit AAs against.

38. We would suggest that these new QC ought to align closely with the current Table 1 requirements for all MROs. There will need to be some differences, but these QC cover the basic principles of operating a sound business that are necessary for ensuring AAs are well run with good standards of service.

39. In terms of membership and/or audit fees to be paid if options 1, 2 or 3 are taken forward, this would not be an area for Government to comment and is for MedCo to consider. It would though, be helpful if respondents would provide input on what they think these fees should be. Any responses received in this area will be passed on to MedCo for consideration in the event options 1,2 or 3 are progressed.

40. In terms of answering the questions below, we would like to confirm that by AA we are referring to organisations who are contracted by DMEs to provide administrative services in relation to the provision of MedCo medical reports.

Question 9

Have you in the past, or are you currently, using the services of an administration agency? If so, what specific administration services do they provide you with?

Please provide details of any services provided.

Question 10

Do you agree that administration agencies should be assessed/audited by MedCo to ensure they are operating to agreed common standards?

Please explain your reasoning.

Question 11

Do you think administration agencies providing services to DMEs should undertake audit interviews with MedCo on a voluntary basis?

Please explain your reasoning.

Question 12

Do you think that administration agencies should be audited against specific qualifying criteria, similar to that used to audit MROs on MedCo?

Please explain your reasoning.

Question 13

Do you agree that DMEs should only be allowed to contract with administration agencies who are authorised by MedCo?

Please explain your reasoning.

Question 14

Do you have any other comments or suggestions in relation to the use of administration agencies by DMEs?

Please explain your reasoning.

Question 15

Do you have any comments or suggestions on the level of MedCo audit or membership fees administration agencies should pay?

Please explain your reasoning.

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Review of Fixed Cost Medical Reports

41. In 2014, the Government introduced a fixed cost medical reports (FCMRs) for initial medical reports used in support of soft tissue injury claims, to tackle the rising cost of medical evidence and to support the MedCo reforms. These changes were made through amendments of the Civil Procedure Rules (CPR), specifically to Part 45^{[footnote 6]}.

42. The following were introduced in relation recoverable disbursements:

Initial report from a MedCo accredited medical expert: £180.

Additional reports (where justified) from:

(i) Consultant Orthopaedic Surgeon (inclusive of a review of medical records where applicable): £420;

(ii) Consultant in Accident and Emergency (A&E) Medicine: £360;

(iii) General Practitioner (GP) registered with the General Medical Council: £180; or

(iv) Physiotherapist registered with the Health & Care Professions Council: £180;

(c) obtaining medical records: no more than £30 plus costs from the records holder limited to £80 in total for each set of records required. Where records are required from more than one holder the FRC applies to each set of records required;

(d) addendum report on medical records (except by Consultant Orthopaedic Surgeon): £50; and

(e) answer to questions under Part 35: £80.

Where appropriate, VAT may be recovered in addition to the cost of obtaining a fixed cost medical report or medical records.

43. The £180 FCMR for initial reports is intended to cover both payment to the medical expert and the cost of organising the medical examination, and all current MedCo medical reports are covered by this regime. As noted above, there are some additional costs included in the CPR which apply to secondary specialist reports by GPs, physiotherapists, A&E consultants and orthopaedic surgeons but there are no regimes in place at present for other experts, such as dentists and psychologists.

44. When consulting on and setting this figure in 2014, the Government considered a range of factors such as the level of work required to arrange and conduct an examination and to write and return a report. Also considered were industry agreed guidelines published by the Association of Medical Reporting Organisations (AMRO), which provided a rate of £250 for initial soft tissue injury reports.

45. In addition, the Government considered the impact on the costs of medical reports from the introduction of the ban on referral fees through section 56 of the Legal Aid, Sentencing and Punishment of Offenders Act 2013^{[footnote 7]}. Following the introduction of this Act a noticeable increase in the cost of initial medical reports was identified in MROs not signed up to the AMRO agreement.

46. On 31 May 2021 the MedCo regime was extended from just soft-tissue injury claims to cover all road traffic accident-related personal injury medical reports for claims valued up to £5,000. This extension ensured clarity and certainty as to cost, as well as a consistent approach for both compensators and claimants regarding all claims affected by the implementation of the whiplash reforms.

47. However, given this extension and the fact that eight years have passed since the introduction of FCMRs, it is now appropriate to review the level they are currently set at. As noted at paragraph 44 above several factors were considered when setting the levels currently in use and these remain valid today.

48. The continuing functioning of around 40 MROs in this market is indicative that the £180 FCMR for an initial report does still cover the level of work required. This includes arranging/conducting an examination and writing and returning a report to the claimant and/or their representatives. However, it is likely that reduced volumes of claims and outside factors such as inflation and its subsequent impact on the cost of living means that the margins for MROs and DMEs have been reduced.

49. MoJ analysts have reviewed the different costs available to assess the potential inflationary impacts since they were first introduced in July 2014 using the Services Producer Price Index (SPPI)^{[footnote 8]}. This is consistent with the approach taken by MoJ in relation to the recent wider review of fixed recoverable costs in the Fast Track.

50. The following provides an overview of a potential new set of FCMRs based on this analysis and revised by 1.183% using the SPPI and rounded to the two nearest significant figures:

Initial report from a MedCo accredited medical expert: £210.

Additional reports (where justified) from:

(i) Consultant Orthopaedic Surgeon (inclusive of a review of medical records where applicable): £500;

(ii) Consultant in Accident and Emergency (A&E) Medicine: £430;

(iii) General Practitioner (GP) registered with the General Medical Council: £210; or

(iv) Physiotherapist registered with the Health & Care Professions Council: £210;

(c) obtaining medical records: no more than £35 plus costs from the records holder limited to £95 in total for each set of records required. Where records are required from more than one holder the FRC applies to each set of records required;

(d) addendum report on medical records (except by Consultant Orthopaedic Surgeon): £59; and

(e) answer to questions under Part 35: £95.

Where appropriate, VAT may be recovered in addition to the cost of obtaining a fixed cost medical report or medical records.

51. The main argument against extending the current FCMR regime is that it could have a negative impact through increased costs to compensators who ultimately fund the reports. Therefore, before a decision is taken on whether to implement higher FCMRs it is also necessary to take account of the overall financial impact of such an increase on the sector. We would welcome input on this point.

52. Whilst we are seeking views from stakeholders on reviewing the existing FCMRs, it should be noted that there is no intention at this stage to amend the regime for additional specialist reports not already included in CPR Part 45.19.

Question 16

Do you agree that the fixed cost medical reports regime relating to the RTA and Small Claims protocols as described in Part 45.19 of the CPR should be increased in line with the SPPI inflationary measure?

Please explain your reasoning for or against this proposal along with any evidence in support of your position.

Question 17

What is your assessment of the financial impact on potential savings from the Government’s whiplash reforms from increasing the applicable FCMRs in line with the SPPI inflationary measure?

Please explain your reasoning along with any supporting evidence.

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Official Injury Claim: medical report process

53. Medical reports are an important part of the claims procedure and support the negotiated settlement process by explaining the type and extent of injuries suffered. However, they must also provide an independent opinion on a claimant’s injuries of sufficient quality to assist the court if the parties fail to settle at the pre-action stage.

54. The implementation of the whiplash reforms changed the process for bringing and settling an RTA-related personal injury claim valued up to £5,000. The reforms and the introduction of the OIC process enabled unrepresented claimants to take control of their claim and seek their own medical report at the appropriate stage.

55. Now that these changes have been in force for two years, we believe it is right to look at how this innovative new system has worked in practice. This section is therefore a call for evidence on issues related to the new medical reporting process.

56. In doing this, MoJ has considered feedback from range of sources including industry stakeholders - such as those representative groups on the MoJ OIC Advisory Group^{[footnote 9]} - along with data from OIC and MedCo. This has led to the identification of several issues relating to the timing of instructions being sent, the content of reports produced and a gap in the data available on represented claims.

Data available on the OIC Medical reporting process

57. For both unrepresented and represented claimants there is data from MedCo which can be used to map their user journeys. This data shows the time taken between the accident, a liability decision being received, a medical report provider being selected, and an examination being scheduled/completed (Table 1 below).

Table 1: MedCo Data (Feb 22 – Feb 23)

	Days between accident and search	Days between search and selection	Days between selection and examination	Days between examination and report date	Total number of days taken
Unrepresented claims average:	49	5	19	3	76
Represented claims average:	39	0	36	3	78

58. The data shows that represented claimants select an expert more quickly than unrepresented claimants but take slightly longer overall to reach the completed report stage. This faster selection of a provider is likely due to claimant representatives’ greater familiarity with the medical reporting process and with the report providers available through MedCo.

Medical Report Upload Times

59. However, the situation is different for the second stage of the process covering the time taken between the initial report being completed and the report then being checked and uploaded onto OIC. For unrepresented claimants the time taken to upload a report following an examination and the time taken to check for errors and accept and disclose the report can be monitored by combining MedCo and OIC data.

Table 2: OIC Data

	Selection date to upload date	Upload date to check medical date	Check medical date to first offer
Unrepresented claims average:	21 days	18 days	19 days

60. As table 2 above shows, for unrepresented claimants we can see when the medical report provider completes and uploads the report into OIC for factual checks. Once this is complete, we can also monitor the time taken to disclose the report to the at-fault compensator and for an initial settlement offer to be received.

61. For represented claimants, however, no specific data is available from OIC on the stages between the liability decision being made and communicated to the claimant representative and when the report is uploaded onto OIC and subsequently disclosed. The available high-level data shows that the time taken between these stages is longer for represented claims, but no detailed information is available to help us understand why this is the case.

62. This difference in the relative availability of data on represented and unrepresented claimants’ medical journeys relates to the different way represented claimants source reports. Represented claims follow a separate process for checking, uploading to OIC and disclosing the medical report.

63. Unrepresented claimants use the OIC system to contact MedCo and source a provider. The selected expert or MRO will then ensure the completed report is checked for factual errors and will upload it onto OIC which allows the claim to continue. For represented claimants their professional representatives are responsible for contacting MedCo, sourcing a provider, and then checking and uploading the report back onto OIC.

64. The decision to continue with the pre-reform process for represented claimants was taken following discussions with the Civil Procedure Rule Committee sub-group supporting this work, as it was felt to be the logical option at the time the rules and new PAP were being developed. However, we now consider that it is time to look at this again.

Data Gap

65. The links between MedCo and OIC allow for unrepresented claims to be monitored from start to finish. Data is obtainable at each stage allowing checks to ensure the process is working properly, and that claims are not being held up unnecessarily. This joined up process also enables areas for improvement to be identified and actioned efficiently by both MedCo and OIC.

66. However, as the medical process for represented claims is effectively dealt with outside of the OIC process, tracking the data in the same way is not currently possible. This means that we’re unable to fully monitor whether different claimants are having different experiences. We would welcome feedback from respondents in this area to identify specific issues to be tackled and/or improved.

67. Plugging data gaps will provide greater insight into how the process works in practice and in our view enable required changes to be made to improve outcomes for all claimants. A more efficient process will support access to justice for claimants and will support our commitment to improving claims journey for all who undertake it. In addition, further information and insight will help inform future evaluation exercises of the impacts of the reforms on unrepresented claimants and professional users.

Information to be included in Medical Reports

68. Stakeholder feedback has also been provided to MoJ and MedCo which highlights other areas where action may be required. These include medical reports where there has been no reference to the defendant’s version of events where, in line with Part 7.9 of the RTA Small Claims Protocol^{[footnote 10]}, that should have been considered by the medical expert.

69. In addition, the level of information being provided on the cause and the impact on amenity of specific non-whiplash injuries could also be improved. In particular, more information could be provided as to whether ancillary injuries are separate from, or related to, a whiplash injury and on the degree to which both the whiplash and/or any non-whiplash injuries impact the amenity of the claimant.

70. A lack of a clear opinion in the medical report on required issues, such as the defendant’s version of events and/or causation and amenity, can delay settlement discussions and adversely impact on the claimant. MedCo has already issued a reminder to experts about this requirement^{[footnote 11]}, but we are interested in views on what impact this has had and whether further action should be taken to help facilitate improvements in this area.

71. Several recent court judgments have referenced similar issues and reinforce the need for additional information to aid the court in these areas, including in the Court of Appeal (Rabot v Hassam and Briggs v Laditan^{[footnote 12]}). Amendments to reflect the CoA’s judgment are being made to the OIC guidance for claimants on dealing with overlapping injuries and to clarify the standard instructions to medical experts generated by the system.

72. Such clarity supports the settlement process and would also greatly assist in those cases where the parties fail to agree and must seek resolution via the courts.

Liability decisions and the timing of instructions

73. Looking at combined data from OIC and MedCo suggests that these issues may be related to how and when instructions are being sent to medical report providers. The data shows that claims made by unrepresented claimants are, in general, proceeding normally with no significant hold ups in the process.

74. However, there are indications that some claimant representatives are issuing instructions to medical report providers prior to the receipt of liability/causation decisions from the at-fault compensator. This can be demonstrated by looking at data. For example, MedCo data shows that the average time between accident and the search for a medical report provider is similar for represented (39 days) and unrepresented claimants (49 days) but other data points provide a different view.

75. The mode^{[footnote 13]} time taken between the accident and search for unrepresented claimants is 14 days, but for represented claims it is only 1 day (table 3). If you then look at the data from OIC on liability admissions, we can see that the average time taken for a liability decision to be made for unrepresented claimants is 13 days and the average time for represented claims is 18 days (see table 4 below).

Table 3: MedCo Data

	Days between accident and search	Days between search and selection
Unrepresented claims mode:	14	0
Represented claims mode:	1	0

Table 4: OIC Data

	Days to decide liability
Unrepresented claims average:	13
Represented claims average:	18

76. These two data points together suggest that requests for a medical report are being made prior to the receipt of a liability decision from the compensator. If this is the case, this has the potential to impact on the quality of the evidence produced, the time taken to finalise the evidence and the final outcome for the claimant. Where liability is denied (in full or part) or causation challenged, the need to then amend the instructions to the report provider and provide the defendant’s version of events, or for the compensator to challenge a gap in the medical report at a later point, add times to the process for represented claimants.

77. It is probable that this is being done for multiple claims at once for efficiency reasons, but not waiting for this decision is likely to be a key cause of one or more of the issues outlined above. Ensuring that instructions issued in relation to represented claims are issued at the appropriate time, when the relevant information on causation and liability can be included, would likely result in more accurate medical evidence and therefore better outcomes for the claimant.

Aligning the medical report process for unrepresented and represented claimants

78. The Government wishes to explore aligning the processes for obtaining medical reports so that all claims follow the current unrepresented claimant route. This would mean that represented claimants would also obtain their medical reports via a link embedded in the OIC system with the report provider responsible for the fact checking and uploading of the completed report.

79. Aligning the process so that both represented and unrepresented claimants follow the same route would allow for more effective monitoring. It would also better support the process for technical improvements to be rolled out for both claimant types at the same time.

80. As a result, claimant representatives would need to use OIC to source medical report providers rather than use MedCo directly. It would also require the report provider to upload the report onto OIC once they have completed it so that it can be made available for fact checking and/or disclosure. This would smooth out the current two-tier approach and would allow for more detailed analysis of the medical reporting stages for both represented and unrepresented claimants.

81. We would be interested in stakeholder feedback on this proposal and on whether there are other alternative solutions to improving data and analysis in this area.

82. Options to improve performance in this area could include:

• Option 1 - ensuring better knowledge by professional user claims handlers in relation to when instructions for medical reports should be issued;
• Option 2 - improved training and guidance for experts on covering causation, the defendant’s version of events and amenity impacts arising from non-whiplash injuries;
• Option 3 - amending the process for represented claims to ensure that a claim cannot proceed to the medical reporting stage until the liability decision has been made and communicated to claimants and their representatives (this is already the case for claims brought without legal representation);
• Option 4 – aligning the medical reporting process to ensure that both unrepresented and represented claimants followed the same user journey. This option builds on option three above, as unrepresented claimants already need to wait for a liability decision before moving to the medical reporting stage. It also ensures that data gaps are plugged and provides a consistent process for the provision of medical reports for both claimant types.

83. For options 1 and 2 the improvements suggested could be made via updates to MedCo Accreditation modules and through general awareness raising activities. MedCo and OIC have already co-operated to provide helpful information for claimants on arranging a medical examination which has been published via OIC’s new ‘Help Hub’^{[footnote 14]}. However, we would be interested in stakeholder views on whether additional guidance and/or training material would be helpful.

84. Regarding option 3 it should be noted that implementing such a change would not preclude claimants or their representatives from contacting an appropriate medical report provider to assess general availability. It would, however, restrict their ability to formally issue instructions to their selected provider before liability/causation decisions are made (which would still be required to be made within the deadline provided for in the Small Claims PAP).

85. Option 4 would mean that technical changes, to the OIC service and amendments to the Pre-action Protocol underpinning it, would be needed, but overall, we believe this would be beneficial to the process. It would allow for better quality data which in turn would help identify and facilitate improvements to the OIC claimant medical reporting journey. This data would also highlight where consideration of the rules underpinning OIC is required to ensure they work consistently and as intended.

Question 18

Do you agree that changes to the MedCo Accreditation process would help to highlight and embed the specific medico-legal requirements included in paragraphs 7.8 of the RTA PAP and 7.9 of the RTA Small Claims PAP?

Please explain your reasoning for or against this proposal along with any evidence in support of your position.

Question 19

Do you agree that changes to the MedCo Accreditation process or additional guidance and/or training material would be beneficial to medical experts?

If so, please explain what changes or types of material would be most useful along with reasoning to support your position.

Question 20

Do you agree that claimants and/or their representatives must wait for the at-fault compensator to confirm their decisions on liability/causation before instructing their selected expert?

Please explain your reasoning for or against this proposal along with any evidence in support of your position.

Question 21

Do you believe that changes to the RTA Small Claims Protocol would also be necessary to underpin either of the proposals provided in questions 19 and 20 above?

Please explain your reasoning for or against this proposal along with any evidence in support of your position.

Question 22

Do you agree that the process for sourcing medical reports for represented and unrepresented claimants should be the same?

Please explain your reasoning for or against this proposal along with any evidence in support of your position.

Question 23

Do you have any additional suggestions for how data collection on the medical reporting journey for represented and unrepresented claimants could be improved?

Answer these questions online

Equality issues

Background

86. The core issues for this consultation document relate to improvements to the medico-legal process for claimants affected by the implementation of the Government’s whiplash reform programme. Section 149 of the Equality Act 2010 (“the Act”) requires Ministers and the Department, when exercising their functions, to have ‘due regard’ to the need to:

• eliminate unlawful discrimination, harassment, victimisation and any other conduct prohibited by the Act;
• advance equality of opportunity between different groups (those who share a relevant protected characteristic and those who do not); and
• foster good relations between different groups (those who share a relevant protected characteristic and those who do not).

87. In carrying out this duty, Ministers and the Department must pay “due regard” to the nine “protected characteristics” set out in the Act, namely: race, sex, disability, sexual orientation, religion and belief, age, marriage and civil partnership, gender reassignment, pregnancy and maternity.

88. Through this consultation the Government has sought input from stakeholders on a range of proposals to improve the efficiency and quality of the medical reporting process and to increase the level of fixed recoverable costs available in respect of this work.

Direct Discrimination

89. The proposed improvements to the medical reporting process will apply to and benefit all claimants equally. Our assessment therefore is that the proposals are not directly discriminatory within the meaning of the Equality Act 2010.

Indirect Discrimination

90. No changes are being proposed which are likely to result in indirect discrimination within the meaning of the Act to affected stakeholders. Any changes made as a result of this consultation are unlikely to result in anyone with a protected characteristic being put at a particular disadvantage compared to someone who does not share the protected characteristic.

91. However, the Government does not collect comprehensive information about personal injury claimants in relation to protected characteristics. This means that making direct comparisons between different protected groups can be difficult which may affect our understanding of the potential equality impacts of the proposals made.

92. Claimants with particular religious or other beliefs or those who identify with specific gender identities or sexual orientations may feel restricted in the type of medical report provider they can choose from. However, but this risk may be mitigated by the proposed inflationary increase to the fixed recoverable costs, if such increase results in increased market choice.

Question 24

What impact would implementing the changes (where such are proposed) in this consultation document have on protected characteristic groups, as defined in the Equality Act 2010?

Please explain your reasoning.

Answer this question online

Part 5: Statistics

Current volume of RTA related PI claims

93. There were around 367,000 RTA related Personal Injury claims made in 2022/23 in England and Wales^{[footnote 15]}. Of these, around 312,000 were estimated to be whiplash related.

Current volume of claims supported by MedCo reports

94. There were around 268,000 searches on the MedCo system in 2022/23. 84% of these searches resulted in the selection of an MRO, around 14% in the selection of a DME and around 4% in no selection.

Volume of represented/unrepresented claimants

95. Around 544,000 claims have been made using the OIC service since its launch on 31 May 2021. Of which around 493,000 claims were represented, and around 51,000 claims were made by unrepresented claimants.

Current number and type of authorised users

96. There are currently around 1,300 operational Authorised Users on MedCo system.

Current numbers of MROs

97. There are currently 38 operational MROs registered with MedCo, of which 10 are tier 1 high volume national providers and 28 are lower volume tier two providers.

Current numbers of indirect and direct medical experts

98. There are currently 86 operational indirect medical experts and 414 operational direct medical experts.

Questionnaire

Question 1

The wording and/or the rationale of QCs 1.1, 1.3, 1.6, 1.7, 1.8, 1.9, 1.14, 1.15 and 1.16 have been revised. Do you agree with the proposed changes, and do you have any suggestions to further update and improve these QCs?

Please explain your reasoning.

Question 2

We have considered the required capacity included in QC2.2 for MROs seeking to apply for high volume national status and propose it is reduced from 40,000 medical reports per annum to 28,000. Do you agree, and if not, at what alternative level do think this should be set?

Please explain your reasoning.

Question 3

We have considered the number of active medical experts required by MROs seeking to apply for high volume national status which is included in QC2.2 and propose it is reduced from 225 to 175. Do you agree, and if not at what level do think this should be set?

Please explain your reasoning.

Question 4

MoJ believe the requirement for a tier 1 MRO to have an active expert in 80% of regions should remain unchanged. Do you agree?

Please explain your reasoning.

Question 5

The wording and/or the rationale of QCs 3.2, 3.3, 3.4, 3.5, 3.7 and 3.8 have been revised. Do you agree with the highlighted changes, and do you have any suggestions to further update and improve these QCs?

Please explain your reasoning.

Question 6

Do you agree with the proposed changes and/or additions to DME rules 1 to 6, and/or do you have any suggestions to further update and improve these rules?

Please explain your reasoning.

Question 7

Do you agree with the proposed change to the MedCo offer for represented claimants as set out at paragraph 20?

If not, please explain what you believe the offer should be set as along with your reasoning for this and any supporting evidence.

Question 8

Do you agree with the proposal not to change the MedCo offer for unrepresented claimants as set out at paragraph 21?

If not, please explain what you believe the offer should be set as along with your reasoning for this and any supporting evidence.

Question 9

Have you in the past, or are you currently, using the services of an administration agency? If so, what specific administration services do they provide you with?

Please provide details of any services provided.

Question 10

Do you agree that administration agencies should be assessed/audited by MedCo to ensure they are operating to agreed common standards?

Please explain your reasoning.

Question 11

Do you think administration agencies providing services to DMEs should undertake audit interviews with MedCo on a voluntary basis?

Please explain your reasoning.

Question 12

Do you think that administration agencies should be audited against specific qualifying criteria, similar to that used to audit MROs on MedCo?

Please explain your reasoning.

Question 13

Do you agree that DMEs should only be allowed to contract with administration agencies who are authorised by MedCo?

Please explain your reasoning.

Question 14

Do you have any other comments or suggestions in relation to the use of administration agencies by DMEs?

Please explain your reasoning.

Question 15

Do you have any comments or suggestions on the level of MedCo audit or membership fees administration agencies should pay?

Please explain your reasoning.

Question 16

Do you agree that the fixed cost medical reports regime relating to the RTA and Small Claims protocols as described in Part 45.19 of the CPR should be increased in line with the SPPI inflationary measure?

Please explain your reasoning for or against this proposal along with any evidence in support of your position.

Question 17

What is your assessment of the financial impact on potential savings from the Government’s whiplash reforms from increasing the applicable FCMRs in line with the SPPI inflationary measure?

Please explain your reasoning along with any supporting evidence.

Question 18

Do you agree that changes to the MedCo Accreditation process would help to highlight and embed the specific medico-legal requirements included in Parts 7.8 of the RTA PAP and 7.9 of the Small Claims PAP?

Please explain your reasoning for or against this proposal along with any evidence in support of your position.

Question 19

Do you agree that changes to the MedCo Accreditation process or additional guidance and/or training material would be beneficial to medical experts?

If so, please explain what changes or types of material would be most useful along with reasoning to support your position.

Question 20

Do you agree that claimants and/or their representatives must wait for the at-fault compensator to confirm their decisions on liability/causation before instructing their selected expert?

Please explain your reasoning for or against this proposal along with any evidence in support of your position.

Question 21

Do you believe that changes to the RTA Small Claims Protocol would also be necessary to underpin either of the proposals provided in questions 19 and 20 above?

Please explain your reasoning for or against this proposal along with any evidence in support of your position.

Question 22

Do you agree that the process for sourcing medical reports for represented and unrepresented claimants should be the same?

Please explain your reasoning for or against this proposal along with any evidence in support of your position.

Question 23

Do you have any additional suggestions for how data collection on the medical reporting journey for represented and unrepresented claimants could be improved?

Question 24

What impact would implementing the changes (where such are proposed) in this consultation document have on protected characteristic groups, as defined in the Equality Act 2010?

Please explain your reasoning.

Answer these questions online

Contact details/How to respond

MoJ contact details

Please send your response by 10 October 23 to:

Personal Injury Policy Team
Ministry of Justice
Post point 5.23
102 Petty France
London SW1H 9AJ

Tel: 020 3334 3157

Email: whiplash-reform-team@justice.gov.uk

Complaints or comments

If you have any complaints or comments about the Consultation process, you should contact the Ministry of Justice at the above address.

Extra copies

Further paper copies of this Consultation can be obtained from the address above, and it is also available online at https://consult.justice.gov.uk/civil-law/rta-medical-reporting-consultation.

Alternative format versions of this publication can be requested from:

whiplash-reform-team@justice.gov.uk

Publication of response

A paper summarising the responses to this Consultation will be published in approximately three months’ time. The response paper will be available online at: https://consult.justice.gov.uk/civil-law/rta-medical-reporting-consultation.

Representative groups

Representative groups are asked to give a summary of the people and organisations they represent when they respond.

Confidentiality

By responding to this Consultation, you acknowledge that your response, along with your name/corporate identity will be made public when the Department publishes a response to the Consultation in accordance with the access to information regimes (these are primarily the Freedom of information Act 2000(FOIA), the Data Protection Act 2018 (DPA), the General Data Protection Regulation (GDPR) and the Environmental Information Regulations 2004).

Government considers it important in the interests of transparency that the public can see who has responded to Government Consultations and what their views are. Further, the Department may choose not to remove your name/details from your response at a later date, for example, if you change your mind or seek to be ‘forgotten’ under data protection legislation, if Department considers that it remains in the public interest for those details to be publicly available.

If you do not wish your name/corporate identity to be made public in this way then you are advised to provide a response in an anonymous fashion (for example ‘local business owner’, ‘member of public’). Alternatively, you may choose not to respond.

Impact Assessment

The changes proposed in this consultation document do not require the production of a full Impact Assessment. Where required MoJ analysts have considered the available data and made recommendations/proposals for change.

Welsh Language

The policy proposals included in this document do not affect MoJ services in Wales. A Welsh language version of the executive summary and question set included in this Consultation Document is also available on https://consult.justice.gov.uk/civil-law/rta-medical-reporting-consultation.

Consultation principles

The principles that Government departments and other public bodies should adopt for engaging stakeholders when developing policy and legislation are set out in the Cabinet Office Consultation Principles 2018.

Annex A: List of Consultees

The following list is not exclusive, and submissions are welcome from all stakeholders with an interest in medico-legal reporting:

• All Medical Reporting Organisations registered on MedCo
• All direct medical experts registered on MedCo
• All indirect medical experts registered on MedCo
• All authorised users registered with MedCo
• The Law Society
• The Forum of Insurance Lawyers
• The Association of Personal Injury Lawyers
• The Association of British Insurers
• The Motor Accident Solicitors Society
• The Association of Consumer Support Organisations
• The Chartered Society of Physiotherapy
• The British Medical Association
• The Gibraltar Insurance Association
• The Personal Injury Barristers Association
• The British Insurance Brokers Association

Annex B and Annex C are available in the PDF version of the Call for Evidence document: Revisions to the Medical Reporting Process for Road Traffic Accident Claims

1. https://consult.justice.gov.uk/civil-law/future-provision-of-medical-reports/ ↩

2. https://www.legislation.gov.uk/ukpga/2018/29/part/1/enacted ↩

3. Tier 1 MROs are organisations who process high volumes of medical reports and who operate at a national level across England and Wales. Tier 1 MROs must be audited against specific high volume national (HVN) QC to reflect this. Tier 2 MROs process lower volumes of reports and generally operate within smaller geographical areas. ↩

4. Prior to 31 May 2021, RTA-related personal injury claims valued up to £25,000 were processed via Claims Portal. Post reform claims valued up to £5,000 are progressed through OIC whilst claims between £5,000 and £25,000 continue via Claims Portal. ↩

5. https://www.gov.uk/government/publications/medco-new-rules-and-audit-process-for-direct-medical-experts ↩

6. https://www.justice.gov.uk/courts/procedure-rules/civil/rules/part45-fixed-costs#rule45.19 ↩

7. https://www.legislation.gov.uk/ukpga/2012/10/section/56/enacted ↩

8. The SPPI is primarily a suite of individual price indices that provide information on price change for a range of service industries. The SPPI is published by the Office of National Statistics and captures quarterly changes in the price received for services provided by UK businesses to other UK businesses and Government. ↩

9. https://www.gov.uk/government/collections/official-injury-claim-advisory-group ↩

10. https://www.justice.gov.uk/courts/procedure-rules/civil/protocol/pre-action-protocol-for-personal-injury-claims-below-the-small-claims-limit-in-road-traffic-accidents-the-rta-small-claims-protocol#7 ↩

11. https://www.medco.org.uk/news-and-updates/instructions-to-medical-report-providers-and-commenting-on-the-defendant-s-version-of-events/#:~:text=Paragraph%207.9%20of%20the%20Pre,part%20of%20their%20quality%20checks. ↩

12. https://caselaw.nationalarchives.gov.uk/ewca/civ/2023/19 ↩

13. The ‘mode’ is the number which appears most frequently when calculating an average. ↩

14. https://www.officialinjuryclaim.org.uk/help-hub/ ↩

15. Based on Compensation Recovery Unit performance data ↩