A further report should not be recommended merely because the claimant has not recovered by the date of examination. Many claimants examined for a MedCo report will remain symptomatic. The expert’s task is to provide a diagnosis and a reasoned prognosis, not to defer every uncertain element to somebody else.
A second report is justified when it is likely to answer a material medical question that the first report cannot answer safely. It should not be used as a routine precaution, a means of increasing the value of a claim or a substitute for forming an opinion.
The starting point is one report.
Both the RTA Small Claims Protocol and the low-value RTA Protocol proceed on the expectation that, in most cases, one medical report will be sufficient. The first fixed-cost report is obtained from a MedCo-accredited expert and should address the injuries, causation, treatment, functional effect and prognosis within that expert’s competence.
Under the RTA Small Claims Protocol, a further report is justified where it is recommended in the first report, where more time is needed before a prognosis can be determined, where treatment is continuing, or where the claimant has not recovered as expected within the original prognosis. The same broad grounds apply to whiplash claims proceeding under the low-value RTA Protocol.
Those provisions create permission, not an instruction to recommend another report whenever one of the phrases can be repeated.
The expert should still ask what the additional evidence would contribute. If the answer is no more than, the claimant remains symptomatic, it may be more appropriate to provide a reasonable prognosis and allow the claim to proceed.
When the prognosis cannot yet be given.
A further report may be proper when the examination takes place too early for the expert to provide a defensible prognosis.
MedCo clarified in April 2026 that there is no legal minimum interval between an accident and an examination, and no rule requiring every examination to take place at least six weeks afterwards. Its Medical Advisory Board has nevertheless expressed concern about examinations taking place within four weeks in most cases, particularly because recovery patterns may be difficult to assess accurately at that stage.
This does not mean that an early report must always recommend reassessment. A claimant may already have recovered, or the available history may support a conventional short-term prognosis. In other cases, the symptoms may still be developing, treatment may not have started and the expert may have no sound basis for predicting the outcome.
Where that is the position, the report should explain why time is required and when reassessment is likely to be useful. “Further report recommended” is not enough.
The expert should identify the uncertainty. Is the question whether the claimant will recover after physiotherapy? Is the duration of neurological symptoms unclear? Is a provisional diagnosis dependent upon imaging or further clinical investigation?
A recommendation is easier to justify when it is attached to a defined question and a sensible review point.
When treatment may alter the outcome.
Continuing treatment is one of the recognised grounds for obtaining a further report, but treatment alone does not make reassessment necessary.
A claimant undergoing a brief course of physiotherapy may still receive a reliable prognosis at the first examination. The expert can take account of the expected response to treatment and state what should happen if recovery does not follow the predicted course.
A further report becomes more useful where the treatment outcome is likely to have a material effect upon prognosis or function. This may arise where the claimant is awaiting an injection, specialist review, psychological therapy or investigation of symptoms not explained by the initial assessment.
The report should specify what treatment is underway, what outcome is expected and why the final opinion should await its completion. Without that reasoning, “review after treatment” can become a standard phrase applied to every case.
Experts should also avoid making settlement dependent upon treatment that has not been arranged, may not be clinically necessary or is unlikely to begin within a reasonable period.
When another discipline is required.
The first MedCo expert should recommend evidence from another discipline when a material aspect of the alleged injury falls outside their own competence.
A physiotherapist may identify neurological features requiring medical assessment. A general practitioner may consider that persistent shoulder symptoms warrant an orthopaedic opinion. Significant travel fear, intrusive recollections or broader psychological symptoms may require assessment by a psychologist or psychiatrist where diagnosis, causation or prognosis cannot be addressed safely in the initial report.
Practice Direction 35 requires experts to state when an issue falls outside their expertise or when they cannot reach a definite opinion because the information is insufficient. It also reflects the wider principle that expert evidence should be limited to what is required.
Referral should therefore follow the clinical question, not the claimant’s preferred description of the injury.
A mention of headaches does not automatically require a neurologist. Temporary nervousness while travelling does not necessarily require psychiatric evidence. Mild shoulder discomfort does not invariably require an orthopaedic surgeon.
The initial expert should describe the symptoms, explain the limit of their own opinion and identify what the proposed specialist is being asked to determine. A vague recommendation for “a suitable specialist” transfers the decision without assisting the parties.
Failure to recover as predicted.
A claimant who remains symptomatic beyond the original prognosis may properly require reassessment. The purpose is not simply to confirm that the symptoms continue.
The second report should consider why recovery has not occurred. There may be continuing physical injury, an incomplete initial history, poor treatment engagement, psychological factors, unrelated disease or symptoms that are no longer medically explained by the accident.
A revised prognosis should not automatically extend the original period by another convenient block of months. The expert must examine what has happened since the first report and whether the current presentation remains consistent with the index injury.
The RTA Small Claims Protocol permits a further report at any point before settlement, including after offers have been made. It also warns that the cost may not be recoverable where the report was not justified.
That makes the reasoning in the first report important. The recommendation may later be used to explain why further evidence and expense were reasonable.
What should not trigger another report.
A second report should not be recommended merely because:
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the claimant requests one.
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symptoms were present at examination.
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the solicitor may prefer a longer prognosis.
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the expert is reluctant to commit to a reasonable range.
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a psychological symptom is mentioned without significant impairment; or the first report contains factual errors that could instead be corrected.
Nor should the expert recommend a specialist report to protect themselves from every possible criticism. An expert is expected to recognise uncertainty, but not to eliminate it through a succession of referrals.
There are cases in which the proper opinion is conditional. The expert may state that recovery is expected within a given period, but that reassessment would be reasonable if symptoms continue beyond it. That does not always require an immediate recommendation for another report.
A recommendation needs a reason.
A useful recommendation should tell the parties four things: what further evidence is required, which discipline should provide it, what question that expert should answer and when the report should be obtained.
For example:
“If the claimant’s reported travel avoidance remains functionally disabling after completion of the recommended treatment, assessment by a suitably qualified psychological expert would assist in determining diagnosis, causation and prognosis.”
That is more helpful than simply stating that psychological evidence is required.
A MedCo expert should recommend a further report when the additional evidence is medically necessary, proportionate and likely to resolve a material uncertainty. The recommendation should arise from the findings, not from habit.
The first report does not have to answer every possible question. It should, however, make clear why another expert or another examination is genuinely needed.
