Physical examination is essential when the questions being asked depend upon present clinical findings that cannot be established from the records. It should not be arranged merely because examination is traditional, but neither should it be removed because a desktop report is faster or less expensive.

The question determines the method.

Not every medico-legal instruction requires a physical examination.

An expert reviewing whether earlier clinical treatment was appropriate may be able to answer from the contemporaneous records, imaging and accepted factual history. A radiologist can interpret available scans without physically examining the claimant. A records-based opinion may also be necessary where the claimant has died, is too unwell to participate or cannot be located.

The position changes when the expert is asked to diagnose a current condition, assess ongoing physical restriction or provide an opinion on future recovery. Those questions often depend upon findings that do not appear in documentary evidence.

The GMC recognises that an expert may sometimes be asked to give an opinion without consulting or examining the person concerned. Where that happens, the expert must explain the limitation and be able to justify proceeding on that basis.

The absence of an examination is therefore not automatically improper. It must be compatible with the particular opinion being requested.

Current clinical signs may need to be tested.

A physical examination allows the expert to assess matters such as movement, tenderness, strength, sensation, reflexes, swelling, scarring and neurological function.

These findings may help determine whether symptoms remain consistent with the original injury or whether further investigation is required. They may also reveal a condition that was not apparent from the supplied records.

A claimant describing arm numbness after a neck injury may require neurological assessment. Continuing shoulder restriction may indicate a problem different from the original soft-tissue diagnosis. A visible scar may need direct inspection before its appearance and likely development can be described.

The expert should not assume that an examination will produce an objective answer to every disputed symptom. Pain cannot be measured directly, and performance during one appointment does not establish the claimant’s function throughout an ordinary day. Examination findings are one part of the evidence rather than a test of honesty.

Function cannot always be understood from records.

Medical notes may state that the claimant has restricted movement or difficulty walking without describing the extent of the restriction.

Direct assessment allows the expert to observe how the claimant rises from a chair, walks, changes position or performs relevant movements. It may also provide an opportunity to discuss what happens during work, domestic tasks, travel and exercise.

This does not mean that observed ability should be treated as proof of sustained capacity. A claimant who can bend once during an examination may still experience difficulty with repeated lifting. Someone who walks across a consulting room may not be able to manage a full working day.

The expert must compare the physical findings with the reported function, treatment records and documented activity. Where they differ materially, the discrepancy should be explored rather than converted immediately into a conclusion about exaggeration.

Diagnosis may depend upon positive findings.

Some conditions require characteristic examination findings rather than diagnosis by exclusion.

A functional neurological disorder, for example, should be identified through positive clinical signs and an appropriate neurological assessment. Complex regional pain syndrome, peripheral nerve injury and certain joint conditions may also require findings that cannot be confirmed from a written history alone.

Normal imaging does not remove the need for examination where the alleged condition is principally clinical. Equally, an examination should not be used to override clear imaging or specialist evidence outside the examining expert’s competence.

Where another discipline is needed, the first expert should identify the unresolved clinical question and recommend the appropriate specialist. Practice Direction 35 requires experts to state when an issue falls outside their expertise or when insufficient information prevents a definite opinion.

A physical examination may be essential for prognosis.

Prognosis is not produced from diagnosis alone.

The expert may need to consider the claimant’s present movement, strength, neurological status, progress and response to treatment. A person who has regained almost full function by the examination date may reasonably receive a different prognosis from somebody with continuing neurological signs or marked restriction.

Timing matters as well. MedCo confirmed in April 2026 that there is no fixed minimum period between an accident and examination. Its Medical Advisory Board nevertheless considers examinations within four weeks too early in most cases unless the claimant has recovered or has an unmet treatment need. The concern is that a meaningful recovery pattern may not yet be established.

An early physical examination may document the current presentation without allowing a safe final prognosis. The expert should distinguish between the need to examine and the ability to predict recovery.

MedCo reports have specific requirements.

For MedCo soft-tissue and whiplash reporting, a physical face-to-face appointment is required. Current MedCo Examination Guidelines state that the examination must be physical rather than virtual and take place in a confidential, private, safe and professional setting. They also provide for at least 15 minutes of face-to-face time, while making clear that experts should allocate longer where the case requires it.

The guidelines require the accident circumstances, injuries, progress, treatment, relevant medical history and impact upon work and daily life to be discussed directly with the claimant. Questionnaires may assist, but they cannot replace that interaction.

A standard first MedCo report should therefore not be converted into a desktop or video exercise merely because the records appear straightforward.

Remote consultation is not the same as physical examination.

A video consultation may allow the expert to take a history, observe general movement and discuss symptoms. It does not allow reliable palpation, reflex testing, detailed sensory assessment or measurement requiring physical contact.

Remote assessment may be suitable for some psychiatric, psychological or follow-up questions, depending upon the individual and the purpose of the instruction. It should not be described as a physical examination where no physical contact occurred.

The report must state how the assessment was conducted and identify what could not be tested. Any resulting limitation should be connected to the opinion rather than hidden within a standard disclaimer.

Consent and dignity still matter.

A physical examination should be limited to what is necessary for the instruction. The expert should explain what they intend to do, obtain appropriate consent and respect requests concerning privacy, assistance or a chaperone.

The appointment is not ordinary treatment. The expert should make the purpose of the examination clear and keep accurate notes of the history, findings and any part of the assessment that could not be completed. GMC guidance requires examination notes to be accurate, balanced and free from material omissions.

An examination should never become more extensive simply because the claimant has agreed to attend.

The report must acknowledge what remains unknown.

Even a thorough physical examination has limits. It provides evidence from one appointment and may not resolve conflicting histories, missing records or disputed function.

The expert should explain which conclusions arise from the examination, which depend upon the claimant’s account and which are supported by documentary evidence. If pain prevented reliable testing or the claimant declined part of the assessment, that should be recorded neutrally.

A physical examination is essential when direct clinical findings are needed to answer the questions properly. It is less important where the instruction concerns historical treatment, documentary interpretation or another matter that can be resolved safely from existing evidence.

The correct method is not determined by convenience. It is determined by what the expert needs to know.

Where current diagnosis, neurological status, physical function or prognosis depends upon direct assessment, the expert should examine the claimant. Where the records are sufficient, a carefully limited paper opinion may be defensible.

The important distinction is not between modern and traditional reporting. It is between an opinion based upon enough evidence and one that merely sounds complete.