An examination is not required for every medico-legal opinion. Some questions can be answered from records, accepted facts and published evidence. Others cannot be addressed safely without meeting the claimant.
The proper question is whether the expert can answer this instruction reliably and explain the limitations.
What can be answered from the documents?
Some instructions concern events recorded in detail. A clinical negligence expert may be asked whether earlier treatment met an acceptable professional standard. The claimant’s present appearance may add little to an analysis of contemporaneous records. A records-based opinion may also be appropriate where the person has died, cannot participate because of severe illness or is unavailable for another legitimate reason. An expert may be asked for an initial advisory view, to identify whether further evidence is required or to comment on a narrow issue such as imaging.
In these cases, the expert is not pretending to have conducted a clinical assessment. They are answering a defined question from identified material.
The GMC recognises that an expert may be asked to give an opinion about a person without consulting or examining them. It requires the expert to explain any resulting limitation and justify the decision to proceed. That is permission to exercise judgement, not general approval for desktop reporting.
When examination changes the evidence.
A claimant’s current symptoms and function are not always captured adequately in the records. An examination allows the expert to clarify contradictions and explore matters not recorded during treatment. It may reveal restricted movement, neurological signs, altered mood or difficulties with concentration. A single appointment does not prove daily function and should not be treated as a test of honesty. It nevertheless provides evidence unavailable from documents alone.
Examination is particularly important where the expert is asked to diagnose a current condition, assess continuing disability, distinguish between competing explanations or recommend treatment. Psychiatric and psychological opinions often depend upon clinical interview, mental-state findings and a detailed account of function. A paper review may identify symptoms without establishing their nature or severity.
If the absence of examination prevents a definite opinion, Practice Direction 35 requires the expert to say so rather than fill the gap with assumption. Any qualification affecting the opinion must also be stated clearly.
A desktop report is not a cheaper examination.
Cost and speed may influence how evidence is commissioned, but they do not determine what is clinically sufficient. A record-only report should not be chosen merely because arranging an appointment is inconvenient, the claimant has failed to attend once, or a faster turnaround is preferred. The expert must decide whether the method allows the instruction to be completed properly.
Nor should a desktop report be described as equivalent to an examination-based report where it is not. The absence of direct assessment may affect diagnosis, causation, prognosis or recommendations. Those effects should be identified.
A useful limitation might state:
I have not interviewed or examined the claimant. My opinion is confined to the documentary evidence supplied. I cannot provide independent findings concerning current symptoms, mental state, physical restriction or day-to-day function.
That is more informative than saying only that the opinion is based on the available records.
MedCo claims require particular caution.
The position is more restrictive for MedCo reporting.
MedCo’s April 2025 update removed the temporary references to remote examinations introduced during the pandemic. Its current reminder states that examinations must take place in a confidential, private, safe, secure and professional environment, and that the location must be neutral. A standard first MedCo report is therefore built around an examination rather than a records-only review. An expert should not convert it into a desktop exercise because the bundle appears simple. Where examination cannot take place, the problem should be addressed before the report is produced.
That position should not be confused with other medico-legal work in which a records-based opinion may be proper.
The records may matter more than the meeting.
The opposite mistake is assuming that examining the claimant makes a report complete. A claimant may provide a clear account, yet earlier records may show previous symptoms, a different onset or another event affecting prognosis. Physical findings may establish present restriction while saying little about why it arose.
The examination and records answer different questions. The examination provides current evidence. The records provide chronology, earlier presentation and independent documentation, and in some cases, the records will carry greater weight on causation. In others, direct assessment will explain why a brief clinical entry gives an incomplete picture. The quality of the opinion depends upon how the sources are compared, not upon automatically preferring one.
An expert who examines the claimant but fails to review relevant records may produce an opinion resting entirely upon the claimant’s recollection. That may be particularly unsafe where the onset of symptoms, previous history or progress of treatment is disputed.
Equally, records should not be treated as complete transcripts. A clinical note may omit symptoms that were not central to treatment, contain an inaccurate date or repeat information copied from an earlier entry. The expert must interpret the records rather than assume that every entry is definitive.
Keep the opinion within its limits.
An expert proceeding without examination should identify exactly what can and cannot be answered.
They may be able to comment on whether a documented mechanism could cause the alleged injury, whether treatment was appropriate or whether the recorded course is clinically consistent. They may be unable to confirm a current diagnosis, assess disability or give a reliable prognosis.
The report should identify the documents considered, factual assumptions adopted and any material information missing. Where different factual accounts would produce different conclusions, alternative opinions may be needed, and the decision should be reconsidered if the instruction expands. A paper opinion on historical treatment may become unsafe if the expert is later asked to assess current care needs or psychological functioning.
Further information may also alter the position. If later records reveal continuing symptoms that require clinical assessment, the expert should explain that an examination is now necessary rather than stretching the original desktop instruction beyond its proper scope.
An expert can reach an opinion without examining the claimant, but not every opinion.
The defensible approach is to match the method to the question. If the documents provide a sufficient basis, a carefully limited record-only opinion may assist. If direct assessment is necessary to diagnose, test function or resolve uncertainty, the expert should examine the claimant or decline to answer.
The absence of an examination is not automatically a defect. Failing to explain what that absence prevents the expert from knowing usually is.
