Evidence of misrepresentation, dishonesty and fraud by medical agencies supplying solicitors with expert reports means the government should consider formally regulating them, MedCo has argued.
The body that facilitates the sourcing of medical reports in whiplash cases worth up to £25,000 also warned the Ministry of Justice that there were limits on what it could do to prepare for the Civil Liability Act reforms given the April 2020 deadline to introduce them.
Further, it indicated that solicitors would soon have to start paying to use the system.
Responding to the ministry’s consultation on the future provision of medical reports under the new regime, MedCo supported its intention to expand the system so that unrepresented claimants could source the required reports as part of the rise in the small claims limit for road traffic accident-related soft-tissue claims.
However, it said that, since it commenced operations in April 2015, it has encountered “significant problems with many MROs who initially self-certified that they complied with the relevant QC [qualifying criteria].
“There has been evidence of misrepresentation, dishonesty and, in some cases, suspicions of fraud. Where identified these issues have been dealt with by MedCo and appropriate action taken (e.g. termination of agreements).
“To ensure that unrepresented claimants receive a medical reporting service of the highest quality, serious consideration should be given to formal regulation of MROs, especially as they will be required to deal with such claimants direct when the reforms are introduced.”
Following its recently completed auditing of all registered and operational MROs, there are now 10 tier 1 MROs – national, high-volume providers – and 44 tier 2s.
This represents a substantial shrinking in the market. At the end of August 2018, there were 78 MROs in the MedCo system, itself down from 120 at 31 December 2017.
MedCo is funded by MROs and, to a far lesser extent, the medical experts (MEs) who can be instructed directly through the system.
As both solicitors and experts instructed through MROs pay nothing, MedCo said it was moving towards a ‘user pays’ basis of payment next year “to make it more transparent and fairer to all users”.
The flip-side of this was that MROs and MEs have told MedCo that payment of medical report fees “must be guaranteed in some way” – in cases where liability was admitted, “it may be appropriate that arrangements be put in place for the compensator to pay the medical report fee direct to the MRO or ME”.
But where liability was not admitted, “it is highly unlikely that unrepresented claimants will be given credit” by MROs or MEs. Others have questioned what will happen in this situation.
The response said that, when the reforms were implemented, claimants with non-soft tissue RTA injuries over £5,000 would not have to source medical reports through MedCo but those with a similar injury valued at less than £5,000 would have to.
“This is confusing and is also likely to lead to exploitation. For consistency, consideration should therefore be given to extending the scope of MedCo accordingly.
“However, MedCo appreciates that this is unlikely to be achievable prior to April 2020 but it recommends that the issue is reviewed as soon as possible.”
It said first medical reports for sub-£5,000 claims should only be provided by GPs – who “are likely to have sufficient experience and skills to give an opinion and diagnosis in such claims” – rather than specialist doctors.
Allowing more specialists to register with MedCo would be “problematical” and “likely to impinge” on MedCo’s ability to be ready for April 2020.
“Changes to MedCo’s IT system could be extensive due to the number of different specialists who might wish to register and allocating them into the random search/selection process which it operates.
“It is also likely that the more choice available to unrepresented claimants the more complicated the process will become for them and therefore a greater level of operational support will be required.”
Further, it said, giving unrepresented claimants a wider choice of experts “would be confusing”.
“In fact, recently it has come to the attention of MedCo that insurers have begun to see increasing examples of the wrong type of expert being chosen in the first instance to provide a medical report for claimants who are represented.
“This problem is likely to be exacerbated should a wider choice of medical experts be available to unrepresented claimants. This would add additional and unnecessary costs for both parties.”
MedCo also said it did not understand how unrepresented claimants “would be able to distinguish which type of expert would be appropriate for the injuries they have sustained”.
It recommended “a complete review of the current offer, qualifying criteria and MedCo processes specifically for unrepresented claimants” as the current system of being given a choice of several different MROs or MEs would be “too complex” for them.
“It may also become necessary to review the viability of continuing the random search/selection process of medical report providers at the same time.”
Martin Heskins, Executive Chair of the MedCo Board said: “MedCo has participated in the consultation from the point of view of ensuring the new system provides a simple and efficient service for unrepresented claimants.
“We believe that expanding the service to cover all road traffic accident related personal injury claims up to £5,000 is a step in the right direction towards securing this positive outcome.”