There’s been a boom in injury claims in recent years, and with it, the lure of medicolegal work.

What are the pros and cons of medicolegal work, and how do you grow a medicolegal practice?

Is medicolegal work really worth the money?

Medicolegal work might seem to be a nice little earner, but even if fulfil your side of the bargain, do your assessment and write up your report on time, it’s not all plain sailing. If you find yourself part of a ‘no-win, no-fee’ case, proceedings can rumble on for months, even years – which can seriously hit your cash flow when you realise you have a giant tax bill to pay, and nothing (yet) to show for it.

The majority of the services we provide as health care practitioners don’t attract VAT. If you start grow a large medicolegal practice, and you earn over the current VAT threshold (which is £79,000 a year), you have to become VAT registered, which means you have to slap on a 20% charge. That means that whilst you get to invoice more, you are also then liable to pay more corporation tax, and eventually, personal tax on that amount too.

Now whilst it’s true that there are some perks to being VAT registered in that you can claim back some VAT if you make a purchase for business purposes, the reality is that you’re not likely to be able to claim back as much as you think. You also have to jump through red tape to claim your money back.

Where does the work come from?

Most medico legal clinicians will form relationships with solicitors, or med-legal work agencies.

When you first start out, it may take you some time – even a year or two, to become ‘known’. In other words, if you’re going into medicolegal work, you need to think of the long-game, and get your systems and processes in order from the outset. This starts with your mindset. Medicolegal work is about giving your expert opinion in return for money. You’re not looking after the ‘patient’, and it’s important that you can be impartial.

Making sure you get paid for your medicolegal work.

Set up your fees, terms and conditions in advance of accepting any work. Your fees and Ts & Cs need to be approved in writing by the solicitor or agency that you’re servicing, and I strongly advise that you use a billings company who are used to chasing up invoices to do this for you.

Don’t try to wing it. Do your due diligence on the legal team you’ll be working with, and if they are really dragging their feet about paying you, don’t work with them again.

Setting your medicolegal fees.

When it comes to Fees, you need to take into account:

What sector you are working in – is it particularly niche, or is the market flooded in your area?

Think about setting a standard rate for a report, or for complicated cases when you have to plough through war-and-peace scale medical documents, you may want to set an hourly rate. If you’re an experienced medicolegal clinician with a Harley Street address, you might set your fee at £300 an hour. If your entire report generating process seems excessive in time, you may not get paid, and if you’re doing legal aid funded work, they are very likely to set boundaries and cap the hours you can bill for.

Bill for the time it takes you to assess the patient (which will include your examination), dictation and transcribing of your notes, and time for pulling it all together in a proof-read report.

If you have to do ‘little extras’, such as reviewing other presented documents, don’t forget to bill for those too in smaller increments.

Definitely consider outsourcing your transcription to a GDPR compliant specialist transcription company (such as WeType) as it takes mixed medical and legal skills.

Court days. These can really mess with your patience. Each day you are required to go to court, you can pretty much forget about any other kind of work, so it’s really important to set a minimum show up rate, so you can bill for that lost day or time, even if you’re then sent home after 30 minutes.

What if the claimant lets the process down, people don’t show up, or legal teams change their dates last minute?

You should set out in your T’s an C’s at what stage you would bill for a late cancellation, and your charge for a no-show. Think about how much you could be losing out by not being in clinic, and don’t forget to charge for travel, and other expenses that you have to shell out for as a result of the case.

The three kinds of medicolegal ‘witnesses’.

If you’ve ever had to appear in court, you’ll know if that even if you’re not on trial, it can be an intimidating, or even scary place.

There are three kinds of witnesses – an ordinary witness (think a member of the public who spotted someone who was up to no good, doing something bad), a professional witness (think A and E Foundation Doctor who stitched up the head of someone who’d been bottled), and an expert witness (think world’s leading expert on incised head wounds).

The difference between personal injury claim work, and medical negligence claim work.

We’ve all seen adverts on the telly (and even in NHS hospital waiting areas), about making a claim ‘for a trip or a fall’. A little while ago, it seemed like any man and his dog wanted to make a whiplash claim after a bump in a car. This is the bread and butter for many medicolegal clinicians, and it’s different to medical negligence legal work, which essentially scrutinises the standard clinical care given. In both of these cases, it’s important to understand the difference between being a professional witness and an expert witness.

A professional witness will be asked to present facts, whilst an expert witness’s role is to provide an opinion, in order to guide the court. If you’re stepping into the world of medical negligence, you’ll also have to be able to explain complex terms to lay people, and be able to give an opinion based on literature and best practice, and what would constitute acceptable (and logical practice) amongst peers in that particular clinical area.

Sometimes this goes beyond report writing, requiring an appearance in court where the expert witness would have to be prepared to argue their case. In other words, you need to be able to hold your own.

Court appearances aren’t common, but regardless, this kind of medigolegal work is often set out in a very rigid time structure, which you must work within.

Your report will almost certainly be scurtinised, and you have to be very clear about where your boundaries of expertise are. For instance, I’m a Consultatnt in Sport and Exercise medicine, and whilst I regularly see patients with spinal issues, it would be out of my remit to comment on the spinal surgical workmanship. Get this wrong, and it can be end of your medico-legal career, and be damaging for your reputation.

It’s also important that you don’t take on work where there might be a conflict of interest, for example, if you’re chums with, or work with, one of the clinicians involved in the claim.

Medicolegal training.

It goes without saying, that it’s incredibly important to gain training if you’re going to undertake medical negligence work, but thankfully there are some great courses out there, e.g. those run by the Academy of Experts:

http://www.academyofexperts.org/training/expert-witness-training.

and courses run by the Expert Witness Institute:

https://www.ewi.org.uk/events-and-training/

To keep up to date, it’s wise to attend and network at a conference:

https://www.specialistinfo.com/a_ml_cal_year.php

http://medicolegalconference.com/

Additional Useful resources if you’re thinking about getting into clinical negligence work:

https://www.avma.org.uk/resources-for-professionals/events/webinars/

https://www.avma.org.uk/?download_protected_attachment=2015/05/Guidance-on-Remuneration-of-Expert-Fees-01-09-14.pdf

https://www.avma.org.uk/resources-for-professionals/information-for-medical-experts/information-and-forms-for-experts/

You can apply to be on the AvMA (Action Against Medical Accidents) register, and you can become a member of the Academy or Experts of the Institute of Experts. All of this goes some way to improving your kudos with solicitors and barristers.

What’s the best place to start looking for medicolegal work?

Most Clinicians’ first port of call will be an agency, such as:

• Doctors’ Chambers Limited.
• Premier Medical Group.
• Speed Medical Examination Services.
• IQED.

After a while, if you produce a swift turnaround of accurate work, you will begin to earn the trust of solicitors.

As within and sphere of Private Practice, you have to be able to market what you do. It’s important to write up a medicolegal CV,and have a professionally produced website (or website page on your current Private Practice website).

Medicolegal work can prove to be a good source of income if you’re looking to expand your earnings, but it may not be as much as you would earn working seeing patients face to face in Private Practice. Nevertheless, it can bring certain freedoms.

For instance, if you’re an anesthetist in Private Practice, medicolegal work means you’re not dependent on surgical lists, and many Consultants choose to bring medicolegal work into their lives around retirement time.

If you fancy a new challenge, it may be just what you’re looking for.

If you’re thinking about getting into medicolegal work, or if you need guidance on how to promote your medicolegal practice, why not book a Ninja Power Hour Zoom Call? It’s an hour of one-to-one time with me, and a brilliant kickstarter.

https://www.privatepracticeninja.co.uk/ninja-power-hour/