How to set up a medico-legal practice

If you think you might like to take on medico-legal work, you must first ask yourself three very important questions. Here’s a big hint. Unless you can answer “Yes” to all three questions, don’t do it!

  1. Do I have the time to do this?
  2. Can I afford it?
  3. Am I prepared to find myself in the witness box, being cross-examined about my opinion and report?

Before we start, you need to know where your work will come from. Requests for medico-legal reports, otherwise known as ‘instructions’, usually come either from medico-legal reporting agencies who handle the appointment process and procurement of the consultant’s report (and sometimes any follow-up work on a case) or directly from solicitors. Agency and solicitor instructions bring different considerations for a consultant.

Medico-legal reporting agencies will have very strict ‘service level agreements’ or SLAs which you must agree to meet before you will be accepted onto that company’s Panel of Experts and be eligible to receive instructions from them. You’ll have to agree to meet very strict deadlines for providing an appointment, submitting your report, and responding to any requests for follow-up work on a case. These deadlines are short – typically 24 hours after you’ve received all of the paperwork for an appointment date to be offered, and 7 to 10 days from the patient (or client as the patient will now be known) seeing you for assessment for your completed report to be in the hands of the agency.

Believe me, the medico-legal reporting agencies take their SLAs very seriously indeed and you (or most probably your medical secretary) will be chased regularly and relentlessly if you’re late. I’ve been on the receiving end of this if any of my own medico-legal consultants run late with their work and, guess what, it’s utterly miserable!

If you don’t think you can meet these deadlines, my advice to you is … find another way to develop your practice.

That said, you may fare better with a direct instruction from a solicitor and my experience has shown that, when dealing directly with a solicitor, you may be able to negotiate a longer turnaround time for your medico-legal report.

Can you afford it?

What a strange thing to say, I hear you say! You will be introducing a new revenue stream and making more money, so of course you can afford it. Right? Well, not necessarily! I have to tell you up front that you’re not going to be paid any time soon for the medico-legal work which you do. This will expose you to real cashflow problems, especially if you invest a lot of your time and effort into this kind of work.

If you receive your cases directly from solicitors, they may ask you to wait until the settlement of the case before they pay you any of your fees. Beware! This may take years and you’ve still got to pay tax on this! If your cases are sent to you via a medico-legal reporting agency, you may be able to negotiate your payment time, but this is unlikely to be anything less than 3 months from their receipt of your report, and could easily be longer.

I do need to say that if your expertise is very niche and, once your reputation as a medico-legal expert in your field is cemented, you may be able to negotiate a deal for yourself where you’ll be paid before you release your report, either to the solicitor or medico-legal agency. However, you’ve got to be really good at this work and your opinion must be very highly valued indeed by those sending you cases.

You do need to keep in the forefront of your mind that you may find yourself appearing in Court as an expert witness with any of your medico-legal cases. I have no direct experience of this, but I’m sure it’s stressful and it’s definitely time-consuming.

If you’ve decided that you do have time to devote to having a medico-legal practice and you can accept the financial implications, let’s get down to the nitty gritty. What do you have to do next? Here are my suggestions:-

Get some training in report writing skills

You will need to know how to construct a medico-legal report and ‘the legals’ which need to be included to make your reports CPR (Civil Procedure Rules) compliant. Bond Solon run day courses for medico-legal report writing in a number of locations and some of the medico-legal reporting agencies have software which, depending on your speciality, can be used to help you to ‘write’ your report.

Bond Solon also offer a course on courtroom skills and giving evidence which might be worth investing in a little further down the line.

Think about what sort of cases you could help with

By this I mean what sort of injury or condition you are highly familiar with and can provide a clear opinion and prognosis about in terms which a layperson can understand.

Start to assemble the documentation which you will be asked for by the medico-legal reporting agencies or solicitors

… so that you have this ready to send when you approach them for inclusion on their Panel of Experts.

Depending on the agency, this will include some of the following:-

  • Your full CV
  • A brief medico-legal CV – this should be no more than 2 pages long
  • Your medico-legal Terms and Conditions – this will need to be personalised to the ‘deal’ which you have been offered with the individual medico-legal reporting agency or solicitor
  • Your Indemnity Certificate
  • Your ICO certificate – you do have one, don’t you? If you are not registered as a Data Controller with the Information Commissioner’s Office, do it straight away
  • Your DBS certificate
  • Details of where you will be seeing your medico-legal cases
  • A sample report (if you have one) which is redacted
  • What your waiting list is for an appointment
  • Contact details for E-mails, post and telephone calls

If you need any advice with constructing a medico-legal CV from your main CV or would like a hand with writing your medico-legal Terms and Conditions, please get in touch with me.

Contact the medico-legal reporting agencies and apply for inclusion on their Panel of Experts

You will need to spell out very carefully exactly the sort of cases which would be appropriate to send to you. You might say something like this:

Mr Your Name is able to provide a medico-legal opinion in the following areas:-

  • Burns
  • Cutaneous scarring
  • Facial injuries
  • Hand injuries
  • Traumatic amputation
  • Cosmetic surgery of the face, body and breast

Don’t expect a medico-legal reporting agency to understand what you do just from your job title. They won’t. You must tell them.

I can provide you with the details for the major medico-legal reporting agencies. Please get in touch if you’d find this helpful.

If you want to pursue instructions directly from solicitors, you will need to research which firms handle the sort of cases which you could help with and who are the solicitors who handle those cases – and contact them directly.

Once you have done your training and got yourself registered with the main medico-legal reporting agencies, hopefully you will start to receive instructions and your medico-legal practice will be up and running.

I will talk about how to run a medico-legal practice another time.

Final Words

If your medico-legal service really takes off, you will find yourself required to register for VAT on your medico-legal work. Currently the threshold is £85,000 invoiced on medico-legal work over the course of a rolling 12 month period. This will mean that you need to add 20% to your fees and have in place an appropriate system for keeping accurate records of your VAT liability and that you make your payment(s) to HM Revenue and Customs at the due time.

You need to think about where you will keep the papers or digital files from your medico-legal cases. Although more medico-legal reporting agencies will send their instructions and medical records electronically (or grant you access to a virtual portal where you can view medical records, imaging and any other documentation associated with your case(s)), solicitors and some medico-legal reporting agencies still send paper instructions including medical records – and these can be bulky.

It is essential that you have a safe and secure location to store these physical notes (and for any digital records of course), and you may be required to retain these for many years after the case has settled. I’ve found some advice on the MDU’s website which suggests that records should be retained for 10 years after the case was closed or the last correspondence was received from the solicitor about the case.

You must also ensure that, after this time, you dispose of the papers securely. Appropriate methods may be by incineration or cross-cut shredding which you can do yourself, or you could engage a commercial company to do this for you, but you must make sure that they hold the necessary accreditations first.

You also need to retain a copy of your report and any work you have done on your cases in a very secure and GDPR complaint manner on your computer system (which you should back-up) again for the timescale recommended by the MDU, and I would also advise that your reports, external hard drive and PC or MAC are encrypted and protected with a password.

Sue Wilcox is an AMSPAR qualified medical secretary. She has worked as a medical secretary in the NHS and private sectors for more than 40 years. She is the Director of The Medical Secretariat Limited which provides medical secretarial and administrative services to consultants in private practice. You can contact Sue by phone on 0121-242 3299 or 07954 433201 or via E-mail at

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