ACC regularly seeks medical evidence from experts. Such evidence plays a key role in helping ACC give injured New Zealanders the support they are entitled to receive. Expert medical evidence makes it possible for ACC, reviewers and judges to understand a medical situation and make quality decisions on cover, entitlements, reviews and review outcomes.
The right expert
An ACC case manager seeking expert medical evidence must make sure that the medical expert is properly qualified to talk about the issues. Branch medical advisors may help case managers to identify an appropriate expert. In order to give evidence as an expert you need to have the relevant qualifications and be speaking in your area of practice. As well as being qualified and experienced, it is important that any expert is (and is seen to be) independent.
Role of the expert
You are helping the decision-maker interpret the medical facts. It is not a medical expert’s role to make a decision or to offer an opinion on legal issues.
Experts must give their genuinely-held opinions as objectively as possible and present their medical evidence in a clear, relevant and well-reasoned way, using simple language.
Request for a medical report
If an ACC case manager asks you for a medical report, you can expect to receive:
- a covering letter containing clear instructions in writing
- a list of each document provided and clear photocopies of the documents
- an outline of what the report should cover
- details of whether the client is to be examined and if so, the matters the examination should cover
- specific medical questions upon which you are to give advice. These must be directed to the client’s medical condition and not matters of law or entitlement under the Accident Compensation Act 2001. A Branch medical advisor, as an expert in the field of ACC, may refer to the relevant legal concepts in order to identify them
- questions that encourage you to give your reasoning, eg ‘Can you explain …’; ‘Please describe ...’
- neutral questions. An expert’s opinion is worth more if a Court sees that the way in which the question is asked has not influenced the expert.
How to prepare an expert medical report
Medical experts need a clear understanding of the question and must have all the relevant information before preparing the report or contacting the client. If you need more information or believe you need to examine the client, please contact the case manager who asked you for the report.
What your report should cover
- Your relevant qualifications and experience.
- The documents considered, and the inferences you take from them.
- The examination findings (if any).
- The relevant medical history (note any discrepancies between the details given by the client and the information contained in previous documents).
- The nature of the condition.
- The opinion on the specific questions asked, giving reasons.
- Explanation of your conclusions with reference to x-rays, clinical findings and scientific rationale. If your evidence is presented in Court it will be evaluated against evidence provided by other experts. For this reason the rationale for the conclusions must be drawn in a clear and robust way.
The layout of the report should be logical and clear. The use of headings and numbered paragraphs is recommended.
Opinions on expert evidence
Sometimes ACC may ask you to consider another expert’s opinion. In this case, explain as objectively as possible why you agree or disagree with the other person’s views. Is the conclusion based on an incorrect finding of the facts or incorrect clinical findings? Has the other person overlooked or ignored factors that you have taken into account? Take care to avoid personal criticism of any colleague who holds a contrary view.