Medco is a new entrant to the personal injury topography, launched in 2015. The Medco website can be found at http://www.medco.org.uk/home/. The Government launched Medco because it was of the view that too many law firms were so close to their experts that medico-legal reports, specifically in the whiplash arena, were lacking in their independence. The Government was of the view that poor quality medico-legal reports contributed to increasing cost of car insurance.
In simple terms, Medco is supposed to introduce a degree of randomness to the selection of medical experts, as well as providing some light regulation of Medical Reporting Organisations (MROs) otherwise known as “Medical Agencies”.
The Ministry of Justice (MOJ) established Medco following discussions with the various interested parties – organisations representing Claimants, insurers and MROs. Changes were made to the Civil Procedure Rules in order to accommodate Medco.
The Medco board is made up of an independent chair and one representative appointed by each of the founder members who are:
- the Association of Personal Injury Lawyers (APIL)
- the Law Society
- the Motor Accident Solicitors Society (MASS)
- the Motor Insurers’ Bureau (MIB)
- the Forum of Insurance Lawyers (FOIL)
- the Association of British Insurers (ABI)
- the Association of Medical Reporting Organisations (AMRO)
- the British Medical Association (BMA)
- the Chartered Society of Physiotherapists (CSP)
What is the definition of a soft tissue injury claim under the Protocol?
Essentially under the Pre-Action Protocol for Low Value Personal Injury Claims in Road Traffic Accidents, a Medco report must first be obtained in all soft tissue injury RTA claims. In practice, insurers and Claimant solicitors often depart from the scheme in the event that a Medco report would be a waste of money and time and there is agreement.
As per the Protocol: ‘soft tissue injury claim’ means a claim brought by an occupant of a motor vehicle where the significant physical injury caused is a soft tissue injury and includes claims where there is a minor psychological injury secondary in significance to the physical injury.” 16A.
The Protocol demands that in a “soft tissue injury claim” from an RTA that the first medical report must be a fixed cost (the fixed cost is set at £180) medical report from an accredited medical expert selected via the MedCo Portal.
Medical Agencies (MROs) and expert registration and accreditation
How Medco operates has changed since its inception. From mid-2016 medical experts are required to be accredited – in that they need to have completed a course of training by that date.
Experts can register either as Direct Medical Experts (DMEs) or as Indirect Medical Experts (IMEs). If a user, such as a Claimant solicitor, undertakes a search for a medical expert, experts listed as DMEs will appear in the list. A user can then check their practising address. If the user opts to search for MROs and selects an MRO, the MRO will then appoint an IME from its panel. Most experts are registered as DMEs and are also on the panel of one or more MROs.
High volume, national MROs are eligible for Tier 1 status with Medco. The requirements for Tier 1 status include:
- a minimum of two years’ trading history as an MRO providing Medco compliant reports
- the capacity to process at least 40,000 medico-legal expert reports per year from an unlinked source
- a financial instrument of £100,000
- a Chief Medical Officer to ensure effective clinical governance
- a nominated Caldicott Guardian to ensure patient data is protected
MROs that don’t meet the above criteria will be entered into Tier 2.
Medco collects data from medical experts and MROs as part the Data Contributor agreement. This data is collected in order to allow Medco to monitor the performance of experts. In particular, Medco is trying to by identify experts whose reports show patterns of prognosis periods and numbers of conditions diagnosed, or requirements for treatment, that are irregular.
Medco tries to prevent claimant solicitors from selecting the same experts, by trying to add randomness into the selection process. In order to obtain more instructions, some medical agencies have been listing numerous shell companies. Medco has been removing many shell companies from the database.
Should a Claimant solicitor always use a Medco medical report for whiplash claims?
If it is clear to the Claimant solicitor that their client’s soft tissue injuries from a RTA are outside of the norm, then a prudent Claimant solicitor may ask the insurers whether a more specialist medico-legal report can be commissioned. For example, a Claimant solicitor might suggest to the insurers that a Consultant Orthopaedic Surgeon be instructed if it is likely that a Medco medical expert is likely to recommend the instruction of a Consultant Orthopaedic Surgeon, as this is likely to save the insurers time and money.