Seminar written and presented by Angela Price-Stephens at the Trial Lawyers Association of B.C.

Medical Malpractice Conference, Maui, HI January 2014

WHAT LAWYERS LOOK FOR IN A MEDICAL LEGAL REPORT

Angela Price-Stephens, Murphy Battista LLP
Introduction
The outcome of a claim for personal injury is largely dependent on supportive medical expert
opinions rather than those witnesses who speak to the facts of what happened. A factual
witness will likely give the evidence as to how an incident occurred. It is the medical evidence
that will determine what injury, if any, was sustained, together with the condition and prognosis
for the plaintiff.
The plaintiff has the burden of demonstrating causation i.e. that the incident/accident or event
caused the injury or a particular constellation of medical problems. In order for the plaintiff to
succeed, it is not enough to demonstrate that the incident / accident may have caused the
problems. However, proof at the level of certainty is not required. It is sufficient that the
plaintiff demonstrate that the incident/ accident either:

probably caused the injury

likely caused the injury

more likely than not caused the injury

Similarly these terms will not meet the threshold:

may have caused the injury

possibly caused the injury

unlikely caused the injury

The plaintiff may also seek to demonstrate that she is experiencing ongoing problems related to
incident/accident, and that these issues are likely to continue into the future. The medical
expert can play a key role in providing clarification to the court on matters related to the
plaintiffs pre-existing, current and future condition.

Why Use Experts?

An expert is sometimes necessary to assist the trier of fact (the judge or jury). The expert
assists the court by offering an opinion in areas of expertise that is beyond the knowledge and
experience of the trier of fact. It is generally accepted that expert medical evidence is required
in cases involving standards of medical care or personal injury 1. Essentially, for a report to be
admissible it needs to meet the criteria of both necessity and reliability. This means that the
nature of the opinion must be deemed necessary in order for the trier of fact to understand
and weigh the evidence. The opinion set out in the report needs to be based on reliable
principles and methods of research and these principles and methods need to have been
reliably applied to the facts of the case at bar.
The expert may also act as consultant in an advisory capacity to the lawyer identifying the
anticipated problems in establishing liability and assisting with identifying all aspects of care
which may go to quantum, irrespective of whether a report is ever produced.
Whether the expert produces a report or not the true value of the expert lies in providing a
realistic, objective assessment of the issues and not bending too far to accommodate what the
expert anticipates the lawyer wants to hear.

The Medical Legal Report

Medical Legal Reports (MLR) are reports authored by a treating physician or other professional
as opposed to an Independent Medical Evaluation (IME) which is authored by an independent
expert who is specifically NOT treating the plaintiff. For the purposes of this paper I will use the
term MLR to refer to both independent and treating experts.
An experts opinion may be rejected when met with contrary expert opinion from either a
treating expert, or an expert who has been retained to conduct an IME. It is for the judge or
jury to decide whose evidence it prefers.
The courts have acknowledged that treating experts generally have much more experience in
treating the plaintiff before and after the injury, may be more sensitive to cultural issues, and
may have the advantage of having contact with family members, all of which may increase their
1 R. v. Mohan (1994) SCR 9

credibility with the court 2. Conversely, the courts have recognized that treating experts often
have long standing relationships with patients and this increases the risk that they take on an
advocacy role3, and they may tend to rely heavily on self-reporting by the patient 4.
In light of these competing factors, how well the MLR is written can have a substantial impact
on the court when determining which expert opinion it prefers.

What makes a good MLR?

1.

Conforms to the Rules of Admissibility

In order for the MLR to be admitted as evidence, it must meet the requirements of the Civil
Rules in the jurisdiction where the case is being heard. The rules vary between different
provinces, and it is important to confirm the specific requirements. Generally, the Civil Rules
require the following:
Name: The report must include the name of the person responsible for the report. This
requirement is aimed at group reporting, or where one person carries out part of the evaluation
and a second person carries out the balance resulting in different components of the report
being authored by different individuals. Multiple authors and/ or evaluators should be avoided
where ever possible as it may become unnecessarily complicated as to whose opinion is whose.
It may be that all authors of the report (not just the first named or senior author) may be called
to testify.
Qualifications: The report must include the qualifications of the expert. The use of letter
headed paper alone is insufficient 5 and neither is a Curriculum Vitae (CV) alone. It is best to
provide the report on letterhead, to include a statement of the experts qualifications within the
body of the report, and also attach a CV as an appendix. The statement of qualifications should
2 Chiu (Guardian ad litem of) v. Chiu (1999) Carswell BC 2028 (SC)

3 Lehtonen v. Marasco (2008) Carswell BC 2839 (SC)

4 Thiessen v. Kover (2008) Carsewell BC 1445 (SC)

5 Reid v Belcaen 2003 BCSC 1450 para 11

include the nature of practice, recognized specialist and sub-specialist qualifications and length
of experience in the area of practice relevant to the opinion. The qualifications and experience
of the expert is likely one of the most persuasive variables considered by the court when
determining whose opinion in favours.
Facts and Assumptions: The MLR needs to include a list of Facts and Assumptions upon which
the opinion is based. This criterion gives rise to the most challenges. A skilled expert will list
all relevant facts and assumptions relied upon in giving their opinion, while avoiding the
inclusion of excessive or irrelevant information. The expert should not attempt to give a final
determination of the facts themselves 6. It is not the role of the expert to convince the court to
accept or reject the facts and assumptions. Rather, the facts and assumptions must be clearly
stated in the report, and it is left to the court to assess whether all the facts and assumptions
have been (a) proved and (b) carry weight in supporting the opinion.
Duty to Court: The report must include a statement confirming the experts duty to the court to
act as an unbiased expert and not an advocate for any party. The expert is expected to not only
formally state this duty in their report, but to also comply with the duty of objectivity and
impartiality throughout the body of the report and during any court testimony. If an expert is
found to be an advocate for one side or the other, the report will be given little weight or may
be inadmissible7.
Documents Reviewed: The report needs to include a list of documents reviewed, including all
documents referred to within the body of the report.

2.

Includes Patient History

The expert needs to take a complete history as it relates to the injury(s) claimed, including preexisting conditions. In preparing the MLR, the expert should not spend time on irrelevant
conditions, but just note them for completeness and move on. GPs have a particularly tough
time in producing MLRs due to the many sources of information that they have available to
them, which is often a mixture of hearsay, specialist opinions, etc.
Where an expert has failed to take into account the complete medical history and clarify the
source of the information, the weight of the experts report is undermined. On the other hand,
6 Yewdale v. ICBC (1995), 3 BCLR

7 Shobridge v. Thomas et al. (1999) Carswell BC 1747

obtaining a complete history does not mean that the expert is required to delve into the
minutia of the plaintiffs life. Taking an overly zealous history taking is inappropriate, as
articulated by Weatherill J. in the recent BC Court decision (Thibeault v. MacGregor)8:
[95] Counsel provided detailed written submissions on the issue of the Vondette
Reports admissibility. I agree generally with the submissions of plaintiffs
counsel. Dr. Vondettes report is prolix in the extreme. Dr. Vondettes review of
the plaintiffs background was beyond thorough and comprehensive - it reported
the minutia of the plaintiffs social, family, psychological and medical history.
It is important to note that even if the expert becomes aware of a plaintiffs history at trial (long
after taking the history and preparing the MLR), the expert can still maintain credibility, as
noted in the Thibeault decision9:
[64] Dr. Reeves was a delightful, knowledgeable, candid and helpful expert
witness. I have no difficulty accepting her opinions and recommendations, which
did not change when she was made aware of the plaintiffs prior family history,
medical issues and drug use.
3.

Grounded in Thorough Assessment and Good Notes

The expert should undertake an appropriately thorough assessment (where appropriate)

including obtaining a detailed and accurate history. The notes and clinical records will be
ordered for review by the lawyers at some point in the litigation process. The expert who takes
a complete and accurate history and then compiles this information into clear and organized
notes gains credibility as an objective and impartial expert. Similarly for IME experts, their
notes need to be complete, balanced and open minded, not only taking note of complaints
from the plaintiff that support their claim but relevant comments that may not be so
supportive. Irrespective of whether a physical examination is appropriate or not in making an
assessment of the plaintiffs condition is essential that the medical expert consider the full
range of possible diagnoses and indicate why the conclusion reached is the most reasonable
option. This strategy will encourage the trier of fact to trust the experts opinion, which will
ultimately make their opinion more persuasive.

8 Thibeault v. MacGregor 2013 BCSC 808 (CanLII) [Thibeault]

9 Thibeault, supra.

4.

The Expert Has Read Everything

When provided with information about the patient from the referral source, it is important that
the expert has actually read it all. An expert who fails to read all of the information provided
may miss an important detail, which will undermine the credibility of their report and opinion.
The expert should review all documents again if required to testify in court. It is incumbent
upon the expert to ensure they have a full understanding of the facts available to them.
In the Smith v. Moshrefzadeh10 decision, the trial judge rejected the orthopedic surgeons expert
report and testimony, partly because of his failure to carefully review the documents:
Dr. Wahl clearly had not reviewed Ms. Smiths medical records as carefully as the
other expert witnesses and as I mentioned earlier his report was predicated on a
misconception as to the timing of the onset of Ms. Smiths symptoms. Given the
significant concessions he made in cross-examination and the Courts impression
that he displayed a somewhat compromised objectivity in preparing his report, I
consider it unsafe to rely on his opinion.

5.

Stays Within Scope of Expertise

It is important that the expert not express opinions outside of his area of expertise and/or
experience. Common mistakes include:
a. physicians opining outside their medical discipline and specialty;
b. therapists opining on diagnosis or prognosis; and
c. experts trying to take on the role of lawyer or using legal terms

In the Thibeault case, the trial judge was highly critical of an expert Physiatrist, who claimed an
overly wide scope of expertise:
[100] Dr. Vondette pontificated throughout his testimony regarding the virtues of
his specialty and his experience within it. In addition to the field of physiatry, he
apparently views himself as having bountiful knowledge in other specialties in
which he has no formal training, including psychiatry, psychology gynecology,
physiotherapy, family medicine, social work and occupational therapy. He

10 Smith v. Moshrefzadeh 2012 BCSC 1458 (CanLII)

testified that his expertise is such that he tells physiotherapists exactly what I
want done.
MLRs can be undermined by more subtle issues related to scope of practice, such as outlined in
the decision in Smith v. Moshresfzadeh11 where the trial judge stated the following about the
opinion of an orthopedic surgeon:
Each of the doctors persuasively discounted Dr. Wahls opinion that the
degeneration of Ms. Smiths cervical spine shown on her x-rays is the cause of her
current symptoms. While Dr. Wahl is no doubt a well-qualified orthopaedic
surgeon, his practice is focused on the surgical management, not the medical
management, of the spine. (para. 62)
If in doubt, the expert may wish to express his opinion but state that he would defer to a
specialist (and state the specialty deferred to). For example, a physiatrist may feel compelled to
comment on what may appear to be obvious signs of depression and/or anxiety in the patient
he is assessing. He may state the patient appears depressed but defer to a psychiatrist and
recommend such an assessment take place.

6.

Clear Report Format

A well-structured, clear, concise MLR that is free of errors facilitates structured thinking and
assists the lay readers comprehension. An appropriately formatted report is ultimately more
professional and thus more persuasive. Choose a black font that is simple and at least 12 point
size, use 1.5 line spacing when possible, and avoid long paragraphs of text. Include report
section headings and do not be afraid to some white space between sections of the report. The
report should avoid repetition of information.
The Courts have been clear that the author should avoid excessive use of bold font and
underlining of the body of the report. If the author regards a particular fact or issue of great
importance, simply state it to be, rather than using other methods to bring attention to
particular words or phrases. In the case of Warkentin v. Riggs12, the trial judge expressed
frustration with an experts report format as follows:
11 Smith v. Moshrefzadeh 2012 BCSC 1458 (CanLII)

12 Warkentin v. Riggs 2010 BCSC 1706 (CanLII)

He uses bold font to highlight words and phrases which benefit the plaintiffs
claim and support his diagnosis. This is apparent in his review of Ms. Warkentins
history and medical reports. That which is contrary to the plaintiffs claim or
does not support his diagnosis is either omitted or presented in non-bolded font.
This emphasis in support of the plaintiffs claim and the exclusion of contrary
matters is advocacy.
Attached as appendix A and B are two examples of report formats. Appendix A is a more
generic format. Appendix B is geared more towards family doctors who generally have a
tougher time producing concise reports due to the potentially wide variety of sources of
information, the duration of time treating the patient and the range of differing issues
presented to him by the patient. As with all precedents these are to be treated as an aid to the
preparation of a concise well-written report, to be modified where appropriate. I will note
however that some of the best experts who produce consistently excellent reports use the same
format on each occasion.
For particularly lengthy reports where there may be a complex medical history and/or more
than one alleged negligently caused injury (such as an MVA client later suffering alleged
negligence at the hands of their treating doctor) an executive summary set out early on the
document may make a potentially overwhelming report more manageable for the lay trier of
fact. In any event a well written, logical conclusion is essential to the report.

7.

Includes Full Disclosure

An experts report should disclose all meetings and assessments of the patient, or else the
expert risks appearing impartial or selective in what information was disclosed to the court. It is
also important for the expert to fully disclose their own conflicts, ownership, interests, etc. to
maintain objectivity and credibility.
In the case of Rizzolo v. Brett13, an expert who conducted a Functional Capacity Evaluation was
harshly criticized by the trial judge for failing to disclose his proprietary interest in one of the
tools (FAB) he used in his assessment:
[98] Initially, I was impressed by Mr. McNeils apparent sincerity and competence
and his enthusiasm for motion capture as an objective addition to what is
otherwise a subjective evaluation of an individuals functional capacity.
13 Rizzolo v. Brett (2009) BCSC 732 (CanLII)


[102] Mr. McNeil was compelled to reveal at the end of his cross-examination,
that he has a proprietary interest in, and is the President and sole director of
Biosyn Systems. Biosyns website provides Mr. McNeils e-mail address and
advertises its applications in the areas of rehabilitation, industrial, and sports
medicine. It makes the following promise:
Whether performing repeat tests over the course of a rehabilitation
program or performing a single capacity evaluation, FAB will make
your testing more accurate and reliable, will score all of your tests,
and produce a report for you faster.

[105] I consider Mr. McNeils failure to disclose the fact that he is the principal of
Biosyn and that he was an inventor of FAB to represent a shocking lack of
candour. As he has testified in the courts on numerous occasions, he is well
aware that the duty of an expert is to assist the court with an independent and
objective opinion on a particular issue. To withhold such relevant information
misleads the court and, as I have no choice but to reject all of his written and
verbal evidence, constitutes a substantial waste of time. It is impossible to parse
out Mr. McNeils evidence as a qualified expert from that as an undisclosed
salesman for Biosyn.
Full disclosure also includes a duty to the court to disclose changes in the experts opinion or
report that have been influenced by outside factors, including those that may undermine
objectivity.
In the case of Lower v. Stasiuk14, a Psychiatrist prepared a report for a litigant in a family law
matter, but then edited the original draft on significant matters that impacted on the outcome
of the case and the expert was later named in the appeal. In the original case, the trial judge
stated the following about the experts evidence (para. 27):
I do not accept the evidence of Dr. H* He is truly an advocate and appears to be
prepared to do or say whatever is necessary to assist his client, even if it means

14 Lower v. Stasiuk 2013 BCCA 389 (CanLII)

attempting to destroy the reputation of Dr. C* and even if it means allowing the
defendants mother to edit his letter of support for the defendant.

8.

Provides Well-reasoned Recommendations

One purpose of a MLR is to guide the lawyer in ensuring that the client receives appropriate and
timely care. This is essential to ensure that the client takes all reasonable steps to mitigate their
loss which they are obliged to do (quite apart from the genuine desire to make as good a
recovery as possible). While skilled and proactive plaintiff counsel will take the initiative and
find the best experts to assist with the case, it is the expert who must drive the treatment plan
with recommendations. Caution: recommendations may become a double edged sword. For
example, if an expert were to clearly and unequivocally recommend surgery and the plaintiff
(for whatever reason) elects not to proceed with surgery there is a risk to the client that she
may be found not to have mitigated her loss. It is essential therefore those words are chosen
carefully. In this example, ask yourself: is it more reasonable to recommend a consultation with
a surgeon than it is to recommend surgery? Often further testing and imaging is required
before such a recommendation can be made. For a surgeon making such a recommendation,
he should choose his words even more carefully. No surgery is without risk. For a patient who
has already suffered injury (maybe at the hands of a physician) it is a big step to consider such
invasive treatment which may or may not be successful. There is never a guarantee of success.
Accordingly I encourage many such physicians to couch such intrusive recommendations in
terms of Ms. X may wish to consider surgery on her shoulder which would be expected to have
reasonable prospects of resolving a majority of her symptoms but does carry the risk of [list
them]. There may also be a small risk of worsening the pain.
For an expert (especially an occupational therapist) is in important to include only medically
justified recommendations and reasonable costs in their report.
With respect to
recommendations for future care, medically justified is the standard, as opposed to medically
necessary (which is a higher standard) 15 and it is essential that the expert understand this
distinction. While it is important to recommend items that place the plaintiff back in the
position he would have been had the injury not occurred, the weight given to the experts
report will be undermined by straying from medically justified recommendations, and including
unnecessary or overpriced items. An overly generous approach is particularly harmful to the
experts credibility when the lawyer who hired the expert states, as in Rizzolo:

15 Brennan v. Singh (1999) BCJ No 520 (SC (QL)

[112] Mr. K* readily conceded that numerous items are either unnecessary, such
as a cane, bath seat, and assistance with household moving; or are overpriced
such home management assistance at $70 an hour.

9.

Chooses Words Wisely

Loaded Words: It is important that the expert avoid the use of loaded or charged words.
For example, statements such as he claims to have pain versus complained of pain versus
had pain leave very different impressions.
Commenting on Motivation: Comments by an expert regarding lack of effort and motivation by
the plaintiff may be interpreted as malingering, even if that was not the intent of the expert.
There can be many causes for lack of motivation and lack of effort, including depression,
anxiety, pain (or a host of other variables). No matter what the underlying cause an experts
comment about lack of effort or motivation almost certainly will be painted as malingering by
defence.
Entitlement: It is essential that the expert avoid commenting on entitlement issues as opposed
to clinical issues. Engaging in commentary on entitlement issues puts the expert at risk of being
considered an advocate which will undermine the weight of the opinion and report. For
example, use of phrases such as the plaintiff deserves (or doesnt deserve) or should receive
(or should not receive) are not acceptable. It is also inappropriate for experts to comment on
the credibility of a witness (positive or negative) or provide editorial comments 16. It is the role
of the trier of fact to determine the credibility of the witnesses, including the plaintiff.
In the Thibeault decision, the expert Physiatrist was criticized for overstepping the role of the
impartial expert as follows:
He opines on matters that have no relevance to the plaintiffs claim in this
proceeding: He overreaches into the areas reserved for the trier of fact. He makes
remarks that go solely to the plaintiffs credibility. His report in many places is
argument in the guise of opinion (para. 95).
Medical Terminology: Medical experts will likely need to include medical terminology and
concepts in their reports. Make sure to provide definitions of medical terms and explain the
medical concepts in the report. The goal of the report is to assist the trier of fact (judge or jury)
who lack medical expertise. Some of the best reports are those that use the correct term and
16 Campbell v. Sveinungsen (2008) Carswell BC 619

put in brackets a laymans term. Alternatively, use a key at the end of the document. Either
approach can greatly assist the lawyer in persuading a court that the medical and scientific
content of the evidence can be understood by a jury (when defending an application by defence
to strike the jury).
Write

it so your grandmother can understand it

10. Avoids Raising the Bar

In cases where the expert is providing an opinion on medical standards of care, it is

inappropriate for the expert to attempt to raise the bar or suggest a standard beyond that
which exists. If the expert views their role as trying to improve the standards of medical care or
espouses an unrealistic standard of perfection, the expert may be viewed as an advocate by the
court. Where a patients care involves multiple physicians and/or medical care over a long
period of time it can be helpful for the expert to acknowledge when the standard has been met
and not just when the standard was not met. This will make the evolving story/facts clearer for
the trier of fact, assist them to focus on the real issues and will assist the expert gain credibility
as an objective expert.

11. Open Communication with Instructing Lawyer

Open communication mean that the expert is willing and available to speak with the lawyer
who has requested the report. A ten minute telephone call prior to writing the report can make
the difference between producing a report which covers all issues required for the litigation in
the correct terminology, versus producing a poor report (the draft of which will also become
discloseable during the course of the litigation). A poor draft is a breeding ground for damaging
questions for defence counsel to pepper the expert with in the witness box.

Summary:
The most important considerations by the court are the objectivity and knowledge of the
expert. An expert who takes an even handed approach to the plaintiff and to the evidence will
enhance their credibility and long term reputation. Sympathy and empathy for an injured
individual is a valuable quality but no competent plaintiff lawyer wants to retain and be guided

by an overly pro-plaintiff expert. No competent lawyer wants to receive an obviously proplaintiff report. The advocacy must be left to the lawyer.

WHAT LAWYERS LOOK FOR IN A MEDICAL LEGAL REPORT

Angela Price-Stephens, Murphy Battista LLP
APPENDIX A GENERAL OUTLINE FOR MLR
Provide report on letter headed paper.
Addressed to lawyer requesting report (not the court)
Identify the client name, date of birth and date of injury

Dear Ms. Price-Stephens

Thank you for asking me to see Mr. X to conduct a medical legal assessment.
I hereby certify that I am aware of the duty referred to in Rule 11-2 of the BC Supreme Court
Civil Rules and that my report was made in conformity with that duty, and that, if called on to
give oral or written testimony, I will give that testimony in conformity with that duty.
I provide this expert opinion in the field of [state the specialty]
The opinions in this report are based on my assessment of Mr. X on [date] and the records
provided to me by your office.
My history and assessment findings are set in in Appendix A.
The list of records provided by your office is set out at appendix B. [list everything sent; if
certain records were deemed not relevant indicate this to be the case in the appendix]
My notes from the review of the clinical records provided to me by your office are set out in
Appendix C.
You have asked me to provide an opinion on the following:
[list questions in letter of instruction]
Your letter of instruction to me is attached at Appendix D.
I am the sole author of this report and responsible for the opinions expressed. I reserve the
right to update or change my opinion in the event of further information becoming available
to me.
QUALIFICATIONS AND EXPERTISE
[set out in detail] I attach a C.V for your reference.
FACTS AND ASSUMPTIONS
[Set these out in brief numbered paragraphs these will include pre-existing conditions which
may be relevant, injuries outlined in clinical records, the course of treatment including imaging
etc].
OPINION

Based on my assessment of Mr. X and the specific facts and assumptions listed it is my opinion
that he was injured in the [MVA/surgery/fall etc.] on [date]. Those injuries include:
[set out the injuries in numbered paragraphs]
STANDARD OF CARE
CAUSATION
RECOMMENDATIONS
[set out the recommendations in numbered paragraphs]
Yours faithfully,
[dont forget your invoice!]

WHAT LAWYERS LOOK FOR IN A MEDICAL LEGAL REPORT

Angela Price-Stephens, Murphy Battista LLP
APPENDIX B GENERAL FAMILY DOCTOR OUTLINE FOR MLR
Provide report on letter headed paper.
Addressed to lawyer requesting report (not the court)
Identify the client name, date of birth and date of injury

Dear Ms. Price-Stephens

Thank you for asking me to see Mr. X to conduct a medical legal assessment.
I hereby certify that I am aware of the duty referred to in Rule 11-2 of the BC Supreme Court
Civil Rules and that my report was made in conformity with that duty, and that, if called on to
give oral or written testimony, I will give that testimony in conformity with that duty.
I provide this expert opinion in the field of [state the specialty]
The opinions in this report are based on my consultations with Mr. X since he first became by
patient on [date]. I also asked Mr. X to attend my office on [date] for an assessment in
preparation for me preparing this report. I have also considered the records provided to me
by your office. Those records are listed at Appendix A.
You have asked me to provide an opinion on the following:
[list questions in letter of instruction]
Your letter of instruction to me is attached at Appendix B.
I am the sole author of this report and responsible for the opinions expressed. I reserve the
right to update or change my opinion in the event of further information becoming available
to me.
QUALIFICATIONS AND EXPERTISE
[set out in detail] I attach a C.V for your reference.
FACTS AND ASSUMPTIONS
[Set these out in brief numbered paragraphs these may include pre-existing conditions which
may be relevant, the course of treatment including imaging etc. It is not necessary to list every
appointment as these are set out in your records.
Often the two most important reasons a family doctor is required to provide a report and/or
give evidence is 1. To confirm when the plaintiff first made complaint of injury and what the
nature of those complaints were and 2. To confirm that the plaintiff has no pre-existing injuries
which could reasonably be expected to interfere with his/her ability to be independent and/or
work. Bear this in mind when preparing your report. Set this out clearly and you are much less
likely to be called to give evidence at trial.
OPINION

Based on my knowledge of Mr. X and my recent assessment of my patient and the specific
facts and assumptions listed it is my opinion that he was injured in the [MVA/surgery/fall etc]
on [date]. Those injuries include:
[set out the injuries in numbered paragraphs]
STANDARD OF CARE [if requested]
CAUSATION [if requested]
RECOMMENDATIONS
[set out the recommendations in numbered paragraphs. If you wish to defer to specialists or be
guided by the specialist involved state this to be the case.]
Yours faithfully,
[dont forget your invoice!]