In matters of bodily injury, medical expertise is necessary for the assessment of the victim’s compensation.
What is a medical expertise? Why is this expertise important? How to defend yourself during an expertise? What recourse against a medical expertise?
What is a medical expertise?
The main objective of medical expertise is to assess all of the bodily injuries suffered by a victim.
It is up to doctors with a diploma in bodily injury compensation, whose mission is to rule on heads of damage attributable to the initial damage.
This examination is therefore necessary in order to qualify and quantify the damage suffered by the injured person since his accident.
In certain “benign” cases, the insurance will be satisfied with a documentary examination, in particular when the injuries consolidate without any after-effects within a period of less than three months.
In other cases, an expert doctor will therefore be called in.
It can be mandated by an insurance company or a court.
He carries out a clinical examination of the victim, takes note of the medical documents which are given to him and hears the verbal and / or written complaints of the victim.
The expert then makes his medical conclusions and sends a full report to the recipients (insurance companies, victim, or lawyer in the context of legal proceedings).
It is only in the context of a traffic accident caused by a third party that the medical expert is legally obliged to send a copy of his report to the victim.
In other cases, it is up to the victim to make the request to the insurance.
Why is this expertise important?
To submit his report, the medical expert must respond to the heads of mission addressed to him by insurance or the Court.
Among the heads of mission, we find the famous personal injury items, resulting from the DINTLIHAC nomenclature that the doctor must retain or reject and evaluate or even describe.
It is therefore only on the basis of the responses to the heads of mission and assessments of this expert doctor that the victim can then assess the financial compensation to be requested from the insurance, court, etc.
It is in this sense that medical expertise is the key to good compensation because without this expertise, neither the insurance, nor the lawyer or lawyer, nor the magistrate is in a position to know if such or such damage is properly assessed or is related to the initial damage (accident, assault, medical accident, etc.)
The medico-legal conclusions will be applied stricto sensu.
Example : A victim of a road accident complains of increased difficulty in the exercise of his profession (carpenter, plumber / electrician, sports educator, etc.) due to disabling consequences.
In many situations, this very significant damage is often not accepted by the expert doctor even if it was about complaints made by the victim during the expert opinion.
In the same vein, the assistance of a third person (human help), professional or family, the day after the accident to help the victim to accomplish a certain number of tasks such as dressing, washing, household chores , shopping, trips, etc. is often dismissed or undervalued during discussion with the expert physician.
Again, the period of sick leave attributable to the accident can be reduced by the expert who will consider that your state of health allowed you to return to work earlier …
Loss of income beyond the period of sick leave retained by the medical expert could therefore not be compensated!
A bad appraisal cannot therefore lead to a good compensation.
How to defend yourself during an expertise?
First of all, it is essential to have your entire medical file with you during this examination to avoid any discussion with the expert.
Then, it is important to think about writing a summary letter of complaints which will cover your entire journey from the event causing the damage (accident, assault, medical error), the consequences on your personal life (necessary human assistance, pain, psychological, sexual impact, impossible leisure activities, etc.) and professional.
Finally, the main advantage will be to be accompanied by an expert doctor who will defend your medical file against the expert appointed by the insurance or the Judge.
Note that in the context of a legal expertise, the insurance or the opposing party will send its expert doctor to represent its interests.
By going alone, you run the risk that the expert will only take into account the statements of the expert representing the opposing party!
This expert or victim doctor will ensure that your rights are respected and that all the prejudice items defined in the DINTILHAC nomenclature are kept in their upper range.
In order to defend yourself as well as possible, a prior appointment with this recourse doctor must be scheduled as soon as possible so that he can soak up your medical file and your complaints that he will put forward during the expert’s report. .
The better the expertise, the better the compensation for your personal and financial injury.
What recourse against a medical expertise?
It is possible to challenge medical conclusions that do not suit the victim either because the doctor has underestimated the damage or because he has failed to comment on other.
This dispute can be made either in an amicable or in a judicial context.
In an amicable context, it is possible to carry out a so-called contradictory medical expertise if the victim was alone during the first expertise.
Arbitration expertise can also be a good compromise since the expertise is entrusted to a medical arbitrator, deemed neutral, to settle the “dispute”.
Please note, in this case, make sure that the expert arbitrator is not part of the insurance network in question.
In a contentious context, a medical expertise may be requested from a judge before a court.
In this case, it is up to the lawyer to make the request.
In all cases, the assistance of an expert doctor is essential because it will be one of the safeguards of your rights.