The decision reinforces the value of scrutinising subsequent medical reports in OIC claims, particularly where the justification for specialist reports is weak or absent.
Background
The claim arose from a road traffic accident pursued by the Claimant's representatives through the OIC process.
The following medical evidence was obtained by the Claimant's representatives:
- GP report
- Neurology report
- Psychology report
The matter settled pre-litigation for £3,900.00.
The insurer disputed the fees for the neurology and psychology reports on the basis that they were unnecessary and unreasonable:
- The neurology report (£4,435.00) was challenged because the Claimant's hand tremor – identified months after the accident – was unrelated to the index accident.
- The psychology report (£990.00) was challenged because the GP expert had already provided a five-month prognosis for minor psychological symptoms, with no evidence of ongoing issues beyond that point.
DWF maintained the insurer's position and prepared submissions for an RTASC O Hearing, which took place before DDJ Hennessy.
The Court's findings
DDJ Hennessy accepted that the neurology report had been recommended by the GP, and therefore the Claimant's solicitors would have been negligent not to follow that recommendation. However, the Judge agreed that the fee claimed was excessive.
The neurology report fee was therefore reduced from £4,435.00 to £750.00. A reduction of over 80% for this fee alone.
The psychology report fee was disallowed in full. The Court found that:
- There was no clear recommendation for psychological assessment.
- The GP's prognosis indicated that symptoms would resolve within five months, if symptoms had persisted beyond that period, the Claimant should have returned to the GP for a follow-up report rather than commissioning a new expert.
This aligns with the principle that medical evidence in OIC claims must be proportionate, justified and sequential.
The Claimant's costs of the RTASC O Hearing were limited to Small Claims Track costs of £80.00 plus the Court fee of £313.00. These modest sums were far outweighed by the savings achieved.
Why this decision matters
This outcome provides several key takeaways for insurers:
Scrutiny of subsequent medical reports is essential – particularly where symptoms fall outside of the expected prognosis or where causation is questionable.
- Proper recommendations remain central to determining whether further reports are justified.
- Specialist reports must be proportionate to the nature and duration of symptoms.
- Courts are willing to reduce or disallow fees where reports are unnecessary, excessive, or unsupported by the initial report.
This decision reinforces the strategic value of challenging unjustified, disproportionate medical evidence in OIC claims.
