Medical assessment in a personal injury claim: who examines which question?
Human legal and translation review is still pending.
You may encounter a treating professional, medical adviser and independent expert during a claim. They have different tasks. Understanding these differences explains information requests and what reports establish. This guide follows practical decisions about questions, targeted records, discussion, expertise and translation into losses. You need not become a doctor or lawyer to ask for clear explanations.
In this guide
- Map the roles first
- Formulate the question before collecting papers
- Consent should relate to a clear purpose
- Read advice alongside the original question
- When independent expertise may help
- Prepare without rehearsing answers
- Translate medical findings into concrete losses
- Keep planning, costs and final decisions visible
Map the roles first
Your treating professional focuses on healthcare. A medical adviser evaluates health information for the injury process. An independent expert may investigate a specific question when existing information is insufficient. The claims handler has another role again. Ask who performs each task, for which party and through whom you may raise questions. These distinctions make a complicated process easier to follow.
For example, make a small list of names, organisations, tasks and contact routes. Do not put diagnoses in a shared general contact list. When advice is offered, ask in which capacity. A comment on suitable work may serve a different purpose than an opinion on permanent consequences. One document should not silently replace every investigation your case may require.
| Role | Main question | A question you can ask |
|---|---|---|
| Treating professional | What healthcare is needed? | What does this mean for treatment? |
| Medical adviser | What do the records mean for the claim? | Which question remains unanswered? |
| Independent expert | What specific issue needs investigation? | What question has been agreed? |
| Legal representative | What do findings mean for the claim? | How do they enter the loss calculation? |
Formulate the question before collecting papers
The Dutch Personal Injury Council describes questions about injury, connection, limitations and expectations. Your file needs clarity on the issue currently requiring attention. Is uncertainty about symptoms, recovery or a restricted activity? A specific question prevents everyone waiting for a complete file without explaining what is missing.
Request an overview of available information and open points. This may be practical: a treatment letter exists but does not address a recent functional change. A targeted addition may suffice. Do not collect large quantities of historical records simply because more seems safer. First discuss what an addition may clarify and who decides whether it is necessary.
Consent should relate to a clear purpose
KNMG explains explicit consent and targeted questions when treating doctors respond to insurance medical advisers. Read authorisations for purpose, providers and period. Request explanation of unclear scope. Giving consent is not merely a box to tick quickly to move forward; it belongs to an understandable information request.
Keep the signed version and identify its recipient. Ask how you learn what information was actually received and who assesses it. Do not send medical attachments through tools or contact forms on this website. An innocent scheduling enquiry often needs only a reference number. Careful sharing and efficient claims handling need not conflict.
Read advice alongside the original question
Medical advice becomes clearer when its question and source records are known. Ask what conclusions rely on and what remains uncertain. A report may describe limitations without deciding legal attribution or all financial effects. Check its scope before treating a single sentence as the final opinion on the whole case.
Check hours, dates and described activities and identify missing explanations. You need not rewrite medical terminology. Distinguish verifiable factual mistakes from professional assessments needing a further question. Keep your response with the original advice. Later it will show what was clarified and which disagreement truly remains.
When independent expertise may help
The Council explains that expertise can arise where specialist knowledge is needed or medical advisers remain in disagreement. New investigation should address an identified problem. Ask what existing evidence cannot answer. Investigations can involve time, money and personal burden. More testing is not automatically better when the decision it enables remains unclear.
Discuss expertise, questions and selected records before agreeing. Ask about your participation and reporting arrangements. Where parties organise an examination jointly, clarify agreements first. Have the representative explain the agreed significance of the result. Do not assume every report is automatically binding or merely optional.
Prepare without rehearsing answers
Take a short timeline and important daily changes. Answer honestly and identify what you do not know. Expertise is neither a job interview requiring your strongest appearance nor a performance of only your worst day. Specific balanced examples are more useful than conclusions borrowed beforehand from websites.
Ask about companions, breaks, accessibility and explanations in a language you understand well. Do not search for medical test answers to steer responses. If the examination raises a healthcare need, discuss that with your treating professional. A claims examination does not replace treatment and should not be the sole setting where symptoms receive attention.
Translate medical findings into concrete losses
A functional impairment percentage is not the same percentage of salary or an automatic pain and suffering award. Financial effects depend on work, family, assistance and other circumstances. Ask what translation is needed. One claim may require vocational assessment; another requires examination of home support. Identify the expertise responsible.
Use a concrete example during discussion. A restriction may affect a particular task, but what change in time, support or income follows? Making these steps visible lets you check calculations without redoing medical assessment yourself. Keep payments and services recorded separately. The same cost must not unintentionally be added again under different names in the overview.
Keep planning, costs and final decisions visible
After each phase, ask what happens next, who undertakes it and which information is needed. An agreed date may simply be a practical progress arrangement rather than a statutory deadline. Also record who monitors legal periods. Waiting for medical recovery or a report does not automatically mean every entitlement is protected in the meantime.
Before investigation, discuss costs and what happens if the insurer does not accept the full bill. Remaining uncertainties belong in settlement discussions. A final medical state is not synonymous with no symptoms. Ask what expectations and future risks the proposal includes and what rights a definitive agreement may surrender.
Frequently asked questions
Is my treating doctor also my medical adviser?
These roles differ. Treatment provides care; medical advice evaluates information for the claim. Ask the role and question before treating a statement as a complete legal opinion.
Must I agree to every new examination?
Request explanations of purpose, necessity, burden and cost and discuss doubts. This website cannot determine consequences of refusal; those depend on the particular request and file.
Can I point out factual mistakes in a report?
Yes. Identify passage and incorrect fact. Distinguish correction from disagreement on expert conclusions. Ask how your response enters the further process and preserve originals.
Does an invalidity percentage determine compensation?
Not directly. Personal circumstances, income, assistance and other effects require comparison. Ask how findings enter each loss category and what assumptions are used.
Must my treating doctor give the insurer a prognosis?
KNMG distinguishes factual information from an assessment or prognosis for an insurer. With explicit permission, the treating doctor can answer specific factual questions; an insurance prognosis is not part of that disclosure. Ask which medical adviser or expert investigates the assessment question.
Sources for this article
This information concerns Dutch law. Consult the source for current guidance and seek advice about your own situation if you are unsure.
Dutch Personal Injury Council: medical assessmentKNMG: information supplied to an insurance medical adviserGeneral information. This does not replace individual legal advice.
Back to the knowledge baseLegal review
Not legally reviewed yetThis version has not been reviewed by a lawyer or legal professional. Checking sources or editing text is not legal approval.
Editorial team Letselschade in Nederland
We connect explanations to sources and record targeted changes. Legal review is attributed only to the actual reviewed version, with a real reviewer, date and scope. Human legal review of these articles remains open.
Ricardo van der Spoel
Editorial responsibility · Editorial organisation and technology