Sometimes the medical evidence does not speak for itself, and, whether at Court to prove damages or for an appeal of a denial of a disability claim, you need an expert medical opinion. Usually referred to as a medical-legal report, this document is prepared by a health professional and provides medical opinion evidence for use in a legal case. It is an exception to the rule that opinion evidence is generally inadmissible. Since there are certain things the trier-of-fact (judge or other decision-maker) cannot reasonably be expected to understand without the assistance of someone skilled in a recognizable area, the opinion evidence of a medical expert helps the trier-of-fact make sense of and understand the significance of the medical evidence.

To get a medical-legal report, you need:

• an expert

• an idea of what you need their evidence to prove; and

• a carefully-drafted letter requesting the report, with instructions and questions.

An ideal expert is speaking to their specialty, treating you and available. Experience writing medical-legal reports and strong communication skills are also good. However, most people aren't lucky enough to get their ideal expert. Most people must settle for either their family physician or a specialist who hasn't treated them yet. Each option has advantages and disadvantages. A rare condition is probably better served by a specialist, but a long-lasting medical condition with a history, and complicated by life circumstances might be better served by your family physician. Not all physicians charge for a report, so asking upfront can help you choose.

Prior to writing your letter requesting the report, check to make sure it's going to be helpful to your case. You can't hide damaging facts, but you don't have to do the other side's work for them. And once the expert's opinion is in writing, it's likely disclosable (meaning the other side has the right to see it), so you don't want it to be harmful to your case. You will also need to know the issues of your case, or what you need the report to prove. For example, the existing medical evidence may be contradictory, so you need the expert to explain why. You may need to prove that you not only have a medical condition, but that it has impaired your ability to do your job. It's a good idea to talk to your expert to discuss their opinion before committing it, and your request, to writing.

Take some time to write the letter requesting the report - it will determine the quality of the report, as well as being a disclosable document itself. Write like an outside observer, disinterested in the outcome of the case. Be as objective as possible, to better elicit objective and therefore credible answers.

Start with a concise introduction: briefly frame the issue, the proceeding and request their medical opinion, giving them the date by which you need it. You will have already worked this out, but keep in mind that most physicians spend most of their time treating patients and not writing reports. Start this process as early as possible.

Next, provide a brief factual background (chronological, numbered, single-fact paragraphs) for the expert's convenience, as well as so the factual basis of the report is known. If the expert relies on facts not listed there, ask them to include those in their answers. Include all the existing, relevant medical records but don't include any facts that are in dispute, since if you can't prove the disputed fact, it can call the whole report into question.

One last thing before getting to the questions is to ask your expert to acknowledge their role in writing the report, which is to assist the trier of fact and not to advocate for their patient. This is especially important when your expert is your longtime and supportive family physician. A supportive opinion is less helpful than an objective one. If this report is for Court, it may need to have this statement (check the Rules of your Court).

In the first question, ask the expert to provide their qualifications that allow them to write the opinion (profession, credentials, experience, publications, etc). The more these align with the specialty of the opinion, the better. Also ask how long they've been treating you, if this is one of your treating physicians. If your expert is a generalist, the length of time dealing with the issue can win back credibility from not being a specialist, so highlight it.

Know every point you need the report to make and then plan your questions accordingly. Make sure your questions cover every point needed, but keep each question focused on a single point. You don't need to "lead" your witness (the expert) by including your desired answer in the wording of your question. You know the evidence and you already know the opinion. Focus on keeping questions neutral, open and organized. Ask questions that show your doctor is using medical judgment rather than parroting your words, and always ask for the reasons or basis for their answers. Word questions in such a way as to elicit objective and specific, rather than supportive and sweeping, answers. Organize your questions from shorter, simpler questions (for example, diagnosis) to longer, more complex questions (for example, causation). If you have many questions, consider using headings to keep things organized. You want to make the whole request as easy to read as possible.

A medical legal report is usually only as good as the letter requesting it. Start early, and take time and care in crafting something that adds to the credibility of the report, so that you can prove your case.

And if you still need help, you can have a legal coach review your work to make it the best it can be.