Requesting a medical assessment is a crucial step when someone suffers bodily injury, disability, or after an accident. The purpose is to obtain an independent evaluation of the person’s health and any lasting effects to file a claim or prepare for litigation. In Quebec, this medical assessment will be decisive in defining the patient’s rights and the role of the lawyer or medical expert. Our health law attorneys explain everything.
What is a medical assessment: definition
A medical assessment is an evaluation carried out by a medical expert who is commissioned to write an independent expert report. Its purpose is to analyze a medical file, make a diagnosis, determine functional limitations, assess the after-effects, and make recommendations. The medical expert acts impartially; they do not replace the attending physician, but offer an external perspective on the condition of the person being assessed. This expert report may be used in litigation before administrative or civil courts. Under Quebec law, a medical assessment may be ordered by a court or requested by a party in liability proceedings.
When is it necessary to request a medical assessment?
A medical assessment may be requested in various scenarios:
- After a workplace accident or occupational illness, under the CNESST, when the employer or the CNESST requests an independent opinion on the diagnosis, consolidation, permanent impairment, or functional limitations.
- Following a traffic accident, in an SAAQ case, to assess the sequelae, the ability to return to work, or the quality of life in relation to psychological or physical impairment.
- In the event of medical malpractice or bodily injury, when it is necessary to establish a link between the alleged error of a healthcare professional and the patient’s medical condition.
- When the disability insurance file is disputed and the insurer refuses to recognize the disability or minimizes the consequences, an expert opinion can support the claim.
- If the case involves mental disorders (post-traumatic stress, cognitive impairment, mental health), because the expert opinion can provide specialized conclusions.
- In preparation for a liability claim (before courts, administrative tribunals, or civil courts) to quantify damages and losses.
You should not wait indefinitely: the sooner you hire a specialized lawyer, the sooner you can organize your medical file (reports, examinations, previous records) to maximize your chances of success. However, you must wait until your condition has stabilized (maximum level of improvement) before making a final assessment of permanent sequelae. A rushed assessment suffers from a lack of credibility.
Who can request a medical assessment?
The request can come from the plaintiff or the defendant. The mandate must specify the questions to be addressed by the expert. The following individuals may request a medical assessment:
- The worker themselves, in the context of a compensation claim (CNESST) or a civil claim;
- A lawyer representing the victim;
- The employer, insurer, or public agencies (SAAQ, IVAC, CNESST);
- The court or judge, in the context of legal proceedings, may order an expert opinion ex officio;
- Medical specialists or practitioners involved in the case, sometimes to clarify a technical point.
Why request a medical assessment?
A medical assessment allows you to:
- Resolve differences between the attending physician and conflicting opinions.
- Document previous medical conditions to isolate the damage caused by the accident.
- Determine the severity, extent of limitations, diagnosis, and impact on quality of life.
- Establish a causal link between the accident or fault and the current medical condition.
- Support a claim before the CNESST, the SAAQ, or the courts.
- Serve as evidence before the courts or administrative tribunals, with a solid and credible expert report.
- Validate the level of disability, impairment, and limitation of an injured person resulting from the incident.
- Provide treatment or follow-up recommendations to promote the patient’s recovery and improved health.
- Discern liability, causation, and future health risks, thereby informing decisions in liability claims.
A well-written report can tip the scales in your favor. The lawyer plays a strategic role: they determine the specific questions to be asked, choose the appropriate medical expert, and ensure that the assessment is independent and that the report complies with standards.
What is the role of the expert?
The medical expert appointed to conduct the medical assessment must be independent, impartial, and competent in their field of practice. They examine the case file, medical records, the attending physician or specialists, and tests (imaging, analyses, functional tests) and carry out a functional assessment. The expert report provides an opinion on the extent of the injuries, the cause, the permanence of the sequelae, future limitations, and recommendations for treatment or rehabilitation.
What does a medical assessment provide?
The assessment report provides:
- The primary diagnosis and secondary diagnoses;
- An evaluation of functional limitations (mobility, cognition, work capacity, physical constraints);
- The percentage of permanent impairment (according to applicable scales, e.g., CNESST or SAAQ);
- The date of consolidation (when the condition is expected to stabilize);
- Therapeutic or rehabilitation recommendations;
- An opinion on return to work, support measures, or accommodations;
- An estimate of future damages (care, loss of income, impact on quality of life).
This report may influence the amount of compensation or the acceptance of a claim. It may be produced in court as evidence. If contested, the other party may request a second opinion.
How does a medical assessment work?
1. Mandate and appointment
One party (victim, insurance company, lawyer) submits a request for an assessment. A mandate is drawn up specifying the questions to be asked of the expert (determining the cause, extent of the injuries, limitations, after-effects). The medical file, previous reports, and all relevant examinations are attached. The choice of medical expert must take into account their specialty (orthopedics, neurology, psychiatry, depending on the case) and their credibility in court.
The expert accepts on condition that they can act impartially and that there is no conflict of interest. The patient must be informed of the identity of the applicant and the role of the expert.
2. Review of the file and collection of information
Before the examination, the expert reviews the accident files, medical records, specialist reports, and previous history. They may request additional information or examinations if they deem the information insufficient. They are not required to follow the client’s strict instructions if these would circumvent their professional judgment.
3. Physical, functional, and psychological examination
The expert conducts a clinical assessment, objective tests (mobility, strength, cognition, neurology), and sometimes psychological or neuropsychological assessments. They seek to identify functional limitations, cognitive or psychological disorders, sequelae, and expected improvement. They compare their observations with data from the previous file. They must remain impartial even if they discern differences with the attending physician.
4. Drafting of the report and conclusion
The expert produces an expert report in which they respond point by point to the questions asked: cause, link with the accident, consolidated condition, quantification of damages, future recommendations. They must indicate their reasons, assumptions, and the limitations of their assessment. This report will be shared with the parties (contradictory) so that they can submit their comments.
5. Discussion and debate phase
The parties may ask questions, object to certain conclusions or methods of the expert, and request an expert hearing if necessary, before a court or administrative body. The expert may be called to testify in court on the basis of his report.
What type of professionals can perform medical assessments?
Medical experts can come from a variety of specialties (orthopedics, neurology, psychiatry, physiatry, neuropsychology, neurosurgery). They must have expertise in the specific field of practice related to the issue being assessed.
Experts must be actively practicing, recognized in their specialty, subject to codes of ethics, and act independently.
Some specialists belong to societies such as the Société des experts en évaluation médico-légale du Québec (SEEMLQ), which certifies the quality of impartial experts.
In the context of judicial mandates, experts may act as expert witnesses before civil or administrative courts.
How to find a doctor for a medical assessment?
- Legal professional network: a specialized law firm often has a list of reliable experts.
- Professional associations: consult the membership directory to identify experts by region and specialty.
- Medical references: ask the medical specialists involved in your case if they know any medical experts.
- Rigorous selection: choose an expert who has already testified in court, has experience in expert assessments, and is credible with organizations such as the CNESST or the SAAQ.
- Check for conflicts of interest: make sure that the expert does not work primarily for the employers or organizations concerned, which could undermine their impartiality.
The lawyer assists with this process by verifying the expert’s mandate and credibility and ensuring that the report is usable in legal proceedings.
Get help with your proceedings
A medical assessment is requested at strategic moments: after an accident, during a period of disability, or in the context of a medical dispute. Its purpose is to provide an impartial assessment of the patient’s state of health, sequelae, limitations, cause of injury, and prospects for improvement.
To maximize the value of the expert report and effectively defend your rights before the SAAQ, the CNESST, or in court, it is essential to have the support of an experienced medical liability lawyer, a personal injury lawyer, or, more generally, a health law lawyer.
Contact Medlégal to benefit from rigorous legal support in structuring your case, choosing your expert, analyzing the results, and representing you before any court.
