Recent judicial scrutiny of medico-legal agency fees has renewed discussion about proportionality, transparency and value within litigation costs. At the same time, many solicitors are reconsidering the advantages of direct access instruction of medico-legal experts, particularly in dental negligence and dental injury claims.
While medico-legal agencies undoubtedly provide administrative convenience, direct instruction of appropriately qualified experts can often provide:
- reduced overall costs,
- direct expert communication,
- improved continuity,
- and faster case progression.
Importantly, many directly instructed experts are also able to offer deferred payment terms, allowing solicitors and clients to retain flexibility without incurring substantial agency uplifts.
As a practising dental surgeon and medico-legal expert witness with over 35 years of clinical experience and over 800 medico-legal reports completed, I have worked both directly with solicitors and through medico-legal agencies. Having experienced both models, I believe there are several important considerations.
Greater Cost Proportionality
The recent SCCO decision concerning medical agency mark-ups has highlighted increasing judicial concern regarding recoverability and proportionality of expertrelated costs.
Where experts are instructed directly:
- fees are often more transparent,
- administrative duplication may be reduced,
- and overall litigation costs may be lower.
This can be particularly important in lower to medium value claims where proportionality is now closely scrutinised.
Direct instruction may also avoid significant agency uplifts whilst still permitting deferred payment arrangements where appropriate.
Direct Access to the Expert
Direct instruction allows solicitors and counsel to communicate directly with the reporting clinician rather than through an intermediary.
This can improve:
- efficiency,
- turnaround times,
- clarification of issues,
- and responsiveness to supplementary questions.
In complex dental negligence matters, subtle clinical nuances may be lost when communication is filtered through non-clinical administrative channels. Direct access also allows solicitors to develop continuity with a known expert whose reporting style, turnaround and clinical approach are already understood.
Continuity and Accountability
Directly instructed experts often build long-term professional relationships with firms based upon consistency, reliability and quality of reporting.
Solicitors know:
- who is preparing the report,
- the expert’s qualifications and clinical background,
- their communication style,
- and their approach to litigation.
This continuity can improve case management and reduce uncertainty.
Balanced and Independent Evidence
The role of the expert is not to advocate for either party but to assist the court. Direct instruction does not diminish independence. Many directly instructed experts maintain both claimant and defendant practices and are accustomed to providing balanced opinions based solely upon the clinical evidence. In my own medico-legal practice, instructions are received for both claimants and defendants, reflecting a balanced and independent workload.
Conclusion
Medico-legal agencies continue to serve a useful role within litigation, particularly in high-volume or multi-disciplinary matters. However, for many dental negligence and dental injury claims, direct access instruction of an experienced dental expert may provide:
- greater proportionality,
- improved communication,
- deferred payment flexibility,
- faster case progression,
- and enhanced value for both solicitors and clients.
Ultimately, the quality, independence and clinical credibility of the expert remain the most important considerations.