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11.6 Interpretation of Medical Opinion


The purpose of medical report from a Specialist Medical Review (SMR) is to provide expert advice to a Delegate about the nature and probable origin of the alleged condition. In disease cases in particular, the SMR will be looking for medical evidence indicating that the illness can, on the basis of probability, be attributed to some particular cause.

The significance of obtaining a medical opinion on a particular case lies in how well (i.e. how clearly and reliably) the report performs that advisory role, and not merely that, as part of a 'required process', the SMR can be said to have been done.

The medical specialist providing the report has no powers of decision under the Act. It is for the Delegate to make the decision about liability (or indeed, any entitlement referred to in the report), taking into account the doctor's whole report as well as its formal conclusions, and considered along with all other aspects of the case including the alleged circumstances of the injury.

In other words, it is up to the Delegate to thoroughly understand, to interpret and finally to weight the medical evidence against any other competing considerations. This interpretation and weighting does NOT mean that the Delegate is required to exercise medical expertise, but only to exercise common sense and judgement in the use of SMR evidence, particularly where conflicts are evident. In particular it means that Delegates should follow the guidelines below, and/or take the following factors into consideration when accessing medical reports: