Governance body advises Irish firms to prepare for continuing market uncertainty in the face of Brexit

Market uncertainty about Brexit will continue for the foreseeable future and Irish firms need to mitigate the risks as best as possible a packed audience of governance, risk and compliance professionals was told recently at an event looking at the next steps arising from the UK’s vote to leave the EU last June. Organised by the Irish Region of ICSA: The Governance Institute and hosted by William Fry, the ‘Brexit – What Next?’ event highlighted the need for businesses to remain focused as the future of Ireland’s relationship with the UK will not be settled within the two-year timeframe suggested by Article 50. Cormac Little, Partner and Head of Competition & Regulation at William Fry said “Article 50 suggested that the UK’s withdrawal agreement will be finalised in two years. However, this ignores the fact that the approval of the EU’s Council of Ministers and European Parliament, on the one side, and Westminster, on the other, is required. In reality therefore, both the EU and UK negotiating teams will be very pressed for time once the PM fires the starting pistol. The future of Ireland’s relationship with the UK will not be fully determined within this timeframe.”

Brendan Donovan Head of Commercial & Business Treasury AIB, said that market uncertainty is likely to continue for some time. The Irish Economy continues to be highly vulnerable and a “hard Brexit” is now likely in due course unless a significant change in the UK political backdrop occurs. In a scenario where trade with the UK equates to 35% of Irish GDP and the UK takes over 40% of Irish indigenous firm exports, Irish firms should identify the risks facing them and mitigate their risks as best as possible by formulating a plan of action, keeping themselves informed and utilising their relationships with their banking and specialist advisors. Finally, Eoin Caulfield, a Partner in William Fry’s Insurance & Reinsurance Department stated that “Brexit brings with it uncertainties for company secretaries, such as UK directors no longer being suitable for EEA director requirements (Section 137 of the Companies Act 2014). There is a loss of restructuring approaches like cross-border mergers and an unclear regulatory regime. While concepts such as “equivalence” for a non-EEA UK group may help, it is not a full solution. Further work is required here.”

The process of Medicolegal (ML) Reporting in Ireland has not changed for many years and remains inefficient for the most part. Little in the way of innovation used in other industries has been incorporated into the field. As is always the case in any relationship, responsibility is shared between the relevant stakeholders

Prof Seán Carroll, Company Director Medlaw, Medicolegal Reporting Service Providers

Deficits in Medical Practice As a medic I can put my hand up and admit that our profession plays a significant role in these inefficiencies. Many doctors do not like writing medical legal reports. They therefore continually defer medicolegal appointments and are slow in writing the report. Some doctors, because of their dislike of this aspect of their practice, remain disinterested and therefore write poor reports. A significant cohort of the medical profession believes that ML work is not a core part of medical practice which is primarily caring for the health of the patient. This is understandable to some degree and certainly there is little if any training in this area in medical schools. Often the first time a doctor thinks about the medical legal process is when a young doctor opens his first request for a medical legal report. They will then ask a senior colleague for advice and a template for writing their report. This approach does not lead to improvements in quality or standards of ML reporting. As in any other aspect of life when there is an information deficit, there are inefficiencies. Clearly there should be a debate about teaching the skills of ML reporting but in the interim I remind my colleagues that there are excellent courses available in Dublin and London on this and related topics. Attendance at these courses would both decrease the variance in quality of ML reporting amongst the medical profession whilst undoubtedly improving it. The introduction of a modern ML report template would also lead to standardisation and improved quality across the board. It is perfectly reasonable for medics not to have an interest in ML reporting but I suggest that they disclose this early on in the process so allowing the insurance company to move on with another medic. In fact, having a smaller cohort of medics providing ML reporting would probably improve standards and speed up the process. Deficits in Insurance Industry Practice However, it is not all a one-way street. As a Medic my knowledge of the complexities of the insurance world is of course quite limited but based on 17 years of writing medical legal reports, I suggest the following. Recognising that it is in the insurance industry’s best interest to speed the ML process up it follows that it is also in it’s best interest to make it easier for the medical profession to facilitate the process. This can be done very easily The variability in the quality of ML report request letters can, like ML reports themselves be profound. Just like ML reports, an agreed template should be used. This should include all relevant patient/client details, date of accident, parties involved in case, the role of the insurance company in the case and specific instructions to the medic as to what is required. A brief description of nature of accident, location and names of facility or medic in or from whom treatment was received if any and brief nature of

complaints is also greatly appreciated. It is highly likely that the insurance company has this information anyway so why not pass it on and lead to efficiencies. Most personal injury cases will involve the client having been to see their local GP or their local emergency department and perhaps a consultant surgeon. It is immensely frustrating to start a medicolegal consultation and only then recognise that the patient/client has had medical interaction or treatment with regard to the injury but have no medical notes to hand. The consultation is less productive than it should have been. Subsequently the medical notes have to be extracted from the hospital or GP, the x-rays have to be seen, and the additions made to the original report. Time passes, the insurance companies become frustrated and the whole process becomes needlessly prolonged. This happens too frequently and between the two professions we need to do things better. The concept of a personal diary written by the plaintiff patient/client regarding the injury is very valuable and often ignored by the insurance companies (and medical profession). This diary should include the nature of the injury, the subsequent treatment that they received, the dates on which these occurred, the names of the attending doctors, the complaints that they had then and the concerns that they have now. The diary should ideally be delivered before the consultation occurs. If this happened the ML report could be pre-populated before the consultation by the medic’s secretarial team so ensuring a more productive consultation that concentrates on examination rather than history taking. This may sound like a repetition of the letter of instruction but is very useful to the medic. It is also often difficult for the insurance firms to deliver on such a request and I acknowledge that but then it should be documented that such a request has been refused. Often the doctor will receive a large box containing five are six folders of notes relating to every medical interaction that the patient has had since the incident/accident. Very often medical notes are presented in illegible formats due to multiple photocopying and are not in chronological order. Multiple duplications of the same pages serve to confuse and delay the process as does the inclusion of non-relevant medical events. Most sets of medical notes delivered to me could be reduced by at least 50% without diluting the required information, thus reducing time spent and frustration experienced in the ML reporting process. Failure to do this obviously leads to many hours of sifting through medical notes which results in unnecessary expense. There are ways around this. Overall my impression of the efficiency of medicolegal reporting in Ireland is very varied. When the experienced insurance firms instruct experienced medics the process is likely to run smoothly. When either of the parties are inexperienced it does not. With a modest degree of effort and organisation both professions could practice at a higher level.
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