Medical expertise & Insurance medicine

What is medical expertise?

Medical expertise is a specialised medical discipline that involves the objective and independent assessment of a medical condition or physical injury. It plays an essential role in medical and insurance disputesby providing precise, substantiated medical evidence to help settle a dispute or assess a loss.

Its main objective is to :

  • Identifying bodily injury or a health problem following an accident, assault, medical malpractice or occupational illness.
  • Assessing a temporary or permanent disability rateto determine the after-effects and their impact on work capacity and quality of life.
  • Analyse the causal link between a triggering event (accident at work, domestic accident, assault, etc.) and the medical complaints expressed.
  • Draw up a detailed, enforceable medical reportfor insurance companies, courts, employers and mutual insurers.

This is a fundamental tool for resolving insurance disputes and in assessing victims' rights to compensation.

Illustration de l’expertise médicale et de la médecine d’assurance : évaluation des dommages corporels, incapacité, contre-expertise médicale et litige avec assurance suite à accident du travail, maladie professionnelle ou agression.

Insurance medicine and dispute management


La insurance medicine is mainly involved in the medical assessment of insurance cases: private insurance, invalidity insurance, work accident insurance and occupational illness insurance. The medical findings have a direct impact on compensation, disability pensions or recognition of incapacity status.

In the event of disagreement between the insured and the insurance company, an independent expert opinion may be requested in order to :

  • Provide precise medical evidence for amicable or legal proceedings.
  • Check the conclusions of the insurance company's medical officer.
  • Making a medical second opinion complete and well-argued.
  • A neutral and independent assessment of the extent of the medical disabilities.
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The role of the referral doctor

In situations of dispute with an insurance or mutual insurance companyThe use of an independent medical expert makes it possible to :

  • Analyse the entire medical file of the insured.
  • Carry out a thorough and rigorous clinical examination.
  • Establish a detailed counter-expertise and documented, for presentation to insurance companies or before the competent courts.
  • Accompanying the patient during a contradictory expertise.

The independence of the appeal doctor is essential to guarantee an impartial assessment, carried out solely in the interests of the person concerned.

Why is medical expertise essential in the event of a dispute with an insurance company?

In the event of disagreement with an insurance report or a disputed assessment of incapacity, an expert assessment provides a neutral, well-argued and scientifically-based evaluation. It is a key element in defending the victim's rights and obtaining fair compensation that reflects the medical reality of the injury.

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Dr. Jenifer Alexis y Ruiz

General practitioner and medical expert

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Frequently asked questions

Medical expertise is an independent medical assessment designed to objectify bodily injury, evaluate temporary or permanent incapacity and draw up a report for insurance companies, courts or employers.

A medical expert may intervene when there is a disagreement with the insurance company regarding the degree of disability, the origin of the injuries or the amount of compensation.

The insurance medical officer works for the insurance company, while the independent medical expert acts in the exclusive interest of the person examined and is not linked to any insurer.

A second medical opinion is a second assessment carried out by an independent medical expert to challenge or verify the opinion given by an insurance medical officer.

Medical expertise may be requested after an accident at work, an occupational illness, a domestic accident, an assault, or in the event of a dispute with a mutual insurance company or an employer.

The expert's report presents a detailed medical history, clinical findings, assessment of disability, the causal link with the event and the medical conclusions.

Medical expertise may be requested by a patient, their lawyer, an insurance company, a mutual insurance company, a court or an employer, depending on the type of dispute or procedure underway.

The expert studies the complete medical file, carries out an in-depth clinical examination and draws up an objective medical report, which can be used in amicable or legal proceedings.