An examiner's report gets challenged in a predictable order, because the attacks that work are the ones lawyers teach each other. Bias comes first, then the record, then the examination, then the reasoning. Each attack has a drafting habit that neutralizes it, and the habits are cheaper to build than the reputation they protect. What follows is the sequence as it usually runs, with the questions in something like their real form.
"Doctor, how many examinations did you perform last year? What percentage were for insurers or defense counsel? How much of your income comes from this work?" These questions are asked in every deposition and the answers are less important than the composure of the person giving them. An examiner who keeps a log answers from the log: 140 examinations, roughly 70 percent at the request of carriers or defense firms, about a third of professional income. An examiner who guesses, or who is defensive, has conceded the first point. Keep the log. Answer plainly. Then let the record answer the rest.
"You listed the records you reviewed on page two. The physical therapy notes from Summit Rehab are not on that list. You did not review them?" This is the most damaging attack in the sequence, because it is aimed at the foundation of every opinion that follows, and it is entirely avoidable. List everything reviewed, by provider and date range, with page counts. Reconcile the list to the production before the report goes out. Where records are missing that you would expect to exist, say so in the report and state that the opinion is subject to revision if they are produced. An examiner who has already flagged the gap cannot be surprised by it.
"On page six you state the claimant first reported knee pain four months after the collision. Turn to page 412 of the records, the emergency department nursing assessment from the night of the collision. Read the third line." Every factual statement in the summary section is a claim about a specific page, and the other side has a chronology to check them against. One wrong date is a mistake. Three is a pattern, and the question becomes whether the examiner read the records at all. The habit that prevents this is reading every page and citing it, or having every page read and summarized by someone who will cite it, and then verifying the summary against the source before adopting it.
"You quote Dr. Alvarez's note of March 3 where the claimant reported feeling 'much improved.' You did not quote the notes of March 17, April 2, April 21, May 9, or May 30, in each of which the claimant reported worsening pain. Why not?" The answer to this question is never good. A summary that reports the trend rather than the favorable point, including the entries that complicate the conclusion, gives the cross-examiner nothing here and makes the conclusion stronger, because the reader can see it was reached with the complications in view.
"Your report describes full range of motion in the lumbar spine. The treating therapist measured flexion at 35 degrees eight days before your examination and 40 degrees six days after. You did not measure?" and "How long did your examination take? The claimant says eleven minutes." Measure what can be measured, record the numbers, record the duration, and describe what you observed outside the formal exam. Findings that are numbers can be compared and defended. Findings that are adjectives cannot.
"You state with certainty that the disc herniation predates the collision. There is no prior imaging of the lumbar spine in the record. On what do you base that?" State opinions to the standard the forum requires, usually reasonable medical probability, and show the reasoning that reaches it: which findings, on which pages, support the conclusion, and what would change it. An opinion that says "the degenerative appearance described on the MRI report, the absence of acute findings, and the primary care note of 2023 documenting low back pain make it more likely than not that the herniation predates the collision; a prior MRI, if one exists, would settle the question" is an opinion the examiner can defend for an hour. An opinion that says "clearly pre-existing" is an opinion that lasts one question.
"Doctor, you were asked about causation and work capacity. On page fourteen you offer the view that the claimant is 'symptom magnifying.' Were you asked to assess credibility? Are you trained in it?" Answer the questions in the referral letter, in order, and stop. Document discrepancies between the claimant's account and the record as facts. Do not characterize them. Do not offer legal conclusions. Every unrequested opinion is a new line of cross-examination.
It lists every record and reconciles the list to the production. Its summary is complete, chronological, cited, and reports the trend rather than the point. Its examination section has numbers and a duration. Its opinions meet the forum's standard, show their reasoning, and name what would change them. It answers what was asked. None of this takes talent. It takes reading every page and writing down where things came from, which is the part examiners under time pressure skip, and the part cross-examiners count on.
Errors and omissions in the summary of the records. A wrong date, a missed prior complaint, or a record that was produced but not listed as reviewed each undermines the opinions built on it, and each is found by comparing the report against a full chronology.
Only by documenting discrepancies between the claimant's account and the record as facts, and only if asked. Characterizations such as malingering or symptom magnification invite an attack on the examiner's qualifications to make them and rarely help the retaining party.
Name them in the records-reviewed section, state that the opinion is subject to revision if they are produced, and, where it matters, say what the missing record could change. Flagging the gap yourself removes it as a surprise.
Yes, provided the examiner verifies the summary against the source and adopts it as their own. It is common practice and, done well, produces a more complete and better-cited summary than an examiner working alone against a deadline.
Every page read, every entry cited, drafted on your own template.
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