Up to one in three IMEs never happens on schedule.

Across parts of the medicolegal industry, 25 to 35 per cent of booked IME appointments are cancelled or rescheduled. Up to one in three appointments does not happen when it was meant to.

Now hold that against the other number everyone already knows. There are not enough experts. Waitlists in some specialties run months. Lawyers ring around for availability. Claims sit still because a diary slot cannot be found. Ask anyone on any side of the industry what the biggest constraint is and you will get the same answer. Expert time.

Why this is worse than it sounds

A doctor's hour is the one input in this industry that cannot be manufactured. You can hire more admin staff. You can build better software. You can open another clinic. You cannot create more senior specialist time. It is fixed, it is scarce, and every participant is competing for it.

When an appointment falls over inside the cancellation window, that hour is not rebooked somewhere else. It is gone. Not from one provider or one firm. From the industry. From the total pool of expert capacity that every waiting claimant is queued behind. That is why cancellations are not an admin nuisance. They are a capacity leak in the industry's scarcest resource, and the cost lands on everyone at once:

• The lawyer carries the delay, the client conversation, the court timetable pressure, and the momentum lost on the file. A rebooked appointment is often six to eight weeks out, plus report turnaround on top.
• The claimant waits longer and often retells their story to a different doctor, further from the events being assessed. For injured people that has a human cost as well as an evidentiary one.
• The expert loses a diary slot that cannot be resold, on top of preparation time already spent reading the brief. Enough of this and good experts reduce their medicolegal work, which shrinks the pool further.
• The insurer wears extended claim duration, and duration is the biggest cost driver on most long-tail claims.
• Everyone in the queue waits longer. Every wasted slot pushes every other matter back. Wait times are not long despite cancellations. They are long partly because of them.

And unlike the shortage of doctors, this part of the problem is controllable.

The industry treats cancellations like weather

Ask around and you will hear the same explanations. Claimants do not show. Briefs arrive late. Experts get called to court. Life happens. All true. All beside the point.

Cancellations are not random. They cluster. They cluster around certain booking practices, certain lead times, certain communication gaps, and certain providers. Two providers booking the same experts for the same types of claimants can run materially different cancellation rates. Same doctors. Same claimant population. Different numbers.

Confirmation discipline, appointment lead times, claimant communication, travel logistics, early risk flags. These are operational choices, and operational choices show up in the rate.

What good looks like

A good provider treats a booked appointment as scarce capacity to be protected, not just a slot that was filled. In practice that looks like five things you can observe from the outside:

1. They know their number. Ask a provider their cancellation rate on your matters last quarter. Watch what happens. A provider who measures is a provider who manages.
2. They confirm in a cadence, not once. Booking confirmation, a touchpoint the week prior, a reminder the day before. Most no-shows are preventable with contact.
3. They flag risk early. If the brief has not arrived or the claimant has gone quiet, you hear about it before the appointment date, not after.
4. They rebook in days, not weeks. Recovery speed is where the file cost is won or lost.
5. They tell you why. When an appointment falls over, a good provider can explain the cause. Not to assign blame. To fix the pattern.

None of this requires scale, technology, or a particular business model. It requires a provider who has decided the number matters. Which is exactly why it is such a clean test. It separates providers by discipline, not by size or structure.

Augmentation. Transparency. Verification.

Regular readers will recognise the third word. Verification is usually discussed as a report-quality principle. Check the output. Confirm the reasoning. Make it auditable. It applies just as hard to operations. A provider who verifies that a booking will actually happen, at every step between referral and appointment, is running the same discipline that produces a defensible report. The habit is the same habit. Providers rarely have one without the other.

The bottom line

The industry cannot conjure more doctors. It can stop wasting the doctors it has. Up to a third of booked expert time is currently leaking out through cancellations and reschedules, and that leak is driving up costs and extending wait times for every claimant in the queue.

So if you track one number about your providers this quarter, make it this one. Ask for the cancellation rate on your matters, and ask what is being done about it. The answer will tell you more about provider quality than any brochure, panel list or pitch you will hear this year.

Next issue: the report is only as good as the data underneath it, and why data quality is about to become the differentiator nobody in the industry can ignore.