Medical reporting organisations are not medical experts, court rules

A county court in England and Wales has ordered a breakdown of a medical reporting organisation’s fees in order to determine what was paid to the consultant expert called in a case and what was merely the organisation’s agency fees. The decision, while not binding, calls for greater transparency among medical reporting organisations (MROs) in England and Wales.

In Northampton General Hospital NHS Trust v Hoskin, senior circuit judge and designated civil judge Judge Nigel Bird, sitting at Manchester Civil Justice Centre, ruled on an appeal relating to costs. While the substantive claims of the case had been settled in 2020, the appellant, NHS Trust, asked for a breakdown of two sums it was being ordered to pay. These sums – all in all costing around £14,000 – were for two medical reports from consultant experts embodied in an invoice issued by Premex to the respondent, Luke Hoskin.

Premex was one of many MROs in the UK which facilitated the provision of medical reports and medical expertise during legal proceedings, saving solicitors the expense of seeking consultant experts directly.

The parties in this case agreed that the breakdown asked for would show how much of the claimed fee related to the consultant expert’s medical report and how much related to other services provided by Premex. What the respondent disagreed to, however, was that a breakdown was necessary. The respondent argued that the invoiced sums were reasonable.

The court found that the relevant practice direction under the Civil Procedure Rules required “copies of the fee notes … of any expert in respect of fees claimed” as well as “written evidence as to any other disbursement which is claimed”. The practice direction also allowed the judge to limit the amount of an expert’s fees which could be recovered based on what was “reasonably and proportionately incurred”.

The court noted that MROs like Premex were not the experts whose invoices or “fee notes” satisfied the relevant practice direction. It thus required Premex to provide a breakdown between the Premex costs and expert costs.

“Seized of that information, the paying party can make a decision about the fee,” the court said. “In doing so, it may well consider what the ‘going rate’ for a similar report is. Without the fee note the paying party cannot make a rational, evidence-based decision about whether to accept that aspect of the bill, reject it, or make a counteroffer. The court is in the same position.”

The court applied Stringer v Copley, a 2002 county court decision which found it important for MRO invoices to distinguish between the consultant’s medical fee and its own charges, which would in turn inform the court whether the administrative expenses exceeded “the reasonable and proportionate cost of the solicitors doing the work”.

Noting that breaking down an MRO’s costs should not be difficult, the court ordered Hoskin to provide a breakdown between the Premex costs and consultant expert’s costs within 14 days in order to claim the proper expense.