From time-to-time doctors provide services for third parties including medical assessments and preparing reports on a patient for court cases or for life insurance policies

As this type of work varies considerably depending on the level of work required and other circumstances, such as the particular State or Territory in which the work is undertaken, the AMA does not provide any recommended fees for this type of work.

The AMA encourages medical practitioners to establish their own professional fees for the provision of these services subject to relevant State or Territory legislation or other arrangements governing these fees.

Setting Fees and Providing the Service

When a medical practitioner is requested to assess a person on behalf of a third party, such as insurance companies or employers, the traditional doctor/patient relationship does not exist.  The role of the medical practitioner is to provide an impartial medical opinion, not to treat that person.  The result is a report to the third party, not the person or the person’s treating medical practitioner.

The fees charged reflect the effort, skills and resources associated with the service.  Whether a fee is rendered to a patient or a third party the factors to be considered will not change.  Practitioners will set a fair and reasonable fee having taken into account such factors as:

1. In undertaking these services, what income have they forgone?  (ie the cost of the practitioner’s time could be measured as the number of consultations or the value of work, which would otherwise be undertaken during that time).

2. Are other employees of the practitioner involved and if so at what cost?

3. Are there any other costs associated with the service (eg photocopying, telephone calls, etc)?

4. Is any out-of-hours loading appropriate? 

Practitioners are under a contractual obligation in agreeing to complete a report for a third party and before undertaking an examination, complete a form or write a report, should agree on the fee with the third party.

Fees for Medico-legal Work

The AMA recommends that all fees be discussed with the lawyer or relevant agency at the outset, including attendance to give evidence at court and compliance with subpoenas to produce documents (the cost of copying documents, etc).  Statutory arrangements in each State and Territory may set maximum fees for services, particularly in the areas of workers compensation and injuries arising from motor vehicle accidents. 

Although the lawyer or agency might  contact the doctor, as a matter of law it is the lawyers or agency’s client who is responsible for paying the doctor’s fees.

Fees paid for by A third party

Fees for services paid for by insurers or compensation agencies in relation to workers compensation and motor accident third party are subject to regulation by the relevant statutory authority in each State or Territory.