The Senior Costs Judge has ruled that reasonable medical agency fees should not exceed 25% of the underlying expert fee, in a decision welcomed by law firm HF and its insurance clients EUI and Esure as a significant step towards greater transparency in the medical reporting sector.
The ruling follows years of concern over escalating charges, with mark-ups in some cases exceeding 140% of the base expert fee. Single expert reports have frequently exceeded five-figure sums, driven in part by reforms under the Legal Aid, Sentencing and Punishment of Offenders Act (LASPO) and post-pandemic inflation.
The Senior Costs Judge noted that a determinative ruling in this area is needed and indicated that he is minded to grant permission to appeal. One or more parties are expected to pursue that route.
The decision builds on a line of case law that has progressively tightened scrutiny of medical agency charges. A key earlier development came in Northampton General Hospital NHS Trust v Hoskin, in which HHJ Bird ordered that failure to disclose underlying expert fee notes would result in the complete disallowance of agency fees. HF has since secured the disallowance of excessive fees and recovered non-party costs from agencies that obstructed transparency.
Paul McCarthy, partner at HF, said the recent ruling addressed a long-standing imbalance in the market. “Today’s decision marks an important turning point in the long-standing debate around medical agency fees,” he said. “For too long, paying parties have faced escalating charges with little meaningful oversight.”
McCarthy said the 25% cap introduced structure into a process that had lacked it. “The Senior Costs Judge’s clear position that reasonable fees should not exceed a 25% uplift brings much-needed structure and fairness to the process,” he said. “Greater transparency creates a healthier market and helps ensure that resources are directed towards supporting claimants rather than funding unjustified mark-ups.”
He acknowledged further legal proceedings were likely but said the decision provided a basis for broader dialogue. “While further appeals are likely, this decision offers a foundation for more constructive industry conversations,” McCarthy said. “Our focus will be on helping stakeholders navigate the implications and identifying ways to build a sustainable and collaborative framework for the future.”
HF said it hoped the ruling would encourage medical agencies to voluntarily provide copies of underlying expert fee notes, a transparency measure that paying parties and courts have repeatedly sought but which agencies have often resisted.
The ruling is not without its critics. Claimant law firm Slater and Gordon, which represented one of the claimants in the case, expressed concern that the 25% cap was not put forward by either side during proceedings. Medical agency Premex said it was examining the judgment’s implications and warned of broader consequences. The company said that the costs of procuring medical evidence at scale – particularly on deferred payment terms – are significant, and that one possible outcome could be that injured claimants may need to meet these costs from their damages or risk going without medical evidence.
The ruling comes as regulatory pressure in the sector continues to build. The Ministry of Justice said in its 2025 Fixed Recoverable Costs review that it is considering measures to improve transparency, including potential requirements for fee breakdowns and possible limits on agency charges. Market developments have also reflected growing financial strain, with medical reporting organisation SK Medical Practice withdrawing from the MedCo framework in 2025 amid concerns over fees and payment structures.
