TERMS AND CONDITIONS FOR COMPILING MEDICO-LEGAL REPORTS 2020
Standard medicolegal reports are charged as follows vat inclusive:
· Preparation and receiving instructions: R2000.00
· Medicolegal consultation: R8000.00
· Medicolegal report inclusive of narrative: R16,000.00
· RAF4 assessment: R9800.00
· RAF4 FORMS are completed at a cost of R16,000.00 VAT incl if requested as a stand-alone document. The narrative will only be submitted as part of a comprehensive medicolegal report.
· Perusal and analysis of Orthopaedic surgeon report to assess impartiality and objectivity: R8000.00.
· Assessment of the merits of a negligence or malpractice claim against a medical professional and especially an Orthopaedic surgeon. R16,000.00.
Additional fees are charged if the assessments are complex, and that require perusal and analysis of extensive documentation and other expert reports. These fees are charged in 15min increments at R2,000.00 per increment
Reports will not be released without payment if instructed by attorneys acting for plaintiff unless negotiated upfront with a time limit of 24 months. If settlement is delayed for a longer period, then interest is accrued at 10% per annum back dated to the date of release of the report and payable on an annual basis.
Instructions must specifically and clearly mandate me to as to what is required and must, for example, include specific instructions to compile a comprehensive medico-legal report, RAF4 and also must include instructions to compile a joint minute if approached by my counterpart. Chasing down instructions for joint minutes, a rule of the courts, is time consuming and wasteful.
GENERAL CHARGES FOR MEDICO-LEGAL REPORTS:
If a claimant is assessed and no future treatment, impairment or disability is envisaged, then a comprehensive medico-legal report is not compiled. My fees are then as follows Vat Incl:
· Preparation and receiving instructions: R2000.00
· Medicolegal consultation: R8000.00
· Assessment of negligence by a doctor: R16,000.00
Any additional work done is charged at R8000.00 per hour or part thereof VAT inclusive. This would include the compilation of Joint Minutes, Addendums to reports, consultations with Counsel and so on.
Terms and Conditions of payment of medico-legal reports:
Only online payments are accepted to Investec Account 10011721928 Bank code 580105. Cheques are not accepted as payment. Use my reference on the account which is a 6 digit alphanumeric code.
“Qualifying fees”
Should a matter be contested I consider it incumbent on you to discuss my fee with the plaintiff or defendant prior to the trial so that my costs and so-called “collapse” fee is accepted in advance of the hearing or trial. A proforma invoice will be provided detailing my fees prior to the hearing if requested.
My “qualifying fee” or collapse fee for 2020 will be R64,000.00 per day (or R40,000.00) for a half day up to 5hr) including VAT but excluding expenses and travel time that is billed at R3,850.00 per hour. This fee is calculated on R8,000 per hour VAT inclusive. All work done in preparation of a hearing or trial is charged at R8,000.00 per hour VAT inclusive but excluding disbursements.
If I am notified of a postponement or cancellation 10 or more working days before the arbitration or trial, then the fee is waived.
60% of the fee is payable if I am notified of a postponement or cancellation between 5 and 10 working days prior to the arbitration or trial.
The full fee is payable if I am given less than 5 days’ notice.
Please send all notices of cancellation or postponement of a matter to me via e-mail, whatsapp or so as to avoid any miscommunication.
It is my experience that many matters are settled “on the steps” and, if so, I usually discount my fees if I am in a position to make use of that time for other work at such short notice. It is important to appreciate that I cannot schedule any surgical, consultation or other clinical appointments on the day of the arbitration or trial and this represents a loss of income and opportunity far in excess of the fee quoted above.
Claimants must complete my questionnaire at the time of the consultation (attached below).
I advise the instructing attorney of the following excerpt from the guidelines as published by the HPCSA regarding the professional duty of an expert performing medico-legal assessments when considering subjective criteria:
1. Reports by other specialist medical doctors if the claimant has suffered any impairment as a result of the accident. This would include:
· Maxillo-facial surgery report in the case of injuries to the face and teeth
· Plastic surgeon’s report regarding major soft tissue deformities, symptomatic soft tissue scars that are concealable and disfiguring scars that are not concealable
· Psychiatrist report in the case of post-traumatic stress disorder or other mood disorders,
· Ophthalmologist report in the case of eye injury
· ENT surgeon report in the case of ear injury or deafness
· Obstetrician report if there was loss of a foetus
· Neurologist report, or neuro-surgeon report in the case of head injury especially if the claimant develops fits or learning problems
· (Other specialist reports as needed such as Cardiothoracic, General Surgery and so on.)
2. Sworn affidavit detailing the following:
· Place, time and nature of the accident.
· Treatment received
· Convalescence and sick leave details
· Loss of amenities, income or job
· All other problems that have occurred as a result of the accident.
3. Copies of hospital or clinic and doctor’s treatment notes before and after the accident.
4. All previous x-rays and scans
5. Police report of accident
6. Statements of witnesses to the accident.
7. A sworn statement by employer of the effects of the accident on the claimant in terms of their work performance.
8. A sworn statement by a family member or close friend as to the effects of the accident.
9. In the case of school children, a statement of the teacher regarding the performance of the child after the accident compared to prior to the accident.
Paramedical Expert opinions (psychologists, physiotherapist, neuro-psychologists, occupational therapists, audiologists, speech therapists etc) will only be considered if a diagnosis of injury is made by a Specialist Medical Doctor and the nexus of such injury has been “mindfully” attributed to the accident. This is particularly so in soft tissue injuries of the Spine or mild head injuries or if complaints are non-specific to injury and/or are commonly occurring in the normal population such as headaches, neck and back pain and mood disorders.
All plaintiffs should please complete the questionnaire copied below so as to ensure that his or her version of the injury and sequelae are recorded. Completion of the pain disability questionnaire PDQ is important but attorneys acting for plaintiff should be aware that it is merely a self-reported series of questions that a patient (or in medico-legal matters the plaintiff) is tasked to complete independently.
PDQs are useful as a monitoring tool over time when assessing treatment outcomes and natural healing of injuries but are not very useful to determine the actual disability of a plaintiff at a particular point in time. It is entirely subjective and on its own does not have any diagnostic, prognostic or objective impairment weighting to it.
It merely allows a patient or plaintiff the opportunity to express to some extent what they “feel” about the effects of the injuries sustained in an accident at one point in time and thereby direct the assessor to consider the subjective outcomes of the injuries.
Cultural, socio-economic, religious, gender, age-related health problems, life-style factors, drug and alcohol abuse, obesity factors and co-morbidities can entirely negate the usefulness of the PDQ as it relates to the injuries sustained in an accident.
So, interpreting PDQ’s in Medicolegal matters or where other secondary gain factors (both physical or emotional) are at play requires mindful professional judgment not only as to the significance of the complaints but also to the nexus of the injuries sustained in the accident. Medical records detailing specific injuries and co-morbidities, objective clinical and radiological findings, collateral information from employers, associates, friends and family as to the “before and after” the accident are, therefore, mandatory to substantiate the complaints of disability of the plaintiff or patient and also the nexus to the accident.