The below can be used as the basis for a written fee schedule for an independent medical examiner.
Fee and Payment Policy
<Organization> values the positive relationship it has with its clients. This policy stipulates our fees and payment expectations.
Independent Medical Evaluations
Fees are dependent upon the complexity of the case, with the average fee for an independent medical evaluation being $______, and a fee range between $______ to $______. For extremely complex cases we may charge higher fees with the pre-approval of the client. These fees are all-inclusive for the evaluation and report. We bill separately for work after the evaluation. Several factors are considered in establishing the fee for a specific case, including the date of injury, the number of injuries, the amount of medical records, the number of x-ray and other diagnostic studies reviewed, other data reviewed, body regions examined, complexity of the medical analysis, and the performance of a permanent impairment assessment. We can give you an estimate of the fee for an upcoming evaluation based on this information.
We charge a no-show or cancellation fee of $______ for any appointment canceled within three working days of the scheduled visit or for an examinee who arrives late.
Medical File Reviews
The fees for medical file reviews are also dependent upon the complexity of the case, with the average fee being $______. Estimates of fees are available upon request.
Physician fees are based on an hourly rate of $______ per hour. We may require retainers for expert medical services. We bill travel time at $______ per hour portal to portal, plus travel expenses.
Depositions and Testimony
We have established a minimal amount of time with a corresponding fee for the following:
Service Time Reserved Fee
Deposition 1 hr. $______ minimum, and additional $______/hour beyond one hour
Videotape Deposition 2 hr. $______ minimum, and $______/hour beyond two hours
Testimony (local) 4 hr. $______ minimum, and $______/hour beyond four hours
Testimony (out of town) 8 hr. $______ minimum per day
All time is portal to portal, including any travel or waiting time. We bill preparation time at the consulting rate specified above.
One-half the projected fee for the deposition or testimony is due upon scheduling. You must pay the full fee two weeks in advance. If you or the opposing party cancels the appointment two weeks in advance, we return the deposit fee; for one to two weeks advance notice, one-half the fee is returned; and there is no refund for cancellations or rescheduling with less than one week notice.
We may require prepayment for new clients or clients who are not current with their financial obligations. Payment is due upon receipt. Accounts are considered past due if not paid within 30 days and are subject to a late charge of 1.5% per month.