News & Info

The Injuries Resolution Board’s assessments of section 44 medical-report fees and the issue of consistent shortfalls in personal-injury claimants’ medical-report fees – in breach of the board’s own mission statement – both require statutory review. Maria Lakes tears off the band-aid.

The Injuries Resolution Board (IRB), despite its stated objective to offer a “fair, prompt, and transparent resolution of personal-injuries claims”, has consistently applied unfair and ambiguous rules concerning the awarding of section 44 claimant medical-report fees.

This has resulted in consistent shortfalls being awarded in assessments in respect of the medical-report fees incurred by claimants and these victims making up the difference from their general damages – the compensation that is intended to make right their injuries.

This practice is unfair and lacks transparency. How has this arisen, how is it being tolerated and, most importantly, why does nobody appear to care?

Eye for an eye

All victims of personal injury who wish to make a claim for compensation must start the process with an application to the IRB and are required to submit a medical report with their application.

The IRB provided claimants with Guidance on Medical Reports in September 2023, which confirms that “all applications to PIAB must be accompanied by a medical report in order for the application to be deemed complete and accepted into the PIAB process and for section 50 of the Personal Injuries Assessment Board Act 2003 (Statute of Limitations) to apply”.

They confirm that this medical report is referred to “as a treating medical report” meaning that it should be “prepared by a medical practitioner who has treated the claimant in respect of the personal injuries the subject of the relevant claim”.

This guidance also states that “claimants may submit more than one medical report, and any medical report received by PIAB up to the point of assessment will be considered by the assessors”.

As regards the cost of the treating medical report(s), the guidance states that the IRB “will consider all fees and expenses submitted by the claimant or on the claimant’s behalf.

“Fees and expenses that have, in the opinion of the board, been reasonably and necessarily incurred by the claimant in complying with part 2 of the Personal Injuries Assessment Board Act 2003 (as amended) and the rules made thereunder will be allowed in whole or in part as the board in its discretion determines.”

Clearly, the IRB envisages that the claimant will obtain a report or reports from their treating medical practitioner to ground their application, and that the costs of such report or reports will be vouched, claimed, and determined by the IRB.

The IRB also provides a template form for a treating medical report, Form B, which states: “If the claim proceeds to assessment, the claimant may be awarded the reasonable and necessary cost of this medical report.”

There is no guidance given in this form to medical practitioners as regards the appropriate, reasonable, and necessary costs of the medical report.

Section 44(3) of the Personal Injuries Assessment Board Act 2003 (as amended) requires the IRB to include in an assessment “those fees or expenses [that] are fees or expenses that, in the opinion of the board, have been reasonably and necessarily incurred by the claimant in complying with the provisions of this part or any rules under section 46 in relation to his or her relevant claim.”

It is difficult to understand how any claimant could be denied the full cost of a treating doctor’s report in an assessment from the IRB, as this very report is required to comply with the statutory requirements of application to the IRB. Furthermore, while there is clearly a discretion retained by the IRB as regards the awarding of this fee in an assessment, there is no information given to the claimant, nor the medical practitioner preparing the report, of the likely rate that will be recovered in the assessment for the report fee.

Lastly, it is important to note that the claimant has already discharged the medical-report fee to the medical practitioner at the commencement of their claim.

As the average assessment time for a claim now stands at 11.2 months, according to the IRB’s 2024 annual report, the claimant has probably been out of pocket for the medical-report fee for approximately one year by the time the IRB determines whether the cost associated with the report should be awarded in the assessment.

Alas, as will be seen, the full cost of the treating medical report is consistently not being awarded under section 44 in assessments made by the IRB.

Salt in the wound

Time and again in my work as a plaintiff personal-injuries solicitor, I observed assessments where claimants were awarded less than the actual cost of the medical report they submitted to ground their application.

This prompted me to review 103 personal-injury files I opened for clients (from the date of introduction of the Personal Injury Guidelines, which commenced on 24 April 2021, to the date of my analysis on 11 February 2025) in which the IRB had made assessments.

In 51 of these assessments, the claimant was awarded less for their medical-report fee than the actual cost paid for that report. No reason, explanation, or rationale was given for this shortfall in any of the assessments.

Moreover, there was inconsistency in the level of fees paid for the same consultants’ reports in different assessments.

For example, the €500 cost of the same A&E consultant’s report was determined at €400 in two assessments, and €492 in another assessment. The €500 cost of the same orthopaedic consultant’s report was allowed at €500 in one assessment and €400 in another assessment.

The €1,230 cost of the same plastic surgeon’s report was allowed at €738 in one assessment, and €600 in another assessment. Again, no explanation has been provided by the IRB for this inconsistent approach.

Certainly, one would recover the €500 orthopaedic fee and the €500 A&E consultant’s report on taxation/ adjudication. The plastic surgeon’s report of €1,230 would likely be reduced on taxation/adjudication.

Cruising for a bruising

It is contended that there is no justification for the approach of the IRB to this issue. The cost of a claimant’s medical report is surely reasonable and necessary, as required under section 44(3) above.

In the interest of fairness, I asked the IRB for information under the Freedom of Information Acts to try to understand its position.

I sought: “All guidance/guidelines or policies or training in place for assessors to inform them of how much to award for claimants’ medical-report fees.”

I received an extract from the IRB Process Manual (version 10, dated 21 March 2022), wherein the following guidance is given to IRB staff:

“Under Section 44 the Board, on the making of an Assessment, may direct the accepting Respondent to pay to the Claimant a specific amount being the whole or part of the fees and expenses that in the opinion of the Board have been reasonably and necessarily incurred by the Claimant in complying with Part 2 of the Act or any Rules made there under. Each case should be considered on its own merits based on the information provided. In relation to medical report fees and legal expenses the following guidelines apply:

• Guidelines in relation to assessing the amount to be allowed for medical reports submitted by Claimants, and
• Guidelines on legal Costs under section 44 of PIAB Act 2003.”

I also received the guidelines in relation to assessing the amount to be allowed for medical reports submitted by claimants (which are dated 1 February 2019) – see panel at bottom of page.

Whole of your health

A further FOI request seeking “all rules and guidance and training or other documentation regarding the use of discretion by the IRB staff in awarding section 44 medical-report costs in an assessment” revealed no further documents.

Of note, the above guidelines have not been revised since 1 February 2019. During the last six years, the costs of medical reports have increased, as any personal-injury solicitor can attest. No account has been taken of this.

The IRB certainly must be aware of the increase in medical-report fees. Of note is their annual report 2024, which records a sum of €7,891,081 in respect of medical-report fees due to be reimbursed to the IRB, which is an increase from €7,392.629 the year previously.

These medical-report fees are in respect of the independent medical report that the IRB arranges when assessing a case.

The IRB has an independent medical panel that provides this service, and the costs of these reports are reimbursed to the IRB by respondents.

The fees paid to the medical practitioners on this panel are unknown, since an FOI request for “the independent-medical-panel fee structure and all data to do with fees to be paid to medics on the independent medical panel” was refused under section 36(1)(b) of the FOI Act as it was deemed to be commercially sensitive information.

Further, an FOI request for the average cost paid to independent medical-panel doctors used by the IRB, broken down into the various disciplines in the ‘guidelines grid’ in the panel, was also refused in circumstances where monthly financial reports of the IRB would provide some information regarding payments to GPs, orthopaedic surgeons and psychiatrists only, and this information was also refused under section 36(1)(b) of the FOI Act.

Turn your head and cough

The IRB requires all respondents to fully reimburse it for the costs of the medical reports of the independent medical practitioners, but will not always require respondents to fully reimburse the claimants the costs they have paid their treating doctors for their medical reports.

This is a perplexing approach to take towards the victims of injury by an arbitrator charged with the task of fairly compensating such victims.

The current approach of the IRB to claimants’ section 44 medical-report fees is arbitrary.

The IRB holds no records of the percentage of claimants awarded their full section 44 medical-report costs, no records of the average shortfall suffered by claimants of these medical-report costs, and no records of any discussions/consideration or review of the 2019 guidelines in relation to assessing the amount to be allowed for medical reports submitted by claimants.

There are two previous versions of these guidelines, dated 11 December 2018 and 19 December 2017.

The IRB has confirmed that it does not record the medical-report fee claimed on their operating system, but rather this is manually inserted on a ‘submission form’ document for each individual claim.

As this field is not recorded on their operating system, no reports can be generated concerning the medical-report fee claimed.

This suggests that there is little, if any, oversight or monitoring of the level of medical-report fees claimed by claimants versus those awarded under section 44.

The IRB does, however, record the total amount awarded for medical-report fees, and an FOI request seeking “confirmation of the average amount awarded to claimants for the medical report they submit to IRB” from April 2024 to March 2025 reveals an average of €373.

This figure seems low, but without any information regarding the amount claimed for these reports, no conclusion can really be drawn from this data.

Get well soon

I am tired of assessments that do not include the full cost of the medical-report fees incurred by victims, especially where the fee is reasonable. This is unfair.

Full medical report fees are often not awarded in infants’ assessments, which is completely pointless, as these assessments, if accepted by all parties, have to be ruled and the judge will award the full medical-report fees as part of the legal costs.

The independent medical-panel fee structure was refused under FOI by the IRB as the IRB was “satisfied that the information … relates to fee levels charged by individual service providers of IRB’s medical panel, and could prejudice the competitive position of those persons in the conduct of their profession or business or otherwise in their occupation”.

A victim obliged to take up a medical report from their treating doctor to access a legal remedy has limited bargaining power.

They have no understanding of how much a medical report should cost or any awareness of the shortfall they may suffer for the report fee in an assessment.

The IRB assessment of section 44 medical-report fees requires statutory review.

Certainly, one full claimant medical-report fee should be awarded in an assessment, unless the interests of justice require otherwise. Any discretion within the process should be set out clearly and training should be provided to IRB staff.

Claimants and medical practitioners engaging in medical legal work should be made aware of the IRB’s approach and rules on this issue.

The recovery of claimant medical-report fees should be continuously monitored by the IRB, included in their annual report, and recognised as a gateway of access to justice.

The alternative is that some claimant becomes the guinea pig that launches a High Court challenge on this issue and bears a significant costs risk.

I thought it best to highlight this issue in the hope that some momentum follows in order to bring about change. If nothing else, I believe I have discovered a net issue that both plaintiff and defendant personal-injury solicitors can see eye to eye on!

GUIDELINES GRID

Guidelines in relation to assessing the amount to be allowed for medical reports submitted by claimants

Section 44 of the PIAB Act 2003 gives the board a discretion to include with the Notice of Assessment a direction that the assessment shall include the fees and expenses, in whole or in part, that have been reasonably and necessarily incurred by a Claimant in complying with Part 2 of the PIAB Act 2003.

With effect from 1 February 2019 in considering whether to give such a direction in relation to the cost of medical reports submitted with an application, the board will consider:

• The receipted cost of the report,
• The content of the report, and
• The specialisation of the doctor who prepared the report.

Reports outside of these specialities should be considered on a case-by-case basis:

1) €120 to €175 for a limited report more in the form of a letter/account of injuries suffered. This is based by reference to reports such as those provided for Social Welfare and life-assurance companies which cost less than €100.

2) €45 to €75 for a note from the doctor reporting the injuries suffered. This is based by reference to the cost of a doctor’s visit and sick/ absentee note being provided.

3) Where multiple reports are submitted with the application, the following should be considered:

• Do the reports cover the same injuries and treatment thereof such as reports from A&E, orthopaedic, GP, physio, chiropractor, etc,
• Are the reports from different specialists on different aspects of the injuries suffered, such as orthopaedic, plastic surgeon, dental, psychiatric, etc?

4) Where further reports are submitted subsequently after the application:

• Were the reports requested by PIAB,
• Would the injuries have been covered in the report by the independent examiner/s,
• Is there anything unusual in the reports that would affect consideration of the application?”

This article originally appeared in the November 2025 issue of the Law Society Gazette: Insult to injury