The recoverability of medical agency fees in legal costs has become one of the most hotly debated disbursement issues in recent years. What was once a relatively settled area has been thrown into uncertainty by a string of recent decisions demanding greater transparency, proportionality, and justification from claimant solicitors and the medical reporting organisations (MROs) they instruct.
This article charts the recent judicial journey on this issue and offers a closer look at four cases that could define the direction of travel for years to come.
The timeline: a tangle of transparency
In the past couple of years, a series of county court and costs decisions have begun to sharpen the courts’ focus on medical agency breakdowns. Here’s a snapshot of key rulings:
- Wilkinson-Mulvanny v UK Insurance Ltd [2023] (Cardiff CC)
Regional Costs Judge Phillips (now retired) stressed courts should encourage breakdowns to assess reasonableness and proportionality.
- Northampton General Hospital NHS Trust v Hoskin [2023] (Manchester CC)
HHJ Bird required full disclosure of fee breakdowns between expert and MRO. PD 47 imposed a duty on the receiving party to provide a breakdown.
- Sephton v Anchor Hanover Group [2023] (Liverpool CC)
DJ Jenkinson held that agency breakdowns were not essential but reinforced the court’s discretion to assess reasonable sums in their absence.
- Aminu-Edu v Esure Insurance Co Ltd [2024] (London CC)
Circuit Judge Saggerson made transparency the key issue, rejecting claims of commercial sensitivity and capping fees due to the agency’s refusal to provide a breakdown.
- CXR v Dome Holdings [2023] (SCCO)
Judge Gordon Saker found the reasoning in Stringer and Hoskin more compelling and emphasised that without a breakdown it is impossible to compare the fees and reasonably assess.
- Parsons v Stevens [2024] (Truro CC)
DDJ Fentom held that a breakdown was deemed necessary to ensure the proportionality and reasonableness of the costs.
- Craven v Henley [2024] (Manchester CC)
DJ Iyer acknowledged the power to order breakdowns but deemed it unnecessary in this case as the total costs of the disbursement in question (£750 + VAT) fell within a reasonable and proportionate figure.
- Chaudhry v AXA [2024] (Guildford CC)
DJ Murphy emphasised the necessity for transparency to enable the paying party and the Court to assess the proportionality and reasonableness of the claimed costs.
- JXX v Archibald [2025] (SCCO)
Costs Judge Rowley offered the Claimant a choice – (1) Provide the requested breakdowns to assess fees based on both expert work and MRO services – (2) Proceed without breakdowns with fees assessed solely on the reasonableness of the expert’s evidence and disregarding MRO involvement.
- Santiago v MIB [2025] (London CC)
HHJ Dight held the lack of a fee breakdown was not fatal to the claim, as market rates provided sufficient guidance on reasonableness. The Court relied on market rates presented by the Claimant.
- Smith v Portsmouth Hospital NHS Foundation Trust [2024] (Wrexham CC)
DJ Morris held that Stringer and Hoskin emphasised the importance of distinguishing the fees between the expert and the medical agency. A breakdown was provided by Speed Medical and DJ Morris disallowed Speed’s fees and assessed the expert fees.
Spotlight on Key Cases
Hoskin – Where the battle of the breakdowns initiated
Northampton General Hospital NHS Trust v Hoskin was one of the first cases to really highlight the battle of the breakdowns and it seems fitting that it’s a key case.
The claimant sought to recover over £14,000 for two expert reports procured via Premex in a clinical negligence case. An Obstetrics report of £5,400 + VAT and a cardiologist report of £8,775 + VAT. The court found the invoices impermissibly vague, bundling expert and agency fees without separation.
HHJ Bird allowed the appeal and ordered disclosure, holding that CPR PD 47 mandates the provision of expert fee notes because the court cannot meaningfully assess proportionality. Failure to comply, he warned, could result in zero recovery. The judgment reinforced longstanding principles from Stringer v Copley and brought them sharply into modern scrutiny.
Aminu-Edu – Transparency
Aminu-Edu v Esure Insurance Co Ltd [2024] (London CC) was a case I was personally involved in (of course I had to mention), alongside colleagues and Counsel Alec Hancock, and it has since become a frequently cited and important authority.
This judgment from Circuit Judge HHJ Saggerson became something of a classic for its dry wit and devastating logic. It was the next key case that exposed the claimant further and highlighted the level of transparency needed for disbursements to be assessed appropriately.
The claimant’s agency (again, Premex) refused to break down a £2,916 pain management report fee, citing “macro-economic” justifications. The court was unimpressed. It found the argument circular, unsupported by evidence, and transparently aimed at avoiding scrutiny. The judge reduced the recoverable sum to £900 and made it clear: medical agency practices that rely on obfuscation are increasingly at odds with the courts’ demands for evidence based proportionality.
JXX – The SCCO Speaks
In JXX v Archibald [2025] (SCCO), Costs Judge Rowley put another spin on the breakdown conundrum. The court considered whether fees obtained via the MRO ‘MAPS’ were recoverable without a breakdown. The bill of costs totalled at over £900,000 with expert fees totalling over £253,000. The court ruled that composite invoices lacking separation between agency and expert fees were contrary to established case law requiring such evidence for costs assessments.
Costs Judge Rowley offered the claimant an election: disclose the breakdown or have the fee assessed as if only the expert’s fee were claimed.
Santiago – Hope for Claimants Maybe?
In Santiago v MIB, HHJ Dight, following a remittal from the Court of Appeal, had to determine the reasonableness of an interpreter’s fee claimed at £924.
The paying party argued that the lack of a breakdown, especially given the agency’s connection to the claimant’s solicitors, should result in the agency fee or even the entire disbursement being disallowed. However, HHJ Dight held that while the absence of transparency was not ideal, it did not prevent recovery where the overall fee aligned with comparable market rates. He acknowledged that “the absence of a breakdown is not evidence that the Interpreter’s Fee is reasonable or unreasonable” and held that the key test was whether the fee fell within a reasonable market range.
Relying on comparative quotations submitted by the claimant’s costs draftsman, the court found that “the Interpreter’s Fee itself is not out of kilter with the market,” even if “towards the top end.”
Rather than disallow the fee, HHJ Dight trimmed it slightly to £794.40, concluding that transparency, while desirable, was not essential. This case reinforces a pragmatic view that a fee breakdown is not essential if the overall charge is proportionate/reasonable and supported by market evidence.
The Reluctance to Break Down the Breakdowns
Medical reporting organisations often resist providing breakdowns of their fees, citing commercial sensitivity, internal pricing models, or logistical complexity.
Their core argument is that separating the expert’s fee from their own markup oversimplifies the bundled service they offer, which typically includes sourcing the expert, managing appointments, collating records, and quality checking reports. But the real friction lies in their business model: many MROs operate in longstanding, high-volume relationships with claimant solicitors.
These arrangements can involve preferential terms, volume-based pricing, or even shared ownership structures. Providing granular breakdowns might expose wide profit margins or raise questions about whether the solicitor’s selection of the agency was driven by efficiency, or convenience and commercial alignment.
As courts demand greater transparency, these agencies are caught between maintaining commercial confidentiality and enabling their solicitor clients to recover their fees in full. It’s a pressure point that is slowly being pried open by judicial scrutiny.
Where Does This Leave Us
The pendulum seemed to be swinging in the defendants favour, but Santiago suggests a gentle swing back toward the claimants side.
Ultimately, a higher court ruling is needed to direct how this argument is argued going forward. Until then, the argument will continue to spiral outward, expansive and unresolved, much like the universe itself.
