Why fixed-fee schemes make capacity the only way to grow.
If you assess workers compensation, motor accident or personal injury claims, you already know the part of the job nobody trained you for. It is not the assessment. It is the hours of reading, reconciling and drafting that surround it. What is less obvious is why that time matters so much more to your income than it would in almost any other kind of practice.
The answer is in how these schemes pay.
The fee is fixed, so price is not a lever
In most regulated compensation schemes, the fee for a medico-legal report is set by the scheme, not by you. NSW workers compensation fixes medical examination and report fees through a scheme order that is remade each year. In the NSW motor accident scheme, the maximum medico-legal fees sit in regulation and are indexed to inflation, so the number moves only with CPI. You cannot charge more per assessment because you are thorough, or faster, or more senior. The usual way a professional grows income, by raising their rate, is simply closed to you.
It is not that the work is valued at the capped figure. The AMA's own suggested schedule puts a specialist examination and report above what several scheme categories pay, and the RACGP's guidance on report writing tells doctors to price a report by applying their clinical hourly rate to the time it takes, then notes that bodies such as TAC and WorkCover Queensland set fees you must simply comply with. Even the regulators concede the caps can lag: when WorkCover Queensland restructured its medico-legal fees from 1 January 2026, it said the increase was to reflect current market expectations. The gap between what the work is worth and what the scheme pays is real, and you cannot negotiate it away.
That leaves exactly one lever: volume. How many quality reports you can complete, without burning more hours or cutting corners on rigour. Everything about growing a medico-legal practice comes back to that single number.
Where the hours actually go
Here is the uncomfortable part. The assessment, the work you trained for and are genuinely good at, is not what eats your week. A single referral file can run past 500 pages: GP notes, hospital records, prior assessments, imaging, scanned handwriting, none of it in order. Before you can form an opinion you have to read all of it, reconcile it, and hold the chronology in your head.
In pilot testing with practising specialists, that preparation ran to four or five hours per case. The thirty-minute assessment is the small part. The file is the tax.
The bottleneck was never the assessment. It was the reading, the drafting and the typing that surround it.
Lift the tax, lift the ceiling
If preparation is what caps your caseload, then cutting preparation is what raises it. When the file is turned into a structured, source-linked case summary in minutes, your job shifts from manual interpretation to fast validation. You confirm, you correct, you move on. The clinical judgement stays entirely yours. The paperwork does not.
In the same pilot testing, preparation fell from four or five hours to around fifteen minutes per file. Applied across a month of cases, that is not a marginal efficiency. It is the difference between a caseload capped by reading time and one capped only by the clinical time you actually want to spend.
- You cannot raise the fee. So the only growth available is more completed reports.
- Preparation is the ceiling. It is the largest, least clinical part of each case.
- Remove it and the ceiling lifts without asking you to work longer or assess less carefully.
Demand is not the limiting factor. The Personal Injury Commission, which handles medical assessment disputes in the NSW schemes, has reported high and rising assessment volumes and has actively recruited more medical assessors to keep up, and the insurer-commissioned work that sits outside the Commission is larger still. The scarce resource in this work is not cases. It is assessor hours, which is exactly what preparation time consumes.
How Medilee lifts it
This is the gap Medilee is built to close. It reads the referral files and turns them into a structured, source-linked case summary: a clean chronology, the clinically relevant history pulled forward, and the referrer's questions listed out, with every line linked back to the page it came from. Your time shifts from assembling the file to validating a summary, so you confirm and correct instead of reading and reconciling from scratch. It then turns your dictation into a first draft of the answers, which you review, edit and own.
The clinical judgement stays entirely yours. What shrinks is the preparation around it, the one part of a fixed-fee case you can actually change. Give an hour back on every file and, in a scheme where capacity is the only lever, that hour is not just time saved. It is room to complete another report at the same rigour, which is the only form of growth the fee structure leaves open to you.
A note on the numbers
Two kinds of figures appear above, and both carry caveats. The preparation times come from pilot testing, not a guarantee; your own numbers will depend on your case mix, your scheme and how you work. The scheme fees and suggested rates are set by others, change every year and differ by scheme, so check the current schedule that applies to your work before relying on a specific figure. The point is not a promise of a specific income. It is a structural one: in a fixed-fee world, the tool that gives you back preparation time is the tool that grows your practice, because capacity is the only lever you have left.
