Attorney work: records, testimony, liens, and the rate you set

Should You Take the Work? What's Actually Different

Taking attorney referrals and IME work is a business decision with a different risk profile than clinical referrals, not a clinical one: you're agreeing to produce records, possibly testify, and get paid on a schedule the legal system controls rather than a payer's. Nothing bars a clinician from doing this work, but four things change the moment a case has a lawyer attached — how records leave your office, whether you're a fact witness or a retained expert, how and when you get paid, and what rate applies.

Each of those four is covered below, in the order they usually surface once a request actually arrives.

Records Requests: Subpoena vs. Authorization vs. Court Order

HIPAA's baseline rule is that protected health information needs either the patient's authorization or a specific permitted-disclosure category before it leaves your office at all — litigation is one of those categories, but a narrow and procedural one, not an open door 1Ref 1HHS Office for Civil Rights (2026).Summary of the HIPAA Privacy Rule.The baseline HIPAA rule that PHI disclosure requires authorization or a permitted-disclosure category, framing litigation disclosures as a narrow category rather than an open door..

A subpoena without an accompanying court order is the disclosure attorneys send most often, and HIPAA requires you to get "satisfactory assurances" that the patient was notified and had a chance to object, or a protective order, before you produce anything — a bare subpoena alone is not enough 2Ref 2HHS Office for Civil Rights (2026).Court Orders and Subpoenas.That a subpoena without a court order requires satisfactory assurances of patient notice or a protective order before records are produced, distinct from a court order's own authorization.. For the procedural mechanics of responding to the subpoena step by step — the notice window, the objection process — see the dedicated walkthrough on record requests.

If the request instead comes as your own patient's signed authorization directing you to send records to their attorney, that's a right-of-access request: you have 30 days (one 30-day extension with notice), can charge a reasonable cost-based fee, and psychotherapy notes stay excluded even from an authorization the patient signs, unless the authorization specifically names them 3Ref 3HHS Office for Civil Rights (2026).Individuals' Right under HIPAA to Access their Health Information.That a patient-directed authorization to send records to an attorney is a right-of-access request: 30 days plus one extension, a reasonable cost-based fee, and psychotherapy notes excluded absent specific naming..

Testifying: Fact Witness vs. Retained Expert

A treating clinician subpoenaed to testify about their own patient is typically a fact witness — testifying to what happened in treatment, not offering a paid opinion — while an IME evaluator hired fresh by an attorney to render an opinion is a retained expert, paid an hourly consulting rate rather than a clinical fee.

The distinction matters because a fact witness's records and testimony flow from the subpoena or authorization rules above, on the timeline the case sets; a retained expert's engagement is a separate contract you negotiate before you agree to it, including your rate, your scope, and your right to decline the case.

Liens: Why "I'll Get Paid When the Case Settles" Is a Bad Deal

A lien arrangement — where you agree to be paid out of the settlement instead of at the time of service — ties your fee to a case timeline and outcome you don't control, and personal-injury and workers' comp cases can run for a long time before they resolve, if they resolve in your favor at all.

Billing this way also sits outside how you'd normally get paid: IME and forensic work is customarily billed directly to the referring attorney or insurer as a professional fee on your own schedule, not submitted through your regular payer contracts. Many clinicians who take attorney work decline liens for exactly this reason and require payment, or at minimum a retainer, up front instead.

Setting Your Forensic Rate — Separate From Your Clinical Fee

Forensic and IME work is customarily billed at an hourly rate set well above your standard clinical fee, and billed for every hour the work actually takes — record review, report writing, deposition prep, travel, and testimony time, not just the hour in the chair. Retainer-up-front is the common structure: the attorney or their client pays a retainer before you begin, you bill against it, and you stop work, with notice, if it's exhausted and not replenished.

• Bill separately for every task, not a flat per-case fee: record review, report drafting, deposition, and court time each take hours that vary case to case.
• Require a retainer before you start, and replenish it before it hits zero — never work forward on the promise of payment at settlement.
• State your cancellation and rescheduling policy for depositions and court dates in writing, since attorneys reschedule court appearances far more often than patients reschedule sessions.
• Decide in advance whether you'll take contingency or lien-based cases at all — many clinicians who do attorney work simply don't, precisely because of the timeline risk above.

If the Attorney Wants to List You as a Referral Source

An attorney's office that sends you steady IME or evaluation work may want to name you on their own marketing materials or website as their go-to evaluator, and that request runs into the same endorsement-disclosure rule that governs any other testimonial: if there's a material connection — a steady referral relationship, a fee arrangement — between you and the attorney, it needs to be disclosed to whoever reads the endorsement, not left implied 4Ref 4Federal Trade Commission (2023).FTC's Endorsement Guides: What People Are Asking.That an attorney's office listing a clinician as their evaluator must disclose the material connection between them, the same endorsement-disclosure rule as any other testimonial..

The compliance shape for a paid attorney-referral arrangement, as opposed to a disclosed, unpaid one, is the same one that governs any paid referral relationship; that's a separate topic covered in referral flow without buying it, and it's worth reading before you agree to any arrangement that pays either side for sending work the other way.

Before You Say Yes: A Short Checklist

Before accepting the first attorney referral, settle four things in writing rather than by conversation: your hourly rate and what counts toward it, your retainer and replenishment policy, whether you'll accept lien or contingency arrangements at all, and how you'll respond to a subpoena versus a client-directed authorization when the request finally arrives. Clinicians who skip this step tend to improvise it mid-case, which is the worst time to negotiate a rate.

• Put your forensic rate and retainer policy in a one-page engagement letter you send before the first record review.
• Decide your subpoena-response protocol now, not when the fax arrives — know the difference between a bare subpoena and one with a court order attached.
• Keep IME and forensic files separate from your regular clinical documentation practices, since the audience and purpose differ.
• Set a hard rule on liens — accept them, decline them, or accept only with a signed retainer floor — and hold the line case to case.