Third Party Reports and Medical Expert: Reports and Testimony Preliminary Consultation (Discussion Page)
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The issue I have encountered the most (while practicing in ON, which was until 2017 and I do not think this has changed since) is that the use of medical reports for research and publications (whether research-based or otherwise) is not considered as “third party reports”. When medical reports that were already generated are being used for another purpose/other purpose than providing medical care, the reports are provided to “third party” and should be treated as such. Even when the researchers or others who use such reports have obtained REB approval, it is forgotten that such reports should not be at their disposal without at least approval or some sort of credit to those who prepared the reports. Especially if the medical reports are used for any creative/research/academic purposes, intellectual property of the physician who created that report should be respected/granted. What I am proposing for discussion is that all medical reports when used for purposes that are not medical do carry intellectual property. REB approval for any works only means that the proposed work has been found to be ethical and it could be conducted. REB approval does not give directive that any medical reports must be available and granted to those who receive the REB approval. I think it is time that we recognize, respect, and appropriately credit intellectual property of physicians in this context. Certainly, it would be up to individual physician to void their rights if they wish to do so. It is my personal experience that any time I would engage in such projects, all physicians who prepared medical reports that I was using in my published works, actually were expecting to get such credit one way or the other.
AssessMed
There currently exists numerous issues surrounding the way in which physicians in this province are providing third party medical reports and these issues are too numerous to list and explain here. That said, the primary overriding issue is the lack of a written detailed structure that clearly defines what the expectations are for a physician accepting, preparing and delivering an IME are and what are the reasonable expectations that all referral sources should abide by. As I have noted there are numerous procedural issues that lead to significant issues on a day to day basis but just as an example, when physicians agree to accept, submit and get adequately paid for an expert medical report, there is a very firm expectation that if they are required to appear as an expert witness in court, given ample notice, he or she will make it the highest priority to attend court as scheduled. While this is the universally known expectation, when it comes to facilitating this aspect of the IME process, many physicians try and get out of this obligation to appear as an expert witness, claiming they have other obligations like vacations, guest at a wedding etc. and they wreak havoc for the referral source trying to meet the court appointed dates for medical expert testimony. Here is not the place to debate what the requirements are for court appearances by medical experts but to just point out that without very specific and enforceable regulation governing an issue as important as one like this, unnecessary and at times very heated confrontations will continue.
My feeling about third party reports or IME’s is that they are for a specific purpose usually in adjudicating a client’s claim or claims regarding a specific problem. So, to use these reports for research or other uses would seem to me to be an unproductive use of an otherwise good document. If for instance they were being used to demonstrate multiple bad air-bag deployments for example, then these documents may be of use but generally, I would suggest that IME’s should not be allowed to bee red by others and used as a research tool.
I do not feel that it is permissible for the physician performing the IME to use only selective information in the IME and ignore reports and notes from far more qualified specialists in the field, i.e. a community orthopedic surgeon ignoring the reports of academic physiatrists including a world renowned specialist in chronic pain when denying the treatment they recommended. I think that it is professional misconduct and willful misrepresentation for a far less qualified doctor to place his/her opinion above the opinion of the acknowledged experts in the field and this should be made explicit in the College expectations. If this type of behavior could lead to a College complaint and after full investigation the complaint was found to be justified and to be professional misconduct with real consequences it would help to prevent current obvious bias and blatant abuse in the IME industry.
And why is it assumed that the “community” orthopaedic surgeon is “less qualified” than the academic physiatrist? The community surgeon may have far more experience treating these patients, almost certainly has a more varied experience, and may have more experience in dealing with complex medico-legel matters. The quality of work is not necessarily higher in the academic world. I have worked extensively in both environments and can assure the writer hat many community based physicians and surgeons are better at doing their jobs than their academic colleagues. The College makes no distinction in credentialing, nor should you.
I strongly agree with the comment that academic physicians are not necessarily better in doing their jobs than non-academic physicians. However, academic physicians with demonstrated expertize (especially if that includes respectable publication record in specific question or area) could and should be considered as experts. What and how we define expertize is not always clear, is difficult to do, but it has been done all the time. This is another topic in itself worth separate consideration.
I do many third party IMEs. more recently lawyers have asked the family doctor to make a referral to me for a routine consultation with the intention of using the report I write for negotiations or for court. I do the usual medical consultation. is it my obligation to produce an opinion of what the cause of the problem is. Do i have to apportion the percentage of the problem to a disease process versus what is due to the accident. The time spent looking through 20 to thirty pounds of chart allows this separation with full disclosure of all previous tests and physician reports. when i receive a patient from a physician (not a third party report) i use the medical information provided and any other tests I need to diagnose and treat. I do not have the information to allocate blame. So not having this information I feel that I am unable to write the report similar to the report I write for an IME where all the information that is necessary is provided.
I agree with above comments. It is also totally unreasonable on part of the referring physician to get a specialist’s opinion ( mostly not even announced in referral letter if there is a legal issue) and use it or pass it on to the lawyers for legal purposes. I restrict my opinion to the presenting medical issues and there management only, because that is what OHIP pays for. There neither should be an expectation nor should be an attempt to make it anything else.
Reviewed both guidelines. I feel guidelines are very detailed and excellent!
Family doctors are there to provide medical care – not insurance or work notes. Requiring that I waste my time filling out forms is not a medical necessity – the CPSO should regulate the delivery of health care as far as physicians are concerned, and nothing else.
For valid, independent, unbiased and uniform reports on a patients – one that allows physicians to be objective with no bias – work-place and insurance companies can consult physicians who work in this area. Often this work is dumped at my feet and I am supposed to be the expert knowing how long someone should be off work, what kind of work they can do, and so on.
There is wide-spread abuse of this process. Family doctors are not qualified to make judgements on this and should be excluded from making this determination – those who require / request forms to be filled out should have to consult independent medical examiners.
Yes, I strongly agree with this statement. Too much is dumped on the family physician’s feet. How am I supposed to know a patient’s restrictions after having their knee replacement? I have a patient who is also regularly seen by a psychiatrist but I have to fill in their disability paperwork because I am the “hub for their care”, as if that means I should do all of the forms related to their medical conditions? I don’t know what their anxiety/depression limits them from doing – they are seeing you every 3 weeks and me maybe once this year for a pap! The hearing aids forms that are actually completed by audiologists that I sign as if I have the ultimate expertise in it or the orthopedic shoes suggestions that I sign that a chiropodist is technically completing.
This is ridiculous. It is also not medical care and to say that we MUST complete these forms and that we ADVISE not charging the patient for it is blowing my mind.
good guidelines for medico legal expertise
Office of the Information and Privacy Commissioner of Ontario
Response in PDF format.
I do IME for insurance and plaintiffs.If I see a client for IME and he has been treated at my hospital by someone else-and if I get a consent signed by the client that I can review all their medical records-is it illegal for me to see their Xrays ,MRI and consults in the hospital system?
Retired physicians have lot more experience than young ones practicing-so we should never discard experience in medicine-this is the basis of our system we learn while we practice.
MVA Victims who are subjected to Insurance Imposed IE’s must be allowed to have a companion in the appointment to bear witness or be allowed to record the session. This is NOT to authorize the IE examiner, hired by the insurance company, to record the session. This is for the sole benefit of the MVA victim, and the recording can only be made by the MVA victim. I have been subjected to too many Insurance Imposed IE’s. When I finally receive a copy of the report many weeks after the IE, there are predictably numerous errors, omissions, and false statements in that report. But I am not given the means to dispute or otherwise have the errors, omissions, and false statements corrected. The issue is that, whether intentionally made or not, these errors, omissions, and false statements are the justifications used by the insurance company to deny me of my rightful insurance benefits. At the first IE I attended, I had brought my husband with me. The IE doctor told me that, if my husband accompanied into the appointment, then the session is over. If the IE is to be credible, then the report produced from it must be accurate !
When the IME uses falsified medical records to provide a supportive opinion, that opinion should be considered incompetent and/or medical misconduct. That might make IMEs less inclined to use falsified records and lawyers for the doctor less inclined to provide repeat business for them.
I had to attend 6 IME. 10 minutes exams mostly. The neuropsychological exam removed me from a minor injury. It was never actioned. Each dr declined my request to record the exam. None of the doctors are specialists in TBI. The listed tests that they never performed. Hubby was diagnosed with stage 4 cancer the same year as my accident. The adjustor was quoted saying that both of us will be dead before any money ould have to be paid by either insurance company.
As an MVA victim who now have to live with chronic pain for the rest of my life due to a doctor who was paid by the Insurance Company to discredit my injury claims, I respectfully ask the CPSO to take a stronger action to investigate and discipline the doctors who are making more money by submitting reports that result in denying accident victims of their rightful insurance benefits, than they are in practicing medicine. In fact, it is doubtful that the more guilty of these doctors are even treating patients. In the Globe Investigation article published on 1st December 2017 titled ‘Licensed to bill: How doctors profit from injury assessment that benefit insurers.’ According to the article, this doctor was investigated at least four times; one of the complaints was made by another doctor. And yet CPSO did not take any action to discipline this doctor. His licence should be revoked as he is clearly not practicing medicine; or at the very least, be tried for disgraceful, dishonourable and unprofessional conduct.
Since the CPSO last reviewed its policy position on Third Party Reports (IMEs) and medico-legal (expert) testimony; the issue of shoddy, “hired gun” auto insurer commissioned “independent” assessments has received extensive coverage in the mainstream press. The National Post, The Toronto Sun, The Toronto Star and the Globe & Mail have all done investigative reports on this subject. None of the coverage has been flattering.
Suffice it to say that vulnerable car crash victims are the captive subjects of medical assessments performed by the insurers’ “preferred vendors” of IMEs. If an injured claimant refuses to submit to an IME their policy benefits (including treatment benefits) are denied. If they do submit to an IME then they risk becoming the victims of all-too-frequent, spurious allegations of symptom-exaggeration (and/or malingering). As has been repeated in these assorted investigated reports the problem of bias in IMEs is systemic (other problems include “ghost” authors, paper reviews, “consensus” reports and (under)unqualified assessments. Seriously (sometimes catastrophically) injured car crash victims deserve better than to be abused in this way. The CPSO needs to finally crack down on members who are unwilling or unable to provide well-qualified and completely impartial medico-legal assessments. The status quo is undermining trust in both the medical profession and the legal system.
I was subjected to several IME’s by a doctor who is clearly a ‘hired gun’ by the insurance company. I attended only one of those IME’s in person, the other IME sessions were done by ‘paper’ – I was not allowed to attend. This doctor not only ignored the medical reports of a well-reputed Physiatrist, a Physiotherapist, and my Family Doctor, he disregarded my medical history that showed no pre-condition prior to the accident. His reports claimed that my injuries were due to my age! I was 63 at the time of the accident, but I was an athletically fit 63 year old. This avaricious doctor has condemned me to a life of pain and suffering with his false assessments. CPSO needs to crack down on these so-called doctors who are in actual fact violating the Hypocratic Oath. Doctors who get rich working for the Insurance companies are Stealing, Not Healing.
If you require that all statements made in IME’s are sworn to be truthful by the examiner and all records and medical information has been unaltered under penalty of perjury and disciplinary action and possible loss of license. That would go a long way to helping with many of the issues of the rampant insurance bought IME ‘fraud’ against vulnerable accident victims. Of course CPSO would actually have to do something and not cover up the abuse. Something most of us are not holding our breath about.
Ontario Rehab Alliance
Response in PDF format.
My insurer has sent me to many IME’s. It has been my experience that in each case the reports produced by the doctor’s performing the IME outright lied and made many false statements, which I can prove with documents from my treating health care providers and surgeons. One doctor, a neurologist was brought from 12 hrs. away to assess me. There are many qualified neurologists where I live, yet my insurer uses a doctor from 12 hrs. away that will write false reports to benefit my insurer so they can deny clients the much needed medical treatment and therapies my caregivers say I require. It is an absolute abuse of the powers our Government allows our insurance companies to wield. The absorbent amount of money insurance companies will spend on IME’s and lawyers to deny the injured are greater than the amount of money it would have cost to allow their injured clients the therapies and treatments they need. Downright disgusting the way insurance companies treat their clients in need of help. I believe when insurance companies hire the adjusters, they surgically remove there heart and morality!
I think it is unreasonable to insist that “Treating physicians MUST provide reports about their own patients when proper consent is provided”
There are times when we are not the most appropriate healthcare professional to complete the form. The most common example is the Ontario Disability Support Program Application. Often we family physicians are sent a comprehensive psychological assessment done by a PhD psychologist. We are expected to read, what is often a fairly comprehensive report, and then turn the findings into a form acceptable on the application. Now if the only issue is the psychological or developmental disability for which I am not an expert and the psychologist is the expert , then it makes no sense for me to spend my time basically transcribing what the psychologist has written into an ODSP application. This is crazy and a total waste of my time since I am not the expert and the psychologist is. It has been my practice to send a letter back to the patient’s worker explaining that the psychologist should be the individual doing the application form since he/she did the assessment that provides the basis for the application. The way the policy is written suggests the the psychologist, for whatever reason, can simply refuse to complete the application and I would have no choice but to it since the CPSO has forced me to do so. Please change the wording to reflect that we MUST complete the form IF WE ARE THE APPROPRIATE HEATH CARE PROFESSIONAL TO DO SO. no problem then
Also, it is common for treating specialists to refuse to do insurance forms even when they are the most appropriate professional to complete the form, telling patients ” I don’t do insurance forms, take it to your family physician” . This has been common for decades. It is unfair, inappropriate and needs to be addressed.
The third party report regulations do nothing to clean up a system that regularly and routinely harms patients. Nothing.
The last IME I went to I came out as a smoker who should have been sent back to work 20 years ago. I don’t smoke. I have a spinal cord injury that is well documented. It was a nonsense report filled with demeaning remarks that were on par with the in-office experience of badgering me during the exam. The report was made to order for my insurance company but it was so bad that they didn’t use it. The report could affect my medical care for the rest of my life with other medical professionals who might believe this report. That isn’t right.
What will the College do to stop the insurance company bought and paid for doctors from hurting patients by pretending not to see injuries?
I have been to many IME and the real medical information comes from doctors through OHIP where they aren’t being paid to hurt you or to stop your therapy. It is unbelievable that Ontario has doctor oversight system doing nothing to stop patient harm.
So far CPSO is a good example of why self-regulation doesn’t work and how private insurance dollars has made it happen. Where is action to protect patients by facilitating “honest, objective and impartial” reports? That’s lost when complaints about members are buried in secrecy to protect them and not the public.
Take a minute and look at what the courts say about your members. Reflect on that and come up with a better plan to better protect patients because it’s obvious to everyone except this College how desperate patients are when predatory doctors are unleashed on seriously hurt patients.
Insurance Bureau of Canada
Response in PDF format.
So in other words you’re saying let us keep doing what we are doing but make it easier for us.
Ontario Trial Lawyers Association (OTLA)
Response in PDF format.
There unfortunately is no such thing as a insurance company using IME – All of them are paid actors
My first encounter with a Insurance company Surgeon was after the Pain Clinic sent them my results of spinal damage needing immediate Neurosurgeon Assessment .. I was then seen by insurance company surgeon – 30 minute examination entirely in Greek
Two weeks later I have numerous letters from our insurance company of over 25 years stating their surgeon found nothing wrong with me – can return to work – cancelled my claim and treatment of acupuncture and chiropractor.
One year waiting to be seen by GP referral to Nero Surgeon – First thing the Doctor asked was the name and location of the idiot who stated there was nothing wrong with my spine – that would be my Insurance company.
The ‘IME’ for insurance company was a retired 85 yr old Nero Surgeon who had done and completed his medical examination ‘without’ physically examining my spine, neck, or pelvis
It would appeared that he had X-ray vision – when asked why he hadn’t physically-touched examined the areas – he responded – I don’t need too – I have your complete medical file here on my desk
All three other insurance company IME examinations were identical
How can these Insurance companies feel this ethical or legal
First I would like to commend the College of Physicians and Surgeons of Ontario (CPSO) for allowing PUBLIC CITIZENS this opportunity to voice our concerns and opinions with regard to the policies governing INDEPENDENT MEDICAL EXAMINATIONS (IMEs) – KUDOS!
As an Ontarian receiving health care through the Ontario Health Insurance Plan (OHIP) I am grateful to receive care from compassionate doctors, specialists, surgeons and qualified members of the College of Physicians and Surgeons of Ontario (CPSO).
I write from the perspective of an AUTO INSURANCE CLAIMANT who has been injured in multiple motor vehicle accidents (MVA’s) at no fault of my own who will likely be required to attend future IMEs related to SABS files and pending TORT claims. I will request that Independent Medical Examinations (IMEs) be recorded, not out of a distrust for DOCTORS, but out of a distrust for INSURERS and MEDICAL ASSESSMENT COMPANIES who have been caught GHOST WRITING REPORTS.
TO PREVENT ASSESSMENT COMPANIES FROM ALTERING REPORTS doctor’s should be required to read, initial and number every page in the report. That would prevent ASSESSMENT COMPANIES from altering REPORTS after they are validated by the DOCTOR who conducted the IME.
Statistics prove INSURERS spend more dollars assessing than treating CLAIMANT(s). IME DOCTORS need to determine what injuries are a result of the MVA the CLAIMANT is applying for benefits on – and JUSTIFIABLY SO! When there are preexisting injuries or medical conditions IME DOCTORS might need to determine if they were aggravated by the MVA or have nothing to do with the MVA.
INSURED parties and ONTARIAN TAX PAYERS should strive to keep insurance premiums down and support a fair and reasonable IME and INSURANCE CLAIMS PROCESS. When INSURERS deny legitimate CLAIMANT(s) treatment ONTARIO TAX PAYERS end up footing the bill for some of treatment through OHIP. When claimants go without essential treatment, because it is not covered by OHIP, a CLAIMANT’s condition can deteriorate and will likely worsen.
I hadn’t completed a treatment plan I paid privately for when I was injured in another MVA, so I asked the INSURER to obtain the records of the provider so they would have a snap shot of my preexisting condition. THE INSURER refused to obtain the records before scheduling IMEs. I also asked the INSURER to disclose the MEDICAL LIST of records they compiled for review at the IME so I could determine what records I needed to obtain and arrange counter rebuttals.
The only way a CLAIMANT can find out what medical documents are in the possession of the INSURER for review by the IME DOCTOR is to ask for disclosure of the MEDICAL LIST. INSURERS are not required to inform CLAIMANT(s) each time they request CLAIMANT’S records – consent is implied. The authorization stays in effect for the life of the SABS file or until CLAIMANT(s) withdraw consent.
When an applicant receives a notice of an IME the OCF-25 states:
“Within 5 business days of receiving this notice, you are required to provide all reasonably available information and documents that are relevant or necessary for the review of your medical condition prior to your examination to the person or persons conducting the examination identified in Part 4 of this form.”
If an applicant doesn’t obtain a MEDICAL LIST from the insurer how can they know what is missing. Furthermore can doctors and health care providers be expected to hand over CLAIMANTS records on demand so CLAIMANTS can deliver them within five business days to an IME facility. I doubt I could even get an appointment to see my doctor within 5 business days. I THINK THE OCF-25 IS ONE SIDED AND VIOLATES CLAIMANTS RIGHTS TO A FAIR ASSESSMENT.
Under Fee’s the CPSO policy states: “13. Physicians must discuss fees for acting as medical experts with those who are instructing them.” CLAIMANT(s) can’t discuss fees with a medical experts unless insurers disclose the MEDICAL LIST of CNRs being reviewed.
I called a number of assessment companies who advised they wouldn’t conduct rebuttal IMEs on behalf of CITIZENS/CLAIMANT(s). They only conduct IMEs for LAWYERS or INSURERS. So what happens with self representing litigants? They can’t get a fair assessment because they don’t have a lawyer. That doesn’t seem fair or reasonable. We handle our own SABS file. I can understand IMEs requiring a retainer to ensure services rendered are paid for, but it is unfair to deny ONTARIANS & CLAIMANT(s) access to IMEs because they are not legally represented.
The “Health Claims for Auto Insurance (HCAI) electronic system for submitting OCF-18s [treatment mans] -21s, 23s, and the Form 1 to insurers in Ontario electronically is efficient. Before HCAI, INSURERS could claim they didn’t receive treatment plans which resulted in treatment delays. Perhaps HCAI can be expanded to include the collection and retention of CLAIMANT’s SABS files and CNRs. If all records were uploaded to a central processing system and safeguarded from alteration it would reduce the costs of assessments significantly. INSURERS obtain signed waivers at the onset of the claim for benefits to access CLAIMANT’s records if the WAIVERS were submitted to HCAI, INSURERS could be given access through HCAI to prior SABS files. A bring forward system could also be established to ensure OHIP decoder reports and CNRs are routinely obtained to keep CLAIMANT’s records current for as long as the INSURER is paying for the CLAIMANT’s treatments and benefits. This would ensure CLAIMANT(s) were all treated fair and INSURERS couldn’t cherry pick the records they wanted the IME doctor to review. DOCTORS, LAWYERS and INSURERS could also be provided access. This would reduce the high cost of photocopying and exchanging records, would be environmentally friendly and ensure transparency for all parties. It would ultimately reduce SABS processing costs and litigation costs as well.
For INSURERS to refuse to obtain CLAIMANT’s CNRs from their family doctor and current treatment providers before proceeding to assessments is a travesty of justice. It suggests INSURERS don’t want to risk obtaining medical evidence that might support a need for continuing treatment. INSURERS have the capacity to receive documents electronically, which is how they provide the CLAIMANT’S medical records to ASSESSMENT COMPANIES. INSURERS are suppose to pay for CNRs out of SABS benefits – under Cost of Examination. INSURERS can’t claim they are refraining from ordering CNRs to reduce costs, because the cost of obtaining a CLAIMANT’s OHIP decoder report and CNRs is minimal in comparison to the cost of conducting additional IMEs to review the updated CNRS. By obtaining CNRs before the first IME assessment occurs costs will be reduced and the IMEs reports will more comprehensive, thorough and accurate!
I would like CPSO policies to be updated to stipulate that Doctor’s won’t agree to assess CLAIMANT(s) on behalf of AUTO INSURERS before up-to-date medical records are acquired in advance of the first IME. And if when the DOCTOR attends to conduct the first IME they discover that relevant medical records haven’t been obtained, the IME should be ended at the INSURER’s expense. The doctor should be paid fully as if the IME was conducted, but no IME should be conducted and placed on a CLAIMANT(s) file before relevant CNRs are obtained.
Everyone knows there is strength in numbers, that is why INSURERS engage a group of IME doctors to jointly consult with one another and share reports. It not only strengthens the opinions they express, but ensures a well rounded multi-faceted assessment. Medical opinions need to be based on relevant facts not just on first impressions and no one knows a patient/claimant better than the CLAIMANT’s physician and treatment providers so they should be consulted with.
INSURERS must be prevented from rushing CLAIMANT(s) through the ASSESSMENT PROCESS without the benefit of having relevant medical records reviewed. Due to corporate mergers and the growth of INSURERS its not uncommon for an INSURER to INSURE both the at fault DRIVER and CLAIMANT. With this in mind there needs to be even more over sight to prevent INSURERS from taking an adversarial approach as opposed to diagnosing and treating.
DOCTOR(s) conducting IMEs can only report on the information they are provided with by INSURERS or LAWYERS. Doctor’s are taxpayers and I am certain they recognize the need for thorough and efficient IMEs – whether for SABS or TORT Claims. In the long run fair and impartial IMEs will save taxpayers, insurers, and the insured money.
The average ONTARIAN is aware of the need to tackle insurance fraud and curb the excessive costs that drive INSURANCE PREMIUMS up. What the average ONTARIAN doesn’t realize is that when INSURERS cut off INSURED CLAIMANTS before injuries are resolved, the cost is transferred to OHIP and ONTARIO TAXPAYERS end up picking up the tab.
Policies that govern insurance companies, health care providers and our health care systems are unfairly crafted under the influence of generously paid lobbyist hired by CORPORATIONS & INSURERS to ensure policies benefit CORPORATE STAKEHOLDERS.
When CLAIMANTS injuries are the direct result of an MVA, INSURERS should pay for treatment. OHIP must stop asking doctors to do more than their fair share, in less time, for less money while permitting INSURERS to get away without paying their fair share! Doctor’s conducting IMEs should be required to review an entire list of all existing medical records to ensure they obtain and review all that they deem necessary before formulating an opinion. If the documents were on a portal like HCAI DOCTORS could take their time and review records from their office at their own pace.
The CPSO policy states:
Comprehensiveness & Accuracy
21. Physicians must provide expert opinions that are comprehensive and accurate.
22. Physicians must ensure that all relevant information has been considered,
23. and that the information they rely on to form their expert opinions is accurate.
24. Physicians must clearly express when they do not have enough information to arrive at a conclusion on a particular point, or where their opinions are otherwise qualified.
When INSURERS are aware of relevant medical records that pertain to the injuries the claimant is being assessed for and are found to have suppressed or withheld that information – either by error or intentionally they should be held accountable. All reports produced at IMEs with insufficient medical records should be considered incomplete and potential full of inaccuracies. INSURERS should be forced by regulation to obtain and review all preexisting SABS files and request up to date medical records from claimants physicians and treating health care providers prior to ordering assessments.
To proceed to IMEs without proper medical evidence just results in over assessing claimants at a great expense and drives up the cost of insurance for all INSURED ONTARIANS.
I visited the Ontario Medical Association Doctors website and I agree the OHIP billing system needs to be accountable, fair and transparent and neither claims adjusters/nor civilians who lack medical expertise should be deciding whether treatment options are reasonable and necessary.
I suspect some INSURERS and CLAIMS ADJUSTERS, hopefully not all, take an adversarial approach to dealing with injured claimants. It really depends on the insurers optical perspective – was the at fault driver you are suing insured by your insurer? Is your insurer sharing info through an “indemnity clause” with the at fault insurer. How much info are they sharing? Surveillance is used to convince a doctor, jury or judge with footage that the claimant is not as injured as they claim to be – and justifiably so. I understand the need for surveillance I have developed websites for private investigation firms – I get it. But surveillance doesn’t capture bed ridden suffering claimants in the privacy of their home.
From my perspective medical surveillance will ensure the honesty and integrity of the assessment process. Insurers are dragging cases for years as they garner as much footage as they possibly can of claimants, so there’s no need for CLAIMANTS to resist surveillance during the ASSESSMENT PROCESS when it is likely to benefit CLAIMANTS the most!
The principles and quality controls that govern the assessment process must be fair and balanced – neither designed to favour CLAIMANTS nor INSURERS. Ontarians insurance premiums are disproportionately high because of the dollars wasted by INSURERS.
Legislation must be revised to preserve the integrity of the ASSESSMENT PROCESS and protect the STAKEHOLDERS not just the STOCKHOLDERS. That begins with preserving patient records. The STAKEHOLDERS in the healthcare system are not just employers, insurance companies, health care providers, pharmaceutical firms, physicians, treatment providers and government – CITIZENS & CLAIMANTS ARE STAKEHOLDERS TOO! To keep the INSURANCE system fair it is time that CIVILIANS be invited into the discussion, decision and oversight process.
In my opinion transparency is the most important aspect required to conduct INDEPENDENT MEDICAL ASSESSMENTS and an electronic exchange of all relevant medical records will lead to accurate and thorough assessments, better care and better outcomes. Once again I thank the CPSO for allowing CIVILIANS like me to voice our opinion. I challenge the General Insurance Ombudsman Service to do the same – to welcome feedback and input from the PUBLIC in a public forum!
When seriously injured accident victims pursue their insurance benefits, they’ll encounter the main roadblock to these benefits–the insurer-instated system of second opinion insurance medical examinations (IMEs). These are carried out by insurer-hired doctors, and other licensed medical professionals, including chiropractors, physiotherapists, and psychologists.
Medical opinions from treating physicians and health care practitioners are frequently negated, with some insurer examiners seeking other reasons for the claimant’s health dysfunctions, with pre-accident or previous illnesses and psychological factors cited. Too many of these insurer co-opted ‘vendors’ of health reports are only too pleased to write their assessment reports in favour of the insurer because insurance work pays much more than what is earned in private practice. There is a surprising number of what have become known as “rogue” assessors, who are more than willing to accommodate a denial outcome despite knowing that the person’s claim is valid and their health at stake. ‘Experts’ with a moral and ethical compass tend not to work very long as IE and IME assessors, if at all. It has been like this for years and continues to this day. As a result, claimants are forced to hire personal injury lawyers.
When seriously injured accident victims pursue their insurance benefits, they’ll encounter the main roadblock to these benefits–the insurer-instated system of second opinion insurance medical examinations (IMEs). These are carried out by insurer-hired doctors, and other licensed medical professionals, including chiropractors, physiotherapists, and psychologists.
Too many of these insurer co-opted ‘vendors’ of health reports are only too pleased to write their assessment reports in favour of the insurer because insurance work pays much more than what is earned through OHIP.There is a surprising number of what have become known as “rogue” assessors, who are more than willing to accommodate a denial outcome despite knowing that the person’s claim is valid and their health at stake.
Medical opinions from treating physicians and health care practitioners are frequently negated, with some insurer examiners seeking other reasons for the claimant’s health dysfunctions, with pre-accident or previous illnesses and psychological factors cited. Accident victims are sent to repeated IMEs, often to wear them down and in hope that they give up their claim or settle for less than is deserved.‘Experts’ with a moral and ethical compass tend not to work very long as IME assessors, if at all. It has been like this for years and continues to this day. As a result, claimants are forced to hire personal injury lawyers.
CPSO asking for feedback regarding the May 2018 Third Party Report Policy is certainly welcome given its importance for our society. The 2018 Policy introduced the term “must” in 35 places instances in order to “articulate” the College’s expectations. While the Policy defined the term “advised”, it did not define the term “must”. While the term “must” is generally viewed as clear, it nevertheless brings troublesome ambiguity when associated with words such as “personal bias” or “relevant” as illustrated for example in Rules 29 and 34:
29. Physicians must state any findings or opinions contained in a report in a way that is objective and free from personal bias.
Should the term “personal bias” be interpreted as infringement of Human Rights or the result of education, training and experience? Should the following statement be viewed as a personal bias under this Policy? “It is my medical opinion that maintenance chiropractic care is not medically necessary.” The combination of the term “must” and “free of personal bias” without any explanation is therefore itself subject to an arbitrary or biased interpretation.
34. Physicians must only include information in the third party reports which they deem necessary and relevant.
The combination of the terms “must” and “necessary and relevant” is again problematic. In Québec, the CMQ has cautioned an orthopaedic surgeon who had included in the medication list the name of an antidepressant. The CMQ indicated that the listing of an antidepressant was not necessary nor relevant in his capacity of an orthopaedic surgeon. The CMQ has also cautioned a psychiatrist for having addressed all psychosocial determinants of disability in the examinee’s personal life. The CMQ indicated that the psychiatrist should have addressed only factors related to the workplace as the claim was for a work disability. It would be in everyone’s interest for the CPSO to provide some explanation for each instance that the term “must” is used in the policy. Furthermore, the term “advised” is used 21 times in the Third Party Report Policy with the understanding that physicians can use “reasonable discretion” would be best omitted as it adds more ambiguity. If the policy was clear, the CPSO would not advise consulting a lawyer.
In the first paragraph on page 1, the policy states “Together, with the Practice Guide and relevant legislation and case law, they will be used by the College and its Committees when considering physician practice or conduct.”
The CPSO September 2007 Practice Guide states on page 12: “Conflict among the duties outlined in this guide is inevitable. When conflict arises, physicians should first refer to the fundamental values that ground the principles and duties that follow. For example, if there is a conflict between a physician’s obligation to a patient and the obligation to the system (e.g., efficiency), the profession’s commitment to the value of altruism makes it clear that the patient should always come first.”
This same Practice Guide states on page 1: “Together, the values, principles and duties of medical professionalism enable the profession to provide the best quality care.”
I would suggest that with respect to the Third Party Policy, the CPSO should first define the values, principles and duties of medical professionalism in the medicolegal context. The social contract between the profession and its obligation to the system must be better defined in this Policy and Practice Guide. For example, when considering physician practice or conduct does the College and its Committees give precedence to Ontario legislation, regulations, case law, civil rules of procedures when in conflict with the CPSO’s policies? Given the Practice Guide, when there is a conflict between the two, should physicians follow statutes or the College Policy? What are the CPSO committees instructed to follow?
The matters in the Third Party Reports are so fundamental that a new Policy must not be rushed. A wide consultation among societal stakeholders is therefore advised.The Collège des Médecins du Québec sought assistance from le Barreau du Québec by setting up a task force. Perhaps, CPSO should consider a similar but broader approach.
Canadian Life and Health Insurance Association Inc.
Response in PDF format.
RE:Third Party Reports (IME),Medical Experts,and Testimony policy.
I paid for insurance,the accident that permanently disabled me from returning to work I was trained,and experienced for. The accident appeared benign as there wasn’t any blood,or broken bones.Through 6 years,I tried to survive: surveillance,plaintiff and defence IME,becoming homeless, losing friends from university,losing a STEM career,losing the ability to have children due to the inability to take care of their basic needs,losing the chance of marriage as finances sits at the number 1 reason for divorce,losing my athletic identity that I had since I was a child that included varsity competition. Despite telling the IME doctors on both sides the aforementioned,it didn’t matter,their reports made me want to commit suicide. Terms like malingering, histerics, economic gain were used,or implied.Gping to arbitration was another trauma, hearing doctors vocalize their fiction,or careless diagnosis that would prove damning to my claim. When I complained to the cpso,it was clear the intake had instructions to be the least helpful.A Neurologist was angry with me when I challenged the accuracy of their report. I told this.non IME doctor his opinion could be used by an insurer to withdraw treatment.CPSO bylaw/rules suggests doctors keep accurate records since they could be used for legal matters. His reply to my cpso complaint included something to the effect I “kicked down his office door.” I wished I could have that level of strength,or energy so I could play the adrenaline driven sports i no longer played. CPSO didn’t care about the inaccuracies,and this Neurologist’s report forms my health record. A psychiatrist was also inaccurate in his assessment for something like my bending to tie my shoes without bent knees because I can’t.I was seeking treatment access from him as I am suicidal,it was refused. CPSO dismissed my complaint.
When a doctor hears,and sees how upset,and scared a patient is while under surveillance,losing their pre accident life. As their insurance claim drags on,how can either the plaintiff,or defence doctor add to the distress. As years pass,it seems the insurer’s sole goal is to end you is trauma that compounds injuries such doctors contribute to.
CPSO has a culture issue where it protects its members before the vulnerable patients who cross paths with them.
Neurology injury,TBI, PTSD have a high mortality.It’s invisible,and the CPSO’s inability to expect members to have a duty of care towards patients as a whole is the anti thesis to the Hippocratic Oath,their own purpose.
Hearing my godson’s sister say to me “you’re always in pain” when I couldn’t play with hwr in the same way I always had for the 9 of 9 years of life she knew me as a vital, energetic , fun ,over grown child.Another devistating cut into what was left of the pre accident self assured,strong person.
To those doctors who felt I was a fraud.Especially the ones who participated in IMEs.They should meet me now, living the nightmare I told them I may not survive.
I have been on the forefront of a case where the CPSO has been completely and absolutely negligent. I was shocked to realize that EVEN WHEN doctors ALREADY have complaints, the complaints are NOT noted on the CPSO registry. This is completely blasphemous. The reason people go to the registry to check is because they want to see if there are complaints. When they see NONE, they assume there are NONE, but of course, the CPSO hides them. When we brought this horrific “POLICY” to their attention, they referred us to some miniscule “hidden in the small print” policy “allowance,” that gives them the “RIGHT” to continue this practise. It is absolutely horrendous. No self-governing authority should be trusted. The CPSO should be completely dismantled and a proper governing authority should be created to govern doctors so that when errors are found, they are actually properly recorded and doctors held accountable. While the case I am mentioning is NOT an insurance IME matter, the “policy” would still apply to any and all cases. I was completely disgusted with the CPSO and now see them as a completely ineffective, self-protecting and falsifying agency. If they are allowed to hide mistakes by doctors and errors in judgement, then what’s the point of a registry? It becomes a misleading and misrepresentative registry and therefore is not valid.
Professional Association of Residents of Ontario (PARO)
Responses in PDF format:
- Third Party Reports
- Medical Expert: Reports and Testimony
I completed the original questionnaire so I am assuming that transmission went through?
Medical experts should be required to be current, up to date on their specialty: orthopedic surgeons, neurologist, etc. Retired specialists are not current or practising and therefore not equipped to complete an assessment.
Medical experts are provided (hopefully) with appropriate medical records not biased by the insurer in order for them to make an informed, objective opinion.
Ghost writing, or third party writing a report other than the examiner, is a form of negligence, in my opinion. Ghost writing leads to cut-and-paste, which leads to wrongful diagnoses, patient info and findings. The examiner should complete the entire report as it allows them to reflect on their client examination and findings, and a more comprehensive review of the medical data provided.
Regarding medical data provided to the assessor, the client is required to provide necessary documents at their own behest. This is not feasible for the majority of clients. If there is no legal representative for the client, the client should have access to medical records being provided for their own review prior to being sent to the assessor. This allows the client to better understand the focus and records being provided.
In preface, I am a Registered Nurse (retired) having dedicated the last 20 years of my career in working with motor vehicle accident victims with the goal of reaching maximum recovery and rehabilitation. My sole focus has been on the welfare of my clients. Those of you in the rehabilitation industry are aware of the numerous insurer examinations our clients have been faced with over the years. At this point in time, I am unaware if the insurance model has changed thus decreasing these examinations; however my article is to address the multitude of clients having gone before. If this pertains to current situations, it is hopeful this article will be of value.
In 2011, while working up to 12 hours per day for the improvement of my clients, I was involved in a major motor vehicle accident. My thoughts were, “I know how this works, I can handle this, I have been supporting my clients for almost 10 years … piece of cake”.
Wrong! I experienced firsthand the abruptness, the denials, questioning of my integrity, humiliation, frustration, anger, confusion and failure. The course of my involvement for my claim lasted almost 8 years. In that time I underwent scrutiny from my own insurance carrier, the insurance carriers of the other victims (3 in total), and their lawyers. Given the type of accident, I developed PTSD. However, as time progressed, the behaviour of my own insurer increased my PTSD ten-fold. To this day, I experience minimal effects of PTSD due to the accident. I experience moderate to severe effects of PTSD relative to my insurer.
The term PTSD relates to recurring thoughts of the trauma which can be triggered by similar situations, sounds, smells, senses. Over the years I have found these triggers occur when in any medical evaluation, assessment or consultation. These episodes make it very difficult to obtain the help I need by treating medical professionals and their teams. I become defensive, reticent to answer questions for fear of being ridiculed, question the reasons for their questions and provide limited data. All these reactions do not allow for a complete medical work up to enable helpful treatment.
When describing symptoms and their manifestations I become defensive which puts up a barrier for open communication. Even though I had been delivering guidance for my patients to be open when in treatment sessions, I failed to be able to do this for myself.
Now, when I am being assessed for treatment I have learned to indicate at the beginning of the session my difficulties in responding. I ask that they extend some latitude to allow me to become comfortable in their treating environment. I also bring someone with me as an anchor and a focal point should “the walls” start to manifest themselves.
I have written this missive to encourage open dialogue with patients, family, colleagues, medical professionals and clinical teams. As always, a return to maximum health and wellbeing is a priority involving everyone.
Insurer IME’s are a joke. The doctor’s doing the assessments write reports that benefit the insurer and not the injured. I had three IME’s shortly after having a spinal fusion. I had to wear a brace and my movements were limited. When the doctor asked me bend over and touch my toes, arch my back, bend to the side and twist my body I told him I had surgical restrictions and could not do these things as it would damage the fusion. When the doctor wrote his report he said I was a malingerer and had self imposed restrictions. Obviously this doctor knows nothing about spinal fusions and the restrictions we must adhere to. Another doctor that did a IME, again while I was still in a brace and healing from a fusion, took both his hands and pressed down hard on my head. I squealed in pain. The doctor said “that hurt didn’t it”. I had a two pound limit on what I was allowed to lift. What this doctor did felt as if he handed me a hundred pound bag of potatoes. My God, he could have ruined my fusion. This same doctor did the IME without my signing a waiver giving him permission to do so. After the assessment was done he would not let me leave, but made me wait 45 minutes for the documents I was to sign came by fax. Then he instructed me what to write! Another doctor did a IME and when he asked me to raise my right arm I told him I could only go half way as it caused too much pain to go further. This doctor wrote in his report that while I wasn’t noticing him watching me I raised my arm up with full extension. What a lie. My shoulder surgeon’s operation notes states that while I was unconscious in surgery he checked my range of motion in this arm, and in both surgeries I only had half the normal range of motion. These doctor’s have licence to lie and falsely accuse the injured to the benefit of the insurer allowing them reason to deny needed therapy and treatments. The government needs to put an end to these insurance companies horrific treatment of those injured!
I have lost 4 years of my life and my family daily struggles with our situation. I was involved in a traffic accident in April 2016.100%, not my fault.I suffered some back injuries and a concussion.I received some therapy for my back and decided I will go back to work in July the same year, I was hoping the symptoms of the brain injury will go away and my balance will somehow be restored. Unfortunately, one hour later at work I became extremely dizzy.I tried for a few more days but it became obvious that I have no concentration, Back to doctors and ER, several falls and faintings later, I was told not to even try and go on my short term disability. The same year in November my husband was also diagnosed with stage 4 cancer.The insurance company has not paid anything in term of wages. My physio was also paid by our private insurer. Only after the insurance company was asked to start pasying for my physio,in 2017 the adjustor allof sudden started to ask for IME. The first was a neurologist, He spent about 45 minutes asking about my education and employment history.Not verifiable.His exam was two hits in my knees and he waved a pencil in front of my eyes. He had all my medicals since 2010 in front of him. Ignored the fact that my licence was just suspended because of my lack of peripheral vision.He put in the reporttest he did not do, When confronted by the physio specialist with a very detailed report he excused himself and recommended neuropsychologist and ENT. Next was a physiatrist, albeit I had bo complain at that time. He somehow said that my injuries are not his spcialty, again 10-minute exam. Yet the adjustor asked him to rewrite his report8 month later and say there is nothing wrong with me. I asked the adjuster to break down the neuropsychology to two or three sessions. It was not done, so as a result I just slept thru the exam and have practically no recollection hat transpired. However , this doctor recommended that I am removed from the minor injury. Next came a psychiatrist report, not sure why whose first sentence was that he had a languague problem with me. Next was an ENT “specialist”. An extreely smelly old man who chased me in a storage room of sports injury clinic. He smelled of urine were brought and I threw up after the whatever he called the exam. As a result, the insurance company cited all the doctors for not approving my claimand also stopping previously approved occupational therapy.I no have total vertigo , canot do anything. The TBI is getting worse with all the bells and whistles. I cannot afford the needed vestibular treatment. And BTW the adjustor was quoted as sa ying upon learning of my husbands cance. ” thy will both be dead soon so nobody will have to pay anything”. I had a lawyer and his firm forgot to notify me that he quit the firm.
Injured Workers Community Legal Clinic (IWC)
Thank you for inviting public comment on these policies. I have attached a brief submission on behalf of our community legal clinic. Your members should be aware that confidentiality of medical records is not preserved once they are released to the Workplace Safety and Insurance Board.
Knowing that , it would be good practice to limit medical information released to the WSIB to what is necessary to determine the issue before the Board.
Thank you for your consideration.
Response in PDF format.
To whom it may concern,
Firstly, I would like to thank you for the opportunity to provide feedback regarding policies and practices surrounding third party reports and medical expert reports and testimony. I have reviewed both documents in preparation for this submission. By way of background, I am a registered nurse (since 2010) and registered psychotherapist – currently in the non-practicing class, as I was deemed Catastrophically Impaired by my automobile insurer, following several multidisciplinary Assessments.
I have had to undergo multiple third party assessments over the past three years and have met with over a dozen assessors. Unfortunately, my experience with this particular assessor/physician was alarming and it causes me great concern to know that objectivity isn’t necessarily respected. There are significant issues surrounding guidelines pertaining to third party assessments/reports and expert testimony.
Unfortunately the testimony of the medical expert is weighed more heavily than that of the patient/client/claimant. There are long-standing and significant repercussions when assessors are not held accountable for their actions.
Having personally experienced the power differential throughout this process, I had no other option but to record this assessment in order to maintain my integrity and character.
It is truly unfortunate that one needs to resort to recording an interaction in order to counter an expert’s opinion.
Injured worker representtative advocating for workers in the wsib process. Too frequently, claimants files are sent to medical consultants overrule the opinions of treating medical practitioners simply by conducting a paper review of the workers wsib file. I have seen instances of a coroner providing a medical consult overruling the opinion of the orthopedic surgeon who performed the surgery. This is unacceptable in my view.
Paper file reviews must end and insurers must take the professional opinions of treating physicians/health care providers as an honest assessment of their patients condition. Stop treating every health provider as biased toward their patient and stop assuming that injured workers are malingering.
Justice for injured workers!!
Thank you for the opportunity to reflect on the following for CPS.
When I disclosed acts of fraud on my personal medical records a complaint was laid to the CPS. The response was cold; I was scolded and awarded a number of titles by the college. How dare I accuse a Physician & Organization of fraud? The complaint filed was one of over twenty filed, emailed and written out to various places to prompt an investigation. The Medical file rests with no merit.
The ultimate cost has been the physical & emotional derailment in a path to reach recovery. The repeat denials sent my life into a spiral downwards. It set in motion the loss of all material possessions, personal keepsakes & finally those I loved very much. I tried to save it all, but poverty made the final decision. Another denial sealed my fate, resolved to a final status in this life. Not wanting to be a part of it all. I’ve lost my home and plans for a future with partner. I’ve been evicted, left homeless for six months, and again face the risk of homelessness, the result of poverty.
I no longer trust the Medical system in its entirety. I’ve had to force myself to attend certain appointments for serious symptoms, such as blood in the urine and loss of function…. I’m behind on all sorts of testing for cancer, diabetes and others. I do not trust any unknown doctor to hold my personal medical records, other than my personal physician and specialist. A relationship built over time. My suspicions & paranoia continue to isolate me even more.
I am not a malingerer or fake. I represent the pain scale from 5 to 9-10, each day, every hour, and minute in a constant fluctuation. I am a shell of my former self. My kids no longer know me. Isolated in a room, I struggle to exist in this world. There is no compensation that will ever represent the damage done. I’ve reached that crossroad.
The system is failing miserably, somehow driven for Profit only, the casualties, Human Beings. If Insurance coverage is mandatory, why so many in poverty once hurt? There are many being forced onto the Ontario Disability Support Program, a last resort program funded by the taxpayer. Once again I was on ODSP in Ontario. It becomes a fallacy that can destroy lives, while the insurer profits. All Compensation should offer the protections of fair coverage in legitimate claims. If mandated protection is law, with no over-site, then maybe we must add human rights to the equation.
I had a legitimate injury claim that was denied. I continue to pay the consequences.
FAIR (Fair Association of Victims for Accident Insurance Reform)
Response in PDF format.
Why do experts who harm patients get protection from being sued? Why are taxpayers underwriting CMPA to protect doctors when they aren’t even treating patients? Or helping anyone but themselves to lots of money made from rich insurance companies who profit on the backs of car accident victims?
Ontario should put patients first and profit second and stop this harm from happening. CPSO doesn’t take complaints about doctors who hurt car accident victims seriously or there wouldn’t be so many comments about that on this forum. It happened to me and I have trust issues and PTSD from all the imes I had to go to. It was awful.
Ontario Medical Association (OMA)
Response in PDF format.
Ontario Network of Injured Workers Groups (ONIWG)
Response in PDF format.
It has been a little over 10 years since my life changed permanently. I was in an MVA in 2009 and I have never recovered. The worst of it all is that while going through such physical, emotional and psychological changes I never thought that would have to face being victimized, lied to and being terrified of a group of “so-called” professionals that take a very important oath. This oath includes what I consider to be one of the most important principles, which is the principle of non-maleficence. The principle of non-maleficence, which I don’t have to explain to you means “not to do harm”.
Throughout the several years and throughout several of my assessments I feel that many of the IMEs I was subjected to caused great and profound harm in order for them to reach a beneficial outcome.
In one of my very first IME assessments, I had a “so-called” IME follow me into the washroom and then tell me that she could see that I was telling the truth and that she had decided that she was going to end that assessment, as she could see that I was exhausted and that I was in a tremendous amount of pain. At that time, I cried and I thanked her, little did I know that a few weeks later when I received her report, she had lied about everything and said that she believed that I was faking the entire thing and that I was the one that chose to end the assessment. I felt as if the wind had been knocked out of me, I was so depressed after seeing that report, I cried for days on end because I could not get over what she had written, all the lies which were contradictions to what she had originally said to me.
During another insurance IME assessment, the entire process lasted about 10mins to 15mins (between questioning me and barely physically testing). The crazy thing is that she wrote a huge report on me filled with lies regarding her findings from the assessment. How could she write a report of her findings when she had barely taken the time to find out my name much less what was wrong with me, it just made no sense.
I have had assessments where these so-called IMEs would tell me that they would read the consent forms to me in order to speed up the process so that the assessment could begin and all I had to do was sign. When I insisted on reading it for myself after they had read it to me they would get upset and say that it would take up time from the assessment. After reading the actual consent forms I realized that what they claimed to have read was not what was actually written on the consent. I have had further experiences where some of these IMEs actually tried to force me to sign and give them consent to contact my doctor, specialists and pharmacies directly by threatening that the assessment will be considered incomplete and that I would have to do it all over again.
One particular “so-called ” IME was probably one of the worst perpetrators that I had ever met. Prior to the assessment he had me answer questions on a tablet and when I explained to him that some of the answers were generic and did not convey either what I was feeling or that describes my answer he got upset and took the tablet and entered answers even though I told him in the presence of a witness that I was not comfortable with him doing this. During a part of my exhausting +3hrs assessment, he yelled, screamed and threw a tantrum that he should have access to contact my doctor, specialists and pharmacy directly instead of getting the information he required from my lawyer. His consent form said that he was not there to treat me but only to assess me and that he could not give me any medical advice, yet during the assessment he basically mocked me and told me that I was being ridiculous by not giving him direct consent and access to speak to my doctor, specialists and pharmacy that I go to. He stated that I was holding up matters and my progress to my wellness because he could probably recommend better medications that I could take. I was beyond puzzled and shocked at his behavior. I had already given him the list of medications that I take and he had already received all doctor and specialists notes and records regarding my file that my lawyer had given the insurance company. Why was he so hung up on getting direct consent and access to speak to my doctor, specialists and pharmacy that I go to? This “so-called” IME also told me that he had done extensive research and study into CBD and that I should start taking that. This individual constantly repeated during the assessment that he felt sorry for me and kept insisting that people with my condition that he had dealt with or researched often always ended in suicide,
Another “so-called” IME confessed that they were told by the insurance to ask certain questions and that these questions had to be asked in a certain order. After verbal back and forth she also admitted that she basically worked for the insurance company since they had hired her to do the assessment and would be paying her for it, so she had to do what they asked. This is why I call these medical experts “so-called IMEs”.
I do NOT believe that they are trustworthy, respectable professionals much less independent medical experts. I have absolutely no faith in them and your system, because it is broken. How can I believe that these individuals operate with integrity and how can I trust them when they say that they will carry out an unbiased and honest assessment. Would you believe them?
I will go as far as saying about 95% of the insurance IME assessments that I have experienced have been traumatic, distressing, painful and dispiriting.
There are definite monsters that are hiding within your College that pretend to be very committed to the oath they take, when they are willing to lie and cause great and profound harm in order for them to reach a beneficial outcome from the insurance companies.
I can tell you stories after stories of all the trauma that I have experienced at the hand of these “so-called” IMEs, but let’s be honest are you here to protect victims like myself or are you here to protect the individuals umbrellaed under your College?
Ontario College of Family Physicians (OCFP)
Response in PDF format.
Hello, I am a lawyer who specializes in WSIB law for employers. In almost every file in my office, there is a Third Party Report from an assessor. These reports all are requested by the WSIB who asks very limited and standard questions. The standard wording in these referrals by the WSIB also invites the Third Party Assessor to both assess and treat the claimant. This would appear to be in conflict with the 2018 version of the Policy. Also, the reports never adequately address the possibility of feigning and malingering. They are based only upon very limited information provided by the WSIB nurse consultant. Involved stakeholders have no opportunity for input, to provide information or ask relevant questions. Consequently, although employers in Ontario pay very high costs for these reports, their value is very much limited by the lack the valid collateral information provided by the WSIB. Finally, although the reports are relied upon heavily (sometimes exclusively) in adjudicative decision making, there is no mechanism for having these reports challenged in an Appeal Hearing because the data, test scores or answers are not available to another health care expert who may be wanting to review them for an IME paid for by the employer. Essentially, the reports are often misinformed about relevant collateral facts that are known. In these circumstances, these reports are very expensive time wasters which have the power to determine the entire course the most costly WSIB claims. And with no fair and transparent mechanism for review and appeals, they can be a huge waste of resources. I would like very much to see and comment on the revised version of this policy.
Canadian Society of Medical Evaluators (CSME)
Response in PDF format.
“International Medicolegal Practice Code of Conduct” prepared for the Association Internationale en Dommages Corporels
Impact of medical experts in the workers compensation system
Worker compensation claimants at the Workplace Safety and Insurance Board (WSIB) have serious concerns regarding the way the Board’s adjudicators and its Medical Consultants assess work related injury and disease. These concerns range from the way occupational diseases are recognized as work-related, the standard of evidence used by the Board throughout the whole adjudicative process, as well as those medical assessments as to whether a worker is fit to return to work safely without re-injury or the aggravation of existing injuries. In our view the WSIB is mired in a major conflict of interest that seriously compromises the ability of its adjudicators and medical consultants (MC) to render independent and objective medical and scientific assessments of workers’ injuries and diseases caused by their conditions of work. From our experience navigating the worker compensation system, we can only conclude that the negative impact of these practices on workers’ economic, physical and mental well-being, constitutes a form of medical abuse.
Evidence exposing the questionable scientific and medical practices of the Board’s medical and adjudicative personnel was systematically exposed in a study conducted by the Industrial Accident Victims Group of Ontario (IAVGO). That report (NO EVIDENCE: The Decisions of the Workplace Safety and Insurance Board, 2017)reviewed 425 appeal decisions of the Workplace Safety and Insurance Appeals Tribunal. That review found that in all 425 decisions reviewed, the Tribunal identified that medical decisions made by the WSIB’s adjudicators at all levels, backed by its medical consultants, denied various work-related injury claims on the basis of no medical or scientific evidence. More specifically, the IAVGO review indicated the following with respect to the findings of the Tribunal during its deliberations of WSIB’S denial decisions:
• Adjudicators disregard medical evidence submitted by the claims’ physicians;
• Workers were forced back to work before they were fit to return to work without re-injury;
• The psychological health of injured workers was disregarded;
• Compensation benefits were cut even though workers were still injured;
• Generally ignored/discounted was empirical evidence showing an association between workplace exposures and occupational diseases as indicated by the claimant’s physicians.
There is strong evidence that the Board, as an insurer, is in a conflict of interest situation that results in an eschewal of scientific and medical evidence in an effort to keeps its costs, or future costs down at the expense of the economic and physical well-being of workers covered by the Workplace Safety and Insurance Act, and Ontario’s worker compensation scheme. Between 2008 and 2015, when the Board employed the services of CEO, David Marshall to bring down the growing unfunded liability, the results of the WSIB’s austerity program described above, resulted in a doubling of denied claims for Schedule 1 employers.
Of relevance to the College is the fact that this austerity program enlisted the support of the WSIB’s contract and in-house Medical Consultants who provide medical opinions upon which many of the adjudicative decisions are based. These Medical Consultants are referred to by worker advocates as “paper doctors” because on most occasions they provide medical opinions without examining the patient, simply rendering a written decision. What is reprehensible is that these decisions by Board employed doctors are given precedence over the patients’ doctors and other health practitioners.
Indeed, there are documented instances in which contract medical consultants were pressured by the board to render a medical opinion that the WSIB desired. This was exhibited in the case of Dr. Brenda Steinnagel, who was pressured by the WSIB and her employer, Workplace Health & Cost Solutions to ”participate in a fraud upon the public” by changing her medical diagnosis, and was fired by her employer when she refused. We are sure that the College is very familiar with this wrongful dismissal case. This was followed by an in depth study entitled “A Different View” by Kelly Putter for the Ontario Federation of Labour, allegging inappropriate regulation of medical care and ignoring the advice of medical practitioners, resulting in the victimization of injured or diseased workers by the very agency mandated to protect and compensate these workers. This has led to many doctors refusing to participate in a system that abuses their patients. Additionally, the Canadian Medical Association (CMA) raised concerns about shifting cost of occupational disease on both workers themselves and the public health care system.
When it comes to occupational disease determinations, the case of rendering very biased medical and scientific work-related disease assessments is equally problematic from a number of viewpoints. Again these reflect the major conflict of interest between the WSIB’s monetary concerns, as a private insurance corporation, and its mandate to address to the needs of injured and diseased workers.
The under recognition of disease is achieve through a number of questionable practices involving the Board’s medical consultants who principally provide diagnostic and evidential advice to adjudicators on work relatedness. These practices involve the following elements of a pattern of practices that constitute a culture of denial:
• Instead of the WSIB fulfilling its mandate to investigate the work-relatedness of an occupational disease and collect evidence for adjudication, the full burden of proof is placed on the claimant to prove a workplace connection.
• This is further aggravated by an illegal shift from a standard of evidence based on the balance of probability to one based on ‘beyond a reasonable doubt’ in practice. This practice was recently ruled upon by the Supreme Court of Canada as an unreasonable and inappropriate standard of proof in a workers’ compensation scheme.
• This shift in standard of proof is further illustrated in the major tendency to ignore the claimant’s doctor’s findings and medical evidence by not addressing the scientific evidence presented, and substituting findings to deny work-relatedness on the basis of life style factors and “pre-existing conditions,” without evaluating workplace exposures.
• When epidemiological evidence is considered, there is a tendency to ‘cherry pick’ the negative studies, and/or to discount weak positive studies for an association, with the exaltation of weak negative studies in Board decisions. This same pattern is seen with what expert agencies the Medical Consultant chooses to use in rating the toxicity and carcinogenicity of chemical exposures.
• In conjunction with the Board’s approach to epidemiological evidence, there is the practice to use such factors or thresholds such as dose, latency, and exposure duration (established through epidemiological study), as rigid legal thresholds instead of guidelines when considering a workplace connection;
• The Board’s narrow focus on one disease and one chemical, and unwillingness to addressed mixed exposures and disease clusters, is a major short-coming since it fails to address a major reality of workplace exposures, and the dynamics of disease production.
These practices have a number of profound consequences for workers’ compensations schemes, as well as for occupational disease generally:
• There has been a growing trend of the impoverishment of injured and diseased workers and their families;
• A joint study from Trent and MacMaster Universities found that 46% of permanently injured workers were living below the poverty line;
• This has been accompanied by growing mental illness among workers who are idled and without sufficient incomes to support themselves and their families;
• A major result of these practices is that the true extend of occupational disease remains largely unaddressed with only a small fraction of work-related disease allowed. Consequently this leads to a distorted assessment for regulatory and prevention purposes, and shifts the burden of occupational disease onto workers, their families, and our public health care system and society in general.