• FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education

IME

J. C. v B. G. M., 2019 CanLII 1192 (ON HPARB),

J. C. v B. G. M., 2019 CanLII 1192 (ON HPARB), <http://canlii.ca/t/hwz85

28.              In its analysis regarding this aspect of the Applicant’s complaint the Committee came to the following conclusions:

•                    the relationship between the Respondent and the Applicant was that of examiner- examinee and not that of the physician-patient;

•                    it expressed no concerns regarding the Respondent’s billing, found it reasonable and consistent with the Ontario Medical Association’s Guide to Uninsured. Services and, thus, did not amount to a “bribe” or fee splitting;

•                    under PIPEDA, the Respondent was not required to provide information regarding his fees since this is commercial information between the Respondent and CIRA and not personal information. Similarly, the Respondent was not required to provide emails, unless the emails were the only place where personal information was recorded;

•                    it explained that physicians bill the party that retains them to prepare the third-party report which in this case was CIRA, and the amount the insurer pays to CIRA is not relevant to the issue at hand. The Committee noted that the SABS impose limits on the amount an insurer may pay for medical assessments, but this provision is directed at insurers and not physicians;

•                    it concluded that the various amounts billed by the Respondent as evidenced by his invoices were all below the limit of $2000 for fees and expenses for any one assessment as set out in the SABS; it noted that the Committee has jurisdiction over physicians conduct and is not required to determine whether an insurer has met their obligations under the SABS or any other legislation; and

•                    it found that there was nothing in the Record to suggest that the Respondent was splitting fees with CIRA in exchange for CIRA’s referral of the matter to him.

29.              It is common ground that the SABS regulates the rights and responsibilities of the parties regarding automobile insurance policies issued in Ontario.

30.              The Committee, in a clear line of analysis concluded that the SABS regime imposes a limit of $2000 for payments an insurer may make for each medical assessment and that this provision applies to insurers and not to physicians. It explained that the amounts billed by the Respondent were consistent with the OMA’s Guide to Uninsured Services, were reasonable and did not amount to a bribe.

31.              Counsel for the Respondent referenced a previous decision of this Board, J.T. v B.M. CanLII 62879 where the Board concluded at paragraph 58 that:

… the focus of section 25 (5) is on the maximum amount that an insurer shall pay (emphasis added). This issue is separate and distinct from the question of whether or not a physician has charged a reasonable fee for the services provided. While the Committee has the ability to consider, as a matter of professional conduct, whether a physician’s fees are reasonable, the question of whether an insurer has complied with section 25 of the SABS is not within the Committee’s authority.

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