IME

Preparing for an Assessment With the Insurance Company Doctor

by Admin4

http://www.ottawainjurylawyer.co/english/news/what-you-need-to-know-about-the-insurance-doctor-in-your-ottawa-personal-injury-claim-part-1.htm

http://www.ottawainjurylawyer.co/english/news/preparing-for-an-assessment-with-the-insurance-company-doctor-in-your-ottawa-personal-injury-case-part-2.htm

FAIR submission to CPSO Uninsured Services Billing and Block Fees draft policy May 1 2017

by Admin2

What we are seeing is some very poor quality medical opinions at a very high price being paid for by Ontario’s car accident victims who have no say on how their recovery benefits are being used to line the pockets of insurer doctors. Treating physicians are compensated with far fewer dollars to clean up the harm done to their patients with their own much more reasonably priced medical reports. As you can see from some of the links below, some physicians are becoming very wealthy by overcharging for medical reports that are without value and when MVA victims cancel assessments with these same IME providers, they are again being overcharged.

FAIR submission to CPSO Uninsured Services Billing and Block Fees draft policy May 1 2017

Disclosure of Expert Retainer Letters

by Admin4

The issue of whether a party must produce a lawyer’s ‘instructional letter’ when retaining an expert was considered by the Ontario Superior Court in Nikolakakos v. Hoque, 2015 ONSC 4738. This case involved an action for damages arising from personal injuries sustained in a motor vehicle accident in August 2012. Following examinations for discovery held in August 2014, the Defendants requested that the Plaintiff attend a defence medical examination with an orthopaedic surgeon. The Plaintiff agreed to attend the medical examination on the condition that the Defendant’s lawyer provide a copy of the letter of instruction to the orthopaedic surgeon in advance of the assessment.

http://www.millerthomson.com/en/blog/mt-insurance-law-blog/disclosure-expert-retainer-letters/

Nemchin v Green, 2017 ONSC 2283 (CanLII)

by Admin4

http://canlii.ca/t/h36jc

[21] Dr. Hershberg testified that for the past five years or so, 80 to 90 per cent of his income has been generated from conducting defence medical examinations – for defendants in litigation or for insurers in responding to claims. He estimated that (a) as of 2014 he did 80 to 90 assessments per year and (b) in the five years leading up to the date of trial he had done 400 to 500 assessments in total. He charges $600 per hour for his services.

[22] In cross-examination, Dr. Hershberg acknowledged that his curriculum vitae does not portray the extent to which he has been doing assessments for the past five or more years.

[23] Dr. Hershberg’s experience in conducting assessments includes doing other types of assessments within the motor vehicle insurance system and the Workplace Safety and Insurance context. The majority of the information about Dr. Hershberg’s assessment work appears in his curriculum vitae under the heading “Ontario Insurance Commission” (the “Commission”). I find that the appearance created by the manner in which that work is described and included in the curriculum vitae is that the work is in some way done under the auspices of the Commission. In addition, the manner in which that work is described and is included in the curriculum vitae serve to downplay the prevalence in Dr. Hershberg’s work of the defence medical examinations and assessments for insurers.

[24] Based on Dr. Hershberg’s level of experience in conducting defence medical and other assessments, I draw the following inferences:

• He is aware that his qualifications are not likely to be tested on cross-examination unless and until the dispute proceeds to trial or to an arbitration;

• He knows that a copy of his curriculum vitae is provided with his reports when they are served on an opposing party and may be provided to the Court in the course of litigation, the latter including for the purpose of pre-trial conferences;

• He understands that the contents of his report are considered, at least in part, in light of his qualifications and experience as set out in his curriculum vitae;

• He is aware that the contents of his report may play a role in the settlement positions adopted by parties to a dispute; and

• He is aware that the contents of his report, including in the light of his experience as detailed in his curriculum vitae, may contribute to settlement recommendations made by judges and others presiding over pre-trial and other forms of settlement conferences.

[25] It is troubling to me that Dr. Hershberg, carrying out the type of work that he does and understanding the purpose served by his curriculum vitae and reports, is not more careful with respect to the accuracy of and the impression left by the information set out in his curriculum vitae.

[26] I am also concerned by the lack of attention to accuracy demonstrated by the manner in which Dr. Hershberg dealt with the mechanics of the collision – both when he interviewed the plaintiff and when giving evidence at trial. Dr. Hershberg testified that he made notes while interviewing the plaintiff. At the end of the day on which the examination was conducted he would, as was his practice, have dictated his report relying at least in part on his notes.

Hashi and Certas Direct 2017-03-27 Decision: Arbitration, Final Decision, FSCO 5198

by Admin4

https://www5.fsco.gov.on.ca/AD/5198

Dr. Mills and Dr. Seon differed in their respective Addendum Reports with respect to the Brief Battery for Health Improvement 2 (BBHI-2) scores, the Test of Memory Malingering (TOMM) scores, the Applicant’s language difficulties and the overall treatment of the Applicant. Dr. Mills testified he never uses these tests, which test for attributes such as feigning symptoms, malingering and lying. He said that results from such tests are unreliable. They do not take into account the patient’s different cultural background, the suspicion toward a female assessor, and attitudes towards women (all aspects of cultural differences) which could have an important effect on the outcome of those kinds of testing.

As a clinical psychologist he was more interested in the whole picture, which included the fact that the Applicant had come seeking treatment and had endorsed a number of features indicative of serious depression. In his opinion, the Applicant was not feigning his symptoms. He noted that two flags ignored by Dr. Seon were the Applicant’s disclosure at Dr. Seon’s interview that he was taking medication for his pain and had been prescribed anti-depressant medication by his family doctor. These should have alerted her that the Applicant was experiencing real issues of pain and depression, and not feigning symptoms.

[]

In making my overall findings with respect to the Medical Benefits and Costs of Examinations, I must note several things stand out.

The first is the marked contrast between the opinion reports of the Applicant and Insurer. This seems endemic to the Adjudication process under the SABS.

That said, I am giving more weight to the Applicant’s testimony and to his self-reported symptoms to the various assessors and his testimony at the Hearing, over the opinions of Drs. Seon and Chiew that the Applicant was likely feigning his symptoms. This is not in any way to question the skills or expertise of these witnesses; I am not qualified to do that. But I am qualified to weigh and prefer particular evidence over other evidence.

[]

On the psychological side, I prefer the evidence of Dr. Mills given my conclusion that the Applicant was neither malingering nor feigning or exaggerating his symptoms. I accept that Dr. Malik, working under the supervision of Dr. Mills, was providing assistance to the Applicant towards understanding the tests when he required it because of language difficulties. The tests administered through Dr. Malik and interpreted by Dr. Mills supported the Applicant’s symptoms of emotional distress and pain which he attributed to the accident.

I support Dr. Mills’ conclusion that the serious and recalcitrant nature of the Applicant’s ongoing physical pain and psychological impairment is a direct result of the MVA. I also endorse Dr. Mills’ finding that the MVA materially contributed to the Applicant’s impairment and poses a significant barrier to his function, an observation I was able to make from the Applicant’s demeanour throughout the Hearing when he attended. His impairments should not be characterized as falling within the MIG.

Shining a Light on the insurance medical examination business

by Admin4

Distributed to MPPs on January 26th, the first MPP Advisor of 2017 explores efforts in bringing questionable insurance medical examination practices to light.

http://www.otla.com/docDownload/722832

Ontario Human Rights issues in insurance and CPSO perspective on medical documentation, Third Party Reports etc

by Admin4

http://www.ohrc.on.ca/en/consultation-report-human-rights-issues-insurance/auto-insurance

http://www.ohrc.on.ca/en/policy-ableism-and-discrimination-based-disability

https://www.joomag.com/magazine/dialogue-volume-13-issue-1-2017/0360871001489691988/p37?short

http://www.cpso.on.ca/Policies-Publications/Policy/Third-Party-Reports

http://www.cpso.on.ca/Policies-Publications/Policy/Professional-Obligations-and-Human-Rights

https://www.joomag.com/magazine/dialogue-volume-13-issue-1-2017/0360871001489691988/p31?short

Doctor Fired For Not Changing Her Medical Opinion To WSIB’s Liking?

by Admin4

Toronto personal injury lawyer Albert Coforzi: An interesting case out of Hamilton, which throws some light on the behind-the-scenes workings of insurance companies and medical exams.

http://pacelawfirm.com/blog/doctor-fired-for-not-changing-her-medical-opinion-to-wsibs-liking/

Judge Condemns Practice of Ghostwriting Expert Reports

by Admin4

Ghostwriting occurs when the expert relies on another person to prepare all or part of their report. There are different ways this could happen, one scenario could be where a medical expert receives a large volume of medical and rehabilitation records prior to an assessment and, due to a busy clinical practice, does not have time to review and summarize all the records. This review would then be undertaken by someone other than the medical expert whose name is ultimately in the report and who might one day be required to defend the report in Court. This is problematic because the review and summary of these medical records can be used by defence experts to argue that a Plaintiff has been inconsistent in reporting their symptoms.

https://www.thomsonrogers.com/news/judge-condemns-practice-of-ghostwriting-expert-reports/

Ghost Writing in Medical Reports: Something to be Scared Of?

by Admin4

In the case of Kushnir v Macari, the defendant sought an order for defence medicals with an orthopedic surgeon and a neuropsychologist. The plaintiff sought terms to ensure that the reports were not “ghost written”. The court noted that there were reported decisions where an expert had testified that part of their report was in fact written by someone else.

http://www.millerthomson.com/en/blog/mt-insurance-law-blog/ghost-writing-medical-reports-something-scared/