Letter to the Editor: Independent medical examinations provide "necessary check and balance"

Dave

Maybe claimants would attend appointments if they had some choice in relation to the person who will be assessing him/her. There is so much bias in the IME system that for certain assessors one does not even have to attend the appointment to know what the report will say. Personally, I would not allow a family member to attend an appointment with an assessor who does not also have an active treatment practice. Maybe the government should mandate that assessors have at least a certain percentage of their practices involving active treatment to ensure some type of possible neutrality in the system.

The other issue relates to costs. With the pressure imposed by insurers to reduce the costs of assessments (to ridiculously low fees in certain domains), it is no surprise that the assessments are often useless. You get what you pay for. You have to ask why certain assessors would do assessments for such low fees. This is especially true for complex medical conditions in which there is voluminous materials that need to be reviewed.

Third, being a member of CSME guarantees nothing. CSME is not a credentialing board and any medical professional can join as a member or associate member by simply providing 2 sample reports and paying a fee.

Posted January 31, 2013 08:44 AM

Rhona

Some medical professionals are part of the problem and not part of the solution and we don't have to take FAIR's word for it. One only has to review the cases on the Financial Services Commission website. In only two recent decisions 'independent' medical examination reports were described by Arbitrators as inaccurate, failed, misleading, defective, incomplete, deficient, not correct, and flawed. Could it be any clearer that there is an issue with these IME reports? Could it be part of the reason that thousands are lined up at FSCO for hearings to get the coverage they were promised when purchasing their policy?

It is this poor quality of IME reports that insurers routinely, knowingly or not, rely on in order to disqualify many legitimate claimants. IMEs that didn't reflect "stringent quality assurance measures independently and by insurers to ensure they meet the highest standards and adhere to all regulations". These flawed reports must be considered by the trier of fact who has to decide whether the policy-holder is deserving of benefits or not. One could say that the quality of the IME reports can be pointed out or challenged in court but by that time the claimant has already been denied the timely treatment and income replacement based on the defective medical report. That accident victim may have to wait years to get to the Arbitration hearing in order to to have their coverage reinstated and get treatment, benefits that should have been there when they were needed. This is no way to treat legitimately injured accident victims. This cavalier attitude towards vulnerable accident victims has created stress on our public supports and health system - maybe this is why insurers do this - no need to pay it back so why not let the public system pick up the tab?

It's unrealistic to believe that Independent medical examinations provide the necessary check and balances and that everyone involved are highly qualified healthcare professionals. Consumers don't believe it, claimants definitely don't buy it, and many accident victims are often harmed by this fantasy that all is well with IMEs in Ontario. Those who do provide quality IMEs have their reputations harmed by a small group of pro-insurer IME providers who, by their poor quality work product manage to tarnish the reputation of all of Ontario's physicians.

The words of the Arbitrators "inaccurate, failed, misleading, defective, incomplete, deficient, not correct, and flawed" to describe the IMEs that they review should not be so easily dismissed. Those who provide IMEs shouldn't be pointing the finger at FAIR with "This group demonstrates a poor understanding of the auto insurance industry when it smears high-quality independent medical examiners in Ontario with unfounded allegations" without first reviewing the evidence on the FSCO website.
A quick read will tell you that the only people that have been thrown under the bus so far have been accident victims.

Posted December 21, 2012 05:03 PM

OscarB

Dr. Guerriero's opinion might carry more weight if he himself didn't make his a substantial portion of living in the "independent medical assessment" business rendering opinions on behalf of insurers. Make no mistake: There is no independence in the business if IME's.

Dr. Guerriero's "bottom line" contention that "only by delivering high-quality assessments time and time again, do IME companies remain in business" is at best naive. Insurers continue to use IME companies who provide them with opinions that they can use to deny claimants treatment and other benefits they have contracted in their auto insurance policies. That's the real "bottom line" out here in the real world of injured claimants.

And to believe that the Ontario Government is on the side of claimants and not in the pocket of the Insurance Bureau of Canada would be like believing that the fox should be in charge of the hen house.

Dr. Guerriero's comments notwithstanding, the system is broken. It's time for the self serving platitudes to end and for the system to start working like it should. Maybe with a new PC government things will begin to change.

Posted December 21, 2012 11:51 AM

Brian

RE: "Bottom line; only by delivering high-quality assessments time and time again, do IME companies remain in business."

Dr. Guerriero points to CSME membership as proof that all IMEs are of high quality. And yet the President of the CSME warned its members in the Dec. 2011 Newsletter that amateurism, bias and fraud in the IME domain might not be tolerated (as has been the case in the past) due to the rising threat of public scandals. It is hard to reconcile the picture painted in this letter to the editor with the one painted by the CSME President in his Christmas Message to members only a year ago.

Posted December 20, 2012 06:41 PM

Brian

RE: "The value of these independent assessments is directly proportionate to the independence and quality that courts and arbitrators attach to them."

Dr. Guerriero is absolutely correct. It follows that if courts and arbitrators repeatedly find an assessor's assessments to be of little or no value - as articulated in adverse comments - then there ought to be a point at which such an assessor is purged from the system.

Ironically, that very recommendation was made in a Toronto Sun column only a couple of weeks ago:

Concern for professional reps? BY ALAN SHANOFF ,TORONTO SUN SATURDAY, DECEMBER 01

"If a judge or arbitrator has made critical or adverse comments concerning a health professional make the comments public rather than leave them buried in decisions that few read.
Allow adverse comments made about a health professional to be used against the health professional in subsequent cases and disallow the use of any professional who has been the subject of three adverse comments. We can get rid of shoddy, biased independent medical examinations — but only if we want to."

Posted December 20, 2012 05:24 PM