Legal Matters with Chris Richard – Just How ‘Independent’ are Medical Assessments?

You have been denied a medical benefit by your insurance company after you sustained an injury in a motor vehicle accident. You feel a momentary sigh of relief when the insurance company tells you that they are sending you to a doctor who will perform an Independent Medical Assessment (“IMA”) to provide an opinion as to the degree and extent of your disability. You think, “This doctor will help me.” The reality is that the opinion expressed in approximately four out of five IMAs will be in favour of the insurance company. Fortunately, a personal injury lawyer can help you work with the insurance company to get what you need.

Chris Richard, an expert personal injury lawyer in St Catherines, sat down with host Lee Sterry of Niagara’s 610 Newstalk Radio and discussed the topic of the “independence” of Independent Medical Assessments and what they mean for your case. Chris is a personal injury lawyer from the law firm Graves and Richard, a premier law firm in St Catharines.

What are Independent Medical Assessments?

An Independent Medical Assessment is a medical examination set up by an insurance company to determine whether certain treatment being received, or requested to be received, by someone injured in an accident is reasonable and necessary. For example, if someone injured in an accident feels they would benefit from receiving physiotherapy treatment, the insurance company  would set up a mandatory medical examination by a practicing physician to determine the extent of that person’s disability and to provide an opinion as to whether the desired treatment is beneficial. The doctor performs the examination  and then provides his or her opinion in written form.

Just how “Independent” are Independent Medical Assessments?

The doctor who performs the IMA is chosen and paid for by the insurance company. Normally when a doctor performs a medical service, he or she bills OHIP. In the case of IMAs, the doctor bills the insurance company who requested the Assessment. Many doctors who perform these examinations have developed Medical Assessment businesses, and the majority of their income is generated by assessing patients for insurers. In an automobile insurer context, an insurer can pay up to $2,000 for a single Assessment. If the assessment is paid entirely by the insurer, how “independent” is it?

Case studies

Chris shared that several years back he had a client who received a Medical Assessment from a doctor practicing out of a Medical Assessment clinic that had a very small clinical practice and a very large assessment practice. The client had been injured in a car accident and needed help with housekeeping assistance. The insurance company denied the claim and sent her for an IMA. The doctor’s opinion was that the client didn’t require any housekeeping assistance because she could do all of her own house work as long as it didn’t require any lifting, bending, squatting or reaching!

In November 2014, a lawyer, Maia Bent, who was the past president of the Ontario Trial Lawyers Association, was concerned with a final summary report prepared by a doctor at a Medical Assessment Centre that contained significant differences from what the assessment doctor had actually said. The doctor who performed the examination indicated that a certain level of injury had been sustained in the accident. When the summary report was written by a different doctor, however, that opinion was modified or changed or relevant information was omitted. Bent sent out an email to 670 lawyers cautioning them about the Medical Assessment Centre. An action was commenced against Bent for libel, which was dismissed on the basis that her comments appeared to be substantially true and correct.

Independent Medical Assessors vs. Family Doctors

One of the interesting aspects of IMAs is the claim by examining doctors that opinions provided by family doctors doing primary care to the injured person are unreliable. Any treatment that an insurance company is receiving a request to pay has typically been recommended by an injured person’s family doctor. The doctor performing the IMA often takes the position that the family doctor’s opinion is not to be trusted.

The interesting question is who is in a better position to form an opinion? A family doctor is actively involved in the care of that injured person. They likely have known the injured person for years, and have a full understanding of any pre-injury medical conditions and how those conditions could have impacted their patient’s life. The family doctor has followed their patient’s recovery from the time of the accident, has likely seen them regularly, and has in their possession all medical records, including records from every specialist the patient has seen and every test result. Doctors hired by insurance companies to perform IMAs likely met the injured person only once in a meeting that typically would last no more than 30 minutes, and only have access to the medical records provided to them by the insurer meaning that they may not even have access to every diagnostic test.

Knowing this, it is not difficult to see that the family doctor is in a much better position to understand the nature of the disability than the doctor performing the medical assessment.

This system is not likely to change any time soon. The important point to remember is that you do you not need to put great faith in the opinions provided by doctors performing IMAs. If you have been denied a benefit, and now have a scheduled appointment for an IMA, don’t expect that doctor to help you by giving the opinion that you’re disabled. Working with a personal injury lawyer will ensure that you understand how the insurance system works, and highlight any mistakes made. If you’ve suffered an accident and need a personal injury lawyer in St Catherines, contact the team at Graves and Richard. We’ll help you with insurance company disputes, including slip and fall settlements and car accident insurance claims. Graves and Richard has the experienced and knowledgeable personal injury lawyers and long term disability insurance lawyers you need to help win your case.