So true Julie..I tried to tell so many people that this was happening and they just choose to ignore, believe me I didn't think it would happen to us, actually a month or so before the accident, I said to my husband do we really need all this insurance, we live a quiet life don't do half the crazy things we use to and than ....boom...it happened to us

Thank you for your comment. It is so important to be educated about our insurance industry.

How about this idea for educational fun: develop a game of "pin the name on the quotable quote" (related to the Ontario auto insurance IME/IE sysyem). Maybe more motorists would take the time to learn about our vexed auto insurance system if we developed educational contests. For example, maybe whoever can correctly guess the who said the quotes (below) could win a free membership to FAIR?

Who said: “I have often said that it takes about five seconds for someone to effectively criticize the industry in the media...But it takes much longer than that for us to respond to the criticism and provide the other half of the story."

Who said: "It is unfortunate that “Fair Association of Victims for Accident Reform” (FAIR) is not living up to its name in its assessment of the independent medical examiner industry. This group demonstrates a poor understanding of the auto insurance industry when it smears high-quality independent medical examiners in Ontario with unfounded allegations."

Who said: "What needs to be included in his discussion with the College is his obligation to ensure that qualified professionals conduct IMEs ...so that the public can have trust and confidence in a statutory system that has been set up to provide them protection."

Who said: It is no surprise our industry has worked with some of these doctors, after all, they are experts in their fields and everyone wants advice from the best and brightest..."

Who said: "... bias and fraud in the domain of IMEs will be tolerated less and less in the future...cost of automobile insurance and lack of quality control of IMES, leading to public scandals, might soon lead the parties requesting IMES to be more critical when the appraising medicolegal credentials of an expert before hiring his/her services. "

Who said: "It is the duty of every expert engaged by or on behalf of a party to provide evidence in relation to a proceeding under these rules; (a) to provide opinion evidence that is fair, objective and non-partisan; (b) to provide opinion evidence that is related only to matters that are within the expert’s area of expertise..."

Who said: "...the IME business is a harrowing business...it is a high risk business...most IME doctors get complaints..."

Who said: "...mobile rehabilitation services can save insurers money in the long run..."

Who said: " “As we have always said, the auto insurance system needs regular maintenance to insure it is working for consumers.”

Great comments and all true. If I had to guess, I would say the IBC authored most of these!

RE: "It is time that Ontario drivers start to understand the product that is car insurance so they can ensure they have appropriate coverage for an appropriate price."

Ms. Entwistle, From your lips to God's ear...or at least to Alan Shanoff's ear!! Check out his column in the Sunday, Jun.30 edition of the Toronto Sun. His column seems like an excellent "start" toward understanding the Ontario auto insurance product which we as captive consumers are forced (by law) to purchase. Alas, the law is too often absent when it comes to forcing auto insurers to honour their policies when motorists are seriously injured.

Ms. Entwistle,
Can you explain how it can be that some of the Ontario auto insurers' "preferred" assessors can't seem to remember that it is not ok to churn out "inconsiderate and inappropriate" IMEs? Surely it ought to be self-evident to them that they need to be properly qualified and be impartial and refrain from abusive comments?

Fielden v. Health Professions Appeal and Review Board, 2013 ONSC 4261 (CanLII) — 2013-06-19

Divisional Court — Ontario
[1] This is an application for judicial review to quash the May 3, 2012 decision of the Health Professions Appeal and Review Board, which upheld the decision of the Inquiries Complaints and Reports Committee of the College of Physicians and Surgeons of Ontario to verbally caution the applicant. The applicant was alleged to have acted unprofessionally and with bias in administering an independent medical examination to a patient.

[2] The applicant seeks to have the decision set aside and to have the matter remitted to a differently reconstituted panel.

[3] The applicant is an orthopaedic surgeon. On December 20, 2006, Ms. Nancoo sustained several injuries when she was struck by a motor vehicle while crossing the road. On May 4, 2010, Ms. Nancoo submitted an application to the insurer for catastrophic benefits in accordance with the Insurance Act.

[4] The applicant was retained by the insurer to conduct an orthopaedic Independent Medical Examination (IME) of Ms. Nancoo. The applicant met with Ms. Nancoo on August 11, 2010 and conducted the IME. On August 24, 2010, the College received a complaint for Mr. Warren, Ms. Nancoo’s lawyer regarding Dr. Fielden’s behaviour during the course of the IME.

[5] The Committee found that Dr. Fielden’s behaviour when conducting the IME was inconsiderate and inappropriate. The Committee decided not to refer the matter to the Discipline Committee but rather to verbally caution Dr. Fielden in person regarding being professional, objective and courteous in performing IME’s. HPARB dismissed Dr. Fielden’s appeal and determined that the Committee’s investigation was adequate and that its decision to caution Dr. Fielden was reasonable.

Yes, these situations are concerning. I honestly feel that the Colleges take “assessment” complaints less seriously because the bigger risk from a clinical perspective (at least medically) is on the treatment side. I am not sure the Colleges fully understand how the decisions of these “assessors” are taken on the insurance side and how impactful the decisions can be for a person. I wonder if the Colleges feel that because there is no “treating relationship” the damage done can’t be “that bad” in the long term. However, I would beg to differ and feel that the Colleges need to be made more aware of the impact that these assessments can have in the lives of an injured person. I will say that I feel the MVA world is marginally better than the WSIB world were their “assessors” are actual staff of the WSIB. Talk of bias. What we should not do, however, is stop complaining when we feel our issues are not being heard. Like the IBC trying to shut down FAIR, these voices are important and if we push hard enough, for long enough, we should eventually see change when these Colleges notice that half their budget is going to complaint resolution in the insurance sector. Then, and only then, will they try to resolve the problems. I will also say that is imperative that health professionals write “rebuttals” to faulty IE reports. A well worded response, highlighting the errors and poor clinical assessment and reasoning skills can go a long way. I recently had an insurer overturn a decision on IRB, Attendant Care and Housekeeping denials from an IE based on my response which showed how the assessors missed the mark in multiple areas, wrote reports fraught with errors, and seemed to not even address my client’s main deficits. Do I get paid to write these rebuttals? No, but I still believe in their value and feel an obligation to try and improve the climate in which I practice.

They just keep coming:

SS v GC, 2013 CanLII 45566 (ON HPARB), 12-CRV-0656 2013-07-24
http://canlii.ca/t/fzsxg

4. The Respondent, an orthopaedic surgeon, conducted an independent medical assessment (IME) of the Applicant on June 29, 2011 as part of a multi-disciplinary assessment.
……• he did not recall telling the Applicant to “suck it up” or “toughen up” and noted that he does not use such language;
• he may have said something about insurance companies being taken advantage of as part of a general discussion with the Applicant but he did not suggest that the Applicant was making a false claim as evidenced by his report which confirmed that the Applicant suffered serious and extensive injuries; and
• he has given serious consideration to the Applicant’s complaint and acknowledged that he has had previous complaints about his demeanour and ability to communicate well with patients; he has taken a communications course with Dr. Dawn Martin.
14. The Committee noted that there had been previous complaints about the Respondent’s communications. The Committee accepted that the Respondent’s contrition in this case was sincere and stated that it was pleased that he had entered into a communications course with Dr. Martin. Nevertheless, the Committee felt that the Respondent would benefit from reflection and education in the area of communications and decided to issue a written caution to the Respondent to be aware that patients with post-traumatic chronic pain and disability who attend for an IME may not appreciate the Respondent’s efforts at small talk and that the Respondent should refrain from discussing systemic issues or details of his personal life.
24. The Applicant submitted that the Committee’s decision was unreasonable because the caution issued to the Respondent did not reflect the serious impact that the Respondent’s conduct during the IME had on the Applicant and would not ensure that other patients would not experience the same trauma. The Applicant submitted that the Committee should have imposed a requirement that the Respondent should not be permitted to conduct an IME without someone else being present.
VI. DECISION
37. Pursuant to section 35(1) of the Code, the Board confirms the Committee’s decision to caution the Respondent to be aware that patients with post-traumatic chronic pain and disability who attend for an IME, such as [the Applicant], may feel vulnerable, may not appreciate his efforts at “small talk,” and that he should refrain from discussing systemic issues or details of his personal life.

Mr. Entwistle,
I'm confused. FSCO keeps saying it will not tolerate health professionals or others who make false statements and say treatment providers who do so will be prosecuted. Fair enough. But why doesn't FSCO prosecute insurer case managers who falsify the diagnosis/prognosis of doctors and then point to their implausible summaries (false statements) as justification to claw back care from the catastrophically injured? (see below)

Michalski and Wawanesa [+] Arbitration, 2005-12-13, Reg 403/96.

Final Decision, appeal rendered
Each of the case manager's subsequent reports to Wawanesa, in March, April, May, June and July, 2002 state in the body of the report that Dr. Dobrowolski continues to report further improvement. I find each of those comments at significant odds with the contents of Dr. Dobrowolski's notes, records, reports to third parties, and an implausible summary of his opinion. ....

I find Wawanesa could not have been unaware of the reductions in care, or unaware that those reductions were achieved by ignoring the significant cognitive and emotional impairments Mrs. Michalski sustained in the motor vehicle accident.

In each of her reports, the case manager informed Wawanesa of the reductions of attendant care achieved. .....

Wawanesa did not produce a file handler to explain whether it reconsidered its position after receiving the reports of Drs. Kuiack and Mount, the psychologist and psychiatrist who assessed Mrs. Michalski at Wawanesa's request in January 2003. If it did, I do not know why Wawanesa preferred the opinions of the occupational therapists and the case manager, flawed and deficient as they were, to the opinions of its own psychiatrist and psychologist, whose greater expertise in assessing Mrs. Michalski's cognitive function Wawanesa sought. I find Wawanesa failed to act with sound and moderate judgment in reassessing evidence from its own assessors. I find Wawanesa's actions and defaults overlap and compound each other.

Ms. Entwistle,
What happened to the Health Professions magazine? Did it lose interest in these issues? And where did the Alliance of Treatment Providers go? Are they all on summer holidays and so not able to address any of these issues? Alas, abuses like the ones in these health regulatory decisions/censures don't take summer holidays.

Thanks again for your message. The health professional magazine is no longer in circulation, but I can't quite recall why. I am not sure if it was funding or volunteers they were lacking. I am not personally a member of the Alliance, and as such I am unsure where they stand on these issues. However, I will tell you I have engaged in discussions about regulatory issues with our provincial association and hope that our Auto Sector Committee will have some influence. I also plan on running for a seat at our College to try and see if an internal approach to change management would be effective. As one last thought, I would also encourage survivors to sit on college complaint committees if possible. I would hope these would allow for "community members" and survivors would add huge value (I would hope) to the process of complaints and compliant resolution.

Ah, the ever difficult argument of "he said / she said". I had a recent situation where a lawyer told our ABI client not to complain about his assessors because this ultimately made him look "cognitively intact". The lawyer felt his complaint would minimize the data on file that said he has memory problems. My response was to highlight how acutely people can remember things when there is emotion involved. Maybe we can't remember what we had for dinner yesterday, but we can surely remember any experience that holds a negative emotion. My solution to the "he said" problem is to either a) video tape all insurance exams, or b) ensure treating health professionals are the ones assessing. People that work narrowly only doing assessments can lose sight of what it means to render a balanced opinion that is client centered. I also agree that anyone with a strike against them, and the reason for that strike (treater or assessor) should have their name public. Right now there is no "business" consequence to this type of practice behavior and something needs to be done to improve the quality of these assessments.