Articles Posted in Medical Examinations

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Medical experts, along with their reports, are major pieces of evidence in any serious personal injury case in Ontario.

The testimony of a Plaintiff, and that of a Defendant, will likely be self serving.

The Injured Accident Victim Plaintiff will take the stand and provide evidence that the accident was not their fault, and as a result of the accident; that they are seriously injured and can no longer lead a normal life.

The Defendant in a personal injury case will say the exact opposite. The accident was not their fault, and that the Plaintiff did not appear to be injured at all in the accident.

With testimony which is so diametrically opposed; how is a Judge or Jury supposed to decide who is telling the truth? Certainly the credibility and likeability of the parties comes in to play. But there is another major factor as well.

That’s where medical experts come enter the scene. These are often doctors, hired by the Plaintiff’s lawyer, or the Defendant’s lawyer to provide expert testimony or evidence in support of the case, one way of the other. The testimony of these experts, along with the evidence which they tender in to Court can be very persuasive. It’s often the difference between a successful or unsuccessful case. The battle of experts is very real, and it’s very important in a personal injury case.

Medico-legal experts in the context of personal injury cases have come under fire in recent months. A National Post story entitled “Hired Gun in a Lab Coat: How Medical Experts Help Car Insurers Fight Accident Claims” is a fantastic read which sheds some light on how the business of medico-legal experts plays out.

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Earlier this week, the Kathleen Wynne Ontario Provincial government announced unilateral cuts to all of its fees which it pays to doctors. The cuts around around 2.65% across the board for services. Ontario doctors have been without a proper contract with the Government since March 31, 2014. Contract negotiations have broken down such that the Ontario Medical Association (OMA) refuses to accept the provinces proposals; and the province refuses to give in to the OMA’s demands.

In addition to the 2.65% cut to all OHIP plan fees, the province will eliminate funding to doctors to take continuing medical education courses; will reduce the fees for walk-in visits by $1.70 to bring it in line with with the fee for regular visits to a family doctor; eliminate the premium for doctors to accept new patients who are healthy; and eliminate the number of family doctors in well-serviced areas who can join family health teams where doctors are paid by the number of patients they enroll (not fee for service).

10% of Ontario Provincial budget is devoted towards healthcare. Of that 10%; 25% is devoted towards paying doctors. I would be ok if that budget were higher on both ends, but that’s me. Now you know where I stand.

Are doctors happy with these unilateral terms imposed by the government? I haven’t spoken with a single doctor OR patient who has welcomed these changes.

Will doctors strike? No. But the reprecussions will be felt across the provincial health care system. More on that later.

How much does the Province predict they will save by these cuts and changes? Another good question. In fact, that question was so good, that Minister of Health, Dr. Eric Hoskins dodged the question when it was asked to him.

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You’ve been injured in a car accident, or you’ve made a claim for Long Term Disability Benefits.

Benefits have not yet been paid. The insurance is giving you a tough time. They’re treating you like you’ve done something wrong; when all you’ve done is been in the wrong place at the wrong time resulting in serious injuries. All you want are the benefits you need to help you get better, and make ends meet. After all, isn’t that what insurance is for? Isn’t that why you’ve paid mountains of money in premiums all of these years.

You receive a notice in the mail from your insurer. They want you to attend an IME (Independent Medical Examination) with some doctor or therapist who you’ve never heard of, in a strip plaza or office tower that’s far away from home.

Transportation has been arranged, but the assessment is still going to take up a lot of your time.

You have yet to receive any benefits so why should you bother to attend? You don’t want some strange doctor or therapist touching you, or asking you all sorts of personal questions, and then reporting their findings to strangers at the insurance company. It all seems weird. And who’s paying for these examinations anyway? They aren’t covered by OHIP, and you know that doctors’ time isn’t cheap.

If the request for an IME is as a result of a car accident, unfortunately, the Insurance Act and the Statutory Accident Benefits Schedule (that’s the law dealing with car accident benefit claims) requires that you attend.

Here is an excerpt of the relevant section of the SABS:

Examination Required by Insurer

42.  (1)  For the purposes of assisting an insurer determine if an insured person is or continues to be entitled to a benefit under this Regulation for which an application is made, an insurer may, as often as is reasonably necessary, require an insured person to be examined under this section by one or more persons chosen by the insurer who are members of a health profession or are social workers or who have knowledge in vocational rehabilitation. O. Reg. 546/05, s. 21.

So, you’ve now read the law which basically requires your attendance at these examinations. Still..what happens if you just don’t go? Read on and we will tell you!

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If you keep up with the news, you will know there’s a shortage of family doctors. This shortage is more pronounced in rural or remote communities. Perhaps the notion of a shortage of family doctors isn’t accurate, but I’ll let the people at the Ministry of Health and the OMA debate that.

I’m sure we can all agree that people are having a tough time finding family doctors as many people in Ontario are WITHOUT family doctors. Many doctors aren’t accepting new patients.

Family doctors are very important. They represent the front line with respect to medical care and attention when you’re sick, injured or hurt.

In my travels across Ontario, I’m never shocked when people tell me that they don’t have a family doctor or that they haven’t seen a doctor in many years.

Lots of people don’t like going to see the doctor. The doctor’s office may conjure up bad memories, feelings of worry, or helplessness; so going to the doctor’s office isn’t a priority. Or, they can’t find the time in their busy work schedule to see a doctor. Or, perhaps they’ve had no reason for a very long time to get a family doctor when they have no pressing health problems. Or, their community just doesn’t have a family doctor nearby who’s taking on new patients. The closest family doctor might be a few hours drive away and making that drive just isn’t practical.

Our lawyers understand this. But, when an accident happens, the family doctor may be the most important medical professional for your case. Particularly in a chronic pain case.
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You’ve been involved in a car accident, or you’re involved in a dispute against your Long Term Disability Insurer. The adjuster for the insurance company tells you over the phone, or in an incomprehensible letter that they want you to attend a medical examination with a doctor you’ve never heard of.

You don’t know who this doctor is.

You don’t know where their office is located.

You don’t know how you’ll ever get there because transportation has been difficult for you since your accident or disability.

You don’t know why you have to attend the examination.

You don’t know what the examination is for, how long it will last, what tests will be administered.

You have about a million and one other questions about the examination, and you have nobody to turn to.

Enter a Personal Injury Lawyer.

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