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When Occupational Therapists and Insurance Companies Try to Fool You

Insurance companies along with their third party contractor occupational therapists and rehabilitation companies seek to take advantage of innocent accident victims when they are at their most vulnerable. Immediately following a serious accident.

Innocent accident victims are shook following a serious car accident. Their world has been turned upside-down.

They have to manage a boat load of little emergencies because life as they know it has changed. They might be non-weight bearing in hospital in need of 24/7 attendant care, but life still goes on.

Who is going to look after the kids while you’re injured?

Who is going to walk the dog, get the groceries or take out the garbage?

How am I going to manage my work obligations?

How am I going to pay my bills?

Who is going to pay for all of the treatment and medication I need?

Who is going to help me fill out the pile of forms which the insurance companies are asking me for?

How do I apply for Government assistance?

The last thing you need is a stranger doing an assessment of you when you’re in such a vulnerable physical and emotional state.

Yet this is exactly what seems to happen time and time again.

Your car insurer will hear about your car accident one way or another. The more serious the accident, the greater the chance that your insurer will find out about the accident rather quickly, even if you have not reported it. Chances are the other party or parties who were involved in the car accident have. The insurer can track the party involved just by virtue of a quick license plate check; or by checking up the information contained in the Police Report or Occurrence Summary.

Once the insurance company finds out that one of their own insureds has been involved in a serious collision, they open a file (as they should).

But in many cases, it goes beyond simply opening a file.

The next thing you know, is that all of the sudden the injured party is getting unsolicited calls from “agents” or “contractors” from the insurance party. These people identify themselves as occupational therapists who have been retained to conduct an in-home or in-hospital assessment.

Let’s be very clear.

The injured accident victim has NOT requested that s/he be assessed; nor has the injured party authorized for the insurer to retain a third party occupational therapist to come to their home or hospital bed to see them. Sounds like a gross invasion of privacy.

But Canadians are very polite and agree to lost of things so long as they sound above board, official and necessary for their case. It almost acts like an “implied ” or “assumed” sale when someone who sounds like an authoritative figure calls you out of the blue saying that they have been retained by Insurer “X” to come out and see you at your home for an assessment in relation to your accident claim. Not only does s/he agree, but when the assessor comes to their home, the accident victim signs forms which completely legitimizes the entire assessment process.

How can you say know? You think that saying no would negatively impact your claim or make the insurer made. It seems like this is just how things go.

The reality is that agreeing to the assessment in the vast majority of cases hurts the case more than helps it.

You see, these third party assessors who are retained by the insurance company are NOT there to serve you. They are there to serve the party who has retained them. In this case, they have been retained by the insurance company. They will generate a report and come to conclusions which support an insurer’s narrative of the claim. They will view all of the evidence and factors in the case through the lens of an insurer, and not through the lens of an innocent accident victim.

In many cases this translates into less hours of attendant care, less assistive devices, and less treatment recommendations. Treatment will likely be stopped or slowed down earlier given the recommendations and the wording contained in the reports.linkedin-2-300x300

It’s important to note that these third party occupational therapists are paid by the assessment. The more assessments they do, the more money they make.

This financial incentive is important to recognize. It fosters a culture of “first there, first paid“. These assessors are NOT paid through the publicly funded OHIP system. They bill the insurer directly for their work.

There is a financial incentive for theses assessors to get out to see these accident victims in their homes before any other assessor does. Once the in home assessment is completed, the insurer will NOT pay for a further assessment unless there has been a material change in circumstances, or a period of time has gone by.

So, if an injured Plaintiff gets a visit from one of these Third Party Occupational Therapists who was referred by the insurer; and doesn’t like the findings contained in the report; the insurer will NOT fund another report. In fact, the insurer will rely on the findings in that report for the case moving forward. This is why that first step and that first contact with the right assessor is so important. And this is also why insurers are so aggressive at getting their own assessors to see injured accident victims so soon after a car accident.

An insurer may rebut this position stating that they are just trying to do their clients a service by engaging an occupational therapist to get them the help which they need. This altruism couldn’t be further from the truth. The reality is that accident victims are NOT told that they have the choice of assessor or therapist. If accident victims knew they had the choice, instead of that choice being made for them by an insurance company, don’t you think they would do their research and find someone they are comfortable with; particularly when you are inviting this person into your home when at your weakest, more fragile and most vulnerable?



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