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What You Need to Know About the Insurance Doctor in Your Ottawa Personal Injury Claim (Part 1)

March 13, 2017

If you are making a claim for an injury that resulted from a motor vehicle accident or slip and fall, the insurance company has the right to refer you for an independent medical examination (“IME”) by a doctor. There are a few things you should know before going for the assessment.

There is nothing independent about the doctor who will assess you. This doctor is someone chosen by the insurance company or the defence lawyer for the insurance company. In many cases these doctors work exclusively for insurance companies and are chosen because they are more likely to provide “opinions” harmful to your case and beneficial to the insurance company. These doctors are being paid by the insurance company and know very well that a finding of total disability will result in the insurance company having to pay more in a settlement or at trial. If a doctor consistently provides an honest opinion that the accident victim is seriously injured, the insurance company will likely stop using this doctor. Many insurance “IME” doctors make hundreds of thousands of dollars performing IME’s for insurance companies, year in and year out.

Examples of the sorts of practices used by insurance medical doctors were highlighted by two recent articles in the media.

The first is an article in the Toronto Star which describes the case of an insurance company doctor who tried to sue a personal injury lawyer for defamation. The doctor in question brought the defamation claim because the injury lawyer had written an email to 670 other lawyers warning that this doctor had altered medical reports to make the injured victim appear less injured and provided false information in his reports. The defamation case was thrown out because the judge found that the allegations against the doctor were “substantially true”. The judge also concluded that the doctor (for TD Insurance) had made comments in his report that were “most certainly false and misleading”.

The Toronto Star article can be found here.

A second article addressing this issue, entitled “Hired Gun in a lab coat: How medical experts help car insurers fight accident claims” appeared in the following article in the National Post.

The National Post article describes examples of cases where the doctors hired by insurance companies provided “blatantly biased” opinions or were acting as an “advocate” for the insurance company. Insight is also provided regarding the financial benefits received by these “hired guns”. One doctor who regularly performed “IME” reports for insurance companies made $450,000.00 in 2015, mostly from assessments for insurance companies. Another estimated he spent 25% of his time on assessments (mostly for insurers); but his income from doing this was double what he earned from his clinical practice the rest of the time.

It is not suggested that all doctor or experts who perform assessments for insurance companies are biased. A very significant percentage of these doctors perform honest assessments and write honest reports. In fact, all doctors who perform an IME for a court action are required to sign an acknowledgment that they will give evidence that is fair and objective, among other things.

The important thing to understand and remember is that the insurance IME doctor is not on your side. He or she will not treat you or refer you for care. He or she has been hired by the insurance company for a report to help with their case. While the doctor is required to sign an acknowledgment to to be fair and objective, as we can see from the above examples, this does not always happen.

In our next blog post we will outline the things you can do at an insurance medical assessment to protect yourself and help the insurance company doctor provide a fair and honest opinion.



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