Medical evidence is your case maker when you are advancing a personal injury claim in Ontario. The nature of your injuries, the effect they have on your life and the compensation you can be entitled to receive is determined by doctors’ reports, records of treatment and expert opinions from health care practitioners such as medical specialists, psychologists, Life Care Planners or vocational assessors, among others.
It is not uncommon for opposing medical opinions to emerge in a claim. One physician will tell you that your injuries are chronic and serious, and another, usually contracted by the insurance company, will tell you that you are fully or mostly healed or that you can go back to work.
This dispute often arises when an Independent Medical Examination (IME) is conducted. This situation is confusing and even stressful to individuals who sustained injuries and would be harmful to their case, unless dealt with properly.
What is an Independent Medical Examination (IME)?
An Independent Medical Examination (also referred to as IME) is a medical test ordered by an insurance company or defence lawyer whenever a personal injury is being claimed. Likewise, your own lawyer can also refer you for an IME.
Despite the name, if you go to an IME at the request of the defendant or insurance company, the doctor conducting the IME is typically selected and paid for by the insurance company. Their role is to evaluate your injuries and provide an opinion about issues such as:
- Whether your injuries were caused by the accident
- The severity of your injuries
- Whether your condition has improved
- Your ability to return to work or normal activities
- Whether further treatment is necessary
In personal injury claims, especially motor vehicle accident cases, insurers often rely heavily on IME reports when deciding whether to approve or deny benefits.
Why Medical Opinions Often Conflict
Conflicting medical opinions are extremely common in injury claims. There are several reasons for this.
- Different Perspectives
The doctor treating you visits you regularly, tracks your progress, and knows how the injury affects your life. In an accident benefits claim, an IME doctor can meet you, sometimes spend less than an hour, and form an opinion on your condition. - Insurance Company Interests
Insurance companies may request assessments from doctors who specialize in evaluating claims. While these doctors must remain objective, their role is often to provide an opinion that helps the insurer determine whether benefits should continue. These “independent” experts also know that they are being paid by insurance companies and they want to continue to be paid in future cases. - Complex or Invisible Injuries
All the injuries may not necessarily be seen on imaging tests, such as chronic pain, soft tissue injuries, traumatic brain injuries, or psychological disorders. Such subjective conditions are more likely to lead to disagreements among IME experts. A defence IME medical assessor may provide a qualified opinion that you no longer continue to suffer from any objective ongoing medical injuries and therefore have reached maximum medical recovery. The reality, however, is that you may continue to suffer from chronic pain, myofascial pain or a somatic symptom disorder, which are all valid diagnoses that the defence IME doctor may omit to consider. - Recovery Timelines
Various doctors might hold varying views on the duration of recovery and whether the previous symptoms are associated with the accident.
Having conflicting opinions may make a great impact on your claim as well as the benefits accruing to you.
How IME Reports Can Affect Your Claim
Insurance companies frequently rely on IME reports when making decisions about:
- Stopping accident benefits
- Reducing treatment coverage
- Denying disability claims
- Disputing the severity of injuries
- Arguing you can return to work
The Role of a Personal Injury Lawyer in IME Disputes
A skilled personal injury lawyer helps protect your claim when medical opinions conflict. Their role extends far beyond simply reviewing reports.
1. Preparing You for the IME
Many people feel anxious before attending an IME, especially if they don’t know what to expect. Your lawyer can explain:
- The purpose of the examination
- What questions may be asked
- How long will the exam last
- What information should you provide
Adequate preparation would assist in getting an assessment that is a true indicator of your condition.
2. Reviewing the IME Report for Accuracy
IME reports are occasionally erroneous, omitting, or misleading. A personal injury lawyer will systematically go through the report, and he or she will know that there are problems like:
- Incorrect medical history
- Misrepresentation of your symptoms
- Unsupported medical conclusions
- Selective interpretation of records
If problems are found, your lawyer can challenge the report’s credibility.
3. Obtaining Additional Medical Evidence
If the IME opinion contradicts your treating doctor’s findings, your lawyer may seek further medical support through:
- Specialist evaluations
- Functional capacity assessments
- Independent expert reports
- Updated treatment records
These additional opinions can strengthen your claim and counterbalance the insurer’s position.
4. Cross-Examining Medical Experts
In cases that proceed to trial or a SABS hearing at the License and Appeals Tribunal (“LAT”), IME doctors may be questioned about their findings.
Your lawyer can challenge the expert by examining:
- The limited time spent assessing you
- Any inconsistencies in their report
- Whether they reviewed all relevant medical records
- Their experience and potential bias
Effective cross-examination can significantly reduce the weight given to a disputed IME opinion.
5. Protecting Your Entitlement to Benefits
A personal injury lawyer may also challenge the denial of benefits through dispute resolution methods such as negotiation, mediation, or litigation at the Ontario Superior Court of Justice.
Disputes related to accident benefits can be adjudicated at the LAT.
What You Should Do If an IME is Scheduled
In case your insurer sets an IME, you can take a number of measures to safeguard yourself.
1. Be Honest and Accurate
In the examination, be honest about your symptoms. Do not overstate your injuries, and do not understate your troubles. Many assessors conduct validity testing to see if you are giving honest and full efforts in their assessments, so always be honest and give the maximum effort you are capable of providing.
2. Keep a Record of the Appointment
Write down details about the examination afterward, including:
- How long the appointment lasted
- What tests were performed
- The questions the doctor asked
- Any concerns about the evaluation
These notes can help your lawyer if the report later contains inaccuracies.
3. Continue Following Your Treatment Plan
Ongoing treatment and medical documentation from your treating healthcare providers remain critical evidence in your claim.
FAQs
- Do I have to attend an Independent Medical Examination?
In many Ontario accident benefit claims, insurers are legally allowed to request an IME. Failing to attend without a valid reason could result in benefits being suspended. However, your lawyer can review whether the request is reasonable. Likewise, for injury claims in court, defendants are entitled to have you undergo IME assessments, within reason. - Is it possible to invite someone to the IME?
The policies differ, though in certain limited instances, a support person can be invited. Your lawyer can make recommendations to you regarding what is allowed. - What is to be done when the IME doctor declares that I have recovered, and yet I feel pain?
This is a common situation. Your lawyer can seek more medical opinions and dispute the IME report based on your current symptoms and medical treatment history. - Are IME doctors truly independent?
As outlined above, if you are being sent to an assessment by an insurance company or defendant, the IME assessor knows who they are writing the report for and who is paying their fee. They also know that their opinion may impact whether they continue to get these lucrative referrals. - Can conflicting medical opinions affect my settlement?
Yes. Disagreements between medical experts can influence negotiations and the value of a claim. A personal injury lawyer works to ensure that your treating doctors’ evidence and additional expert opinions are properly considered. If your case proceeds to trial, it will be up to the judge or jury as to which expert is preferred.
Protecting Your Claim When Medical Opinions Conflict
Personal injury claims are rarely straightforward, especially when insurers rely on IME reports to challenge the severity of injuries.
Without proper legal guidance, conflicting medical opinions may lead to:
- Denied accident benefits
- Reduced settlement offers
- Disputes about long-term disability
- Delays in compensation
A qualified personal injury lawyer knows how to look at medical cases, how to determine the vulnerabilities of the reports requested by the insurers, and how to prove the full scope of your losses.
Conclusion: Experienced Legal Guidance Makes a Difference
One of the most common problems with Ontario personal injury claims is conflicting medical opinion, especially when an Independent Medical Examination is a part of the case. Such disagreements can be very impactful on your benefits, recovery process and possible compensation.
The assistance of an experienced personal injury lawyer will ensure that the medical evidence is scrutinized, unhelpful reports are disputed, and that your interests are protected despite the insurer obtaining an expert opinion that you do not agree with.
The team at SG Injury Law understands how IME assessments work, especially having worked for insurance companies in the past. We now assist clients to obtain the compensation they are entitled to, balancing your obligation to attend an IME with scrutiny of the IME report and your own expert evidence that protects your interests.