Author: CIWS

AssessMed: A Comprehensive Guide to Independent Medical Evaluations. Understanding the Role of AssessMed in the Medical Evaluation Industry

Have you ever wondered how injured workers receive an unbiased medical evaluation? Or how insurance companies and law firms manage their claims cases with ease? The answer lies with AssessMed, a leading provider of independent medical evaluations across Canada. With a history dating back to 1991, AssessMed has been facilitating comprehensive, objective, and evidence-based medical assessments and file reviews, ensuring high-quality service for all its clients.

AssessMed: More Than Just an IME Provider

AssessMed is not just an independent medical evaluation (IME) provider, but a partner that manages the entire assessment process. From connecting clients with a physician to confirming appointments and securing the delivery of reports, AssessMed is dedicated to making the IME process easy to schedule and manage. But what sets AssessMed apart from other IME providers?

AssessMed’s Unwavering Dedication to Quality and Objectivity

AssessMed’s commitment to quality and objectivity is evident in its assessor qualifying and approval process. All assessors at AssessMed have current clinical practices or teaching appointments, and are experienced professionals within their respective fields of expertise. They are in good standing with their respective colleagues and regulatory bodies, ensuring that all evaluations are credible, defensible, and based on current medical best practices.

AssessMed’s Wide Range of Services

AssessMed offers a wide range of services, catering to the diverse needs of its clients. These services include Catastrophic Assessments, Assessment of Attendant Care Needs, Independent Medical Evaluation (IME), Insurer Examination, File Reviews, Job Site Assessment, Functional Abilities Evaluation, Psycho-Vocational Evaluation, Functional Medicine Evaluation (FME), Physical Demands Analysis (PDA), Vocational and Employability Assessments, Labour Market Re-Entry Assessments, Neuropsychological Assessments/Effort Testing, Future Care Costs, Ergonomic Assessments, Workplace Risk Assessment, Pre-Employment Medicals, and Non-Medical Summary.

AssessMed Cares: Giving Back to the Community

AssessMed’s commitment extends beyond providing high-quality IME services. Through its AssessMed Cares initiative, the company has been actively involved in charitable giving, positively impacting lives across Canada and beyond its borders. From donating to food banks and medical associations to supporting children in developing countries, AssessMed has made significant contributions to various social causes.

AssessMed’s Impact on the Legal and Insurance Industry

AssessMed plays a crucial role in the legal and insurance industry. It provides referral services for both defense or plaintiff law firms as well as in-house counsel representing both P&C auto insurers and Life and Health Disability Insurers. All reports prepared by AssessMed are done so with the understanding that the case may go to trial, ensuring that all information is comprehensive and defensible.

AssessMed’s Blog: A Resource for Industry Information

Looking for the latest news and information in themedical assessment industry? Look no further than AssessMed.com‘s blog. From celebrating the achievements of its team members to sharing updates on its charitable endeavors, the blog serves as a valuable resource for anyone interested in the field of independent medical evaluations.

Why Choose AssessMed?

Choosing AssessMed means partnering with a CARF (Commission on Accreditation of Rehabilitation Facilities) accredited organization that values quality, objectivity, and customer service. Whether you’re an injured worker seeking an unbiased medical evaluation or a law firm needing expert medical assessments for your cases, AssessMed is the partner you can trust.

The AssessMed Advantage: A Deep Dive into its Services

What truly sets AssessMed apart is the breadth and depth of its services. Catering to a diverse range of needs, AssessMed offers a comprehensive suite of assessments that are tailored to provide the most accurate and objective evaluations. Let’s delve deeper into some of these services.

Independent Medical Evaluations (IME)

At the heart of AssessMed’s services is the Independent Medical Evaluation (IME). An IME is a crucial tool in the resolution of claims, providing an objective assessment of an individual’s medical condition. With a roster of experienced professionals across various fields of expertise, AssessMed ensures that each IME is conducted with the utmost integrity and objectivity. Whether it’s for an injured worker or an insurance claimant, an IME from AssessMed provides a reliable basis for decision-making.

Catastrophic Assessments

For cases involving severe injuries or illnesses, AssessMed offers Catastrophic Assessments. These assessments are conducted by a team of CAT certified assessors, who are experienced in handling complex cases. The goal of a Catastrophic Assessment is to determine if an individual’s condition meets the criteria for a catastrophic impairment, which can significantly impact the benefits they are eligible to receive.

Assessment of Attendant Care Needs

AssessMed also provides Assessment of Attendant Care Needs, a crucial service for individuals who require assistance with their daily activities due to their injuries or illnesses. This assessment determines the type and amount of care an individual needs, providing a clear picture of their care requirements.

AssessMed’s Commitment to Quality

Quality is a cornerstone of AssessMed’s services. This commitment to quality is evident in its assessor qualifying and approval process. All assessors at AssessMed have current clinical practices or teaching appointments, ensuring that they are up-to-date with the latest medical practices and standards. Furthermore, they are selected based on their experience and standing within their respective fields, ensuring that each assessment is conducted by a qualified professional.

AssessMed’s Role in the Legal and Insurance Industry

AssessMed plays a pivotal role in the legal and insurance industry. By providing unbiased medical evaluations, it aids in the resolution of claims and disputes. Whether it’s for a personal injury case or an insurance claim, AssessMed’s services provide the objective evidence needed to make informed decisions. Furthermore, all reports are prepared as though the case were going to trial, ensuring that they are comprehensive and defensible.

AssessMed’s Charitable Initiatives: A Testament to Corporate Responsibility

While AssessMed is renowned for its impeccable services in the medical evaluation industry, it’s also a company with a heart. AssessMed Cares, the company’s charitable arm, is a testament to its commitment to corporate social responsibility. Through AssessMed Cares, the company has been actively involved in charitable giving and community service, positively impacting lives across Canada and beyond.

Supporting Wounded Warriors and Children in Need

One of the noteworthy contributions of AssessMed Cares is its donation to Wounded Warriors Canada. This donation supports mental health programs that benefit ill and injured Veterans, First Responders, and their families. In addition, AssessMed has donated to Sleeping Children Around the World, a charity that provides bedding to children in developing countries. These initiatives reflect AssessMed’s commitment to supporting injured workers and children in need.

Empowering Communities Through Education and Employment

AssessMed Cares also extends its support to World Vision, an organization that creates education and employment opportunities by building communities in emerging areas. By empowering communities through education and employment, AssessMed is playing a vital role in breaking the cycle of poverty and paving the way for sustainable development.

AssessMed’s Annual Holiday Toy and Food Drive

During the holiday season, AssessMed’s spirit of giving is in full swing. The company organizes an annual holiday toy and food drive, donating toys and food to local communities. This initiative not only brings joy to children during the festive season but also provides much-needed food supplies to families in need.

AssessMed.com: Your Go-To Resource for Industry Information

For those looking to stay informed about the latest trends, news, and information in the medical assessment industry, AssessMed.com is an invaluable resource. The website’s blog section features a plethora of articles and updates that are not only informative but also insightful. From celebrating the achievements of its team members to sharing updates on its charitable endeavors, the blog serves as a treasure trove of information for industry professionals and the general public alike.

AssessMed’s Impact on Injured Workers

One of the key beneficiaries of AssessMed’s services are injured workers. These individuals often find themselves in a complex web of medical evaluations and insurance claims. AssessMed steps in to provide unbiased, comprehensive, and objective medical evaluations, ensuring that injured workers receive a fair assessment of their condition. This not only aids in their recovery process but also helps them receive the benefits they are entitled to.

AssessMed’s Role in Accident Benefits

Accident benefits adjusters and in-house insurance company lawyers often turn to AssessMed to manage their claims cases with ease. With a roster of experienced professionals across various fields of expertise, AssessMed is equipped to handle every type of case. From orthopedic and psychological assessments to evaluations from endocrinologists, cardiologists, and pediatric specialists, AssessMed offers a wide range of services to cater to the diverse needs of its clients.

AssessMed’s Med-Legal Services

AssessMed’s Med-Legal services are a boon for lawyers, law clerks, and legal assistants. The company provides referral services for both defense and plaintiff law firms, as well as in-house counsel representing P&C auto insurers and Life and Health Disability Insurers. All reports prepared by AssessMed are done so with the understanding that the case may go to trial, ensuring that they are comprehensive, defensible, and ready for any legal proceedings.

AssessMed’s Life and Health Services

Life and Health claims are primarily requested by adjudicators working on insurance claim cases. AssessMed’s roster of experienced professionals is equipped to handle these claims, offering evaluations from a diverse range of medical specialists. This ensures that every claim is handled with the utmost care and expertise, providing a fair and accurate assessment of the individual’s condition.

AssessMed’s Commitment to Innovation and Excellence

At the heart of AssessMed’s success is its unwavering commitment to innovation and excellence. The company continually invests in the latest technologies and best practices to ensure that it stays at the forefront of the medical evaluation industry. This commitment to innovation is evident in the way AssessMed conducts its assessments, manages its processes, and serves its clients.

Adopting the Latest Technologies

AssessMed leverages the latest technologies to streamline its processes and enhance its services. From scheduling appointments to delivering reports, every aspect of the company’s operations is optimized for efficiency and accuracy. This not only ensures that clients receive their reports in a timely manner but also enhances the overall quality of the assessments.

Investing in Continuous Training and Development

AssessMed believes in the continuous growth and development of its team. The company invests in regular training and development programs, ensuring that its assessors are up-to-date with the latest medical practices and standards. This commitment to continuous learning ensures that AssessMed’s team is always equipped with the knowledge and skills to conduct comprehensive and objective evaluations.

AssessMed’s Vision for the Future

As AssessMed looks to the future, it remains committed to its mission of providing high-quality, objective, and evidence-based medical assessments. The company plans to continue expanding its services, reaching out to more clients, and making a positive impact on the lives of injured workers and the wider community. With its commitment to quality, innovation, and corporate social responsibility, AssessMed is poised to continue leading the way in the medical evaluation industry.

AssessMed: A Trusted Partner in the Medical Evaluation Industry

In the complex world of medical evaluations and insurance claims, AssessMed stands as a trusted partner. With its commitment to quality, objectivity, and corporate social responsibility, the company has earned the trust of injured workers, legal professionals, and insurance companies across Canada. But what makes AssessMed a trusted partner in the industry?

Unwavering Commitment to Quality

Quality is at the heart of everything that AssessMed does. From the selection of assessors to the delivery of reports, every aspect of the company’s operations is guided by a commitment to quality. This ensures that every evaluation conducted by AssessMed is comprehensive, objective, and based on current medical best practices.

Relentless Pursuit of Objectivity

Objectivity is a cornerstone of AssessMed’s services. The company understands that the outcomes of medical evaluations can have a significant impact on the lives of injured workers and the resolution of claims. That’s why it goes to great lengths to ensure that every evaluation is conducted with the utmost objectivity, providing a fair and accurate assessment of the individual’s condition.

AssessMed’s Role in the Community

AssessMed’s impact extends beyond the realm of medical evaluations. Through its AssessMed Cares initiative, the company is actively involved in charitable giving and community service. From donating to food banks and medical associations to supporting children in developing countries, AssessMed is making a positive impact on the lives of individuals and communities.

AssessMed’s Vision for the Future

As AssessMed looks to the future, it remains committed to its mission of providing high-quality, objective, and evidence-based medical assessments. The company plans to continue expanding its services, reaching out to more clients, and making a positive impact on the lives of injured workers and the wider community. With its commitment to quality, innovation, and corporate social responsibility, AssessMed is poised to continue leading the way in the medical evaluation industry.

In conclusion, AssessMed stands as a beacon of quality and integrity in the field of independent medical evaluations. Its commitment to providing high-quality services, coupled with its dedication to innovation and corporate social responsibility, makes it a preferred choice for clients across Canada. Whether you’re an injured worker seeking an unbiased medical evaluation, a law firm needing expert medical assessments for your cases, or an insurance company looking for a reliable partner, AssessMed is the name you can trust. Remember, when it comes to independent medical evaluations, AssessMed is the partner that stands by you every step of the way.

Lawyer Sarah Shartal has launched a class action lawsuit on behalf of 230,000 disabled Ontarians caught in bureaucratic quagmire

Thanks to a feisty lawyer, a sympathetic judge and two brave plaintiffs, the government of Ontario may finally be held to account for the way it treats the province’s poorest, sickest citizens.

The lawyer is Sarah Shartal of Roach, Schwartz and Associates.

For years, she has used every device at her disposal – reason, persuasion, harassment, outrage – to get the province to fix its badly broken disability support system. Now, as a last resort, she is trying litigation. She has launched a class action lawsuit on behalf of the 230,000 disabled Ontarians caught in the bureaucratic quagmire.

The judge is Maurice Cullity of the Ontario Superior Court.

Last month, to the surprise of legal observers, he blocked an attempt by the government to have Shartal’s suit thrown out of court. He recognized the importance of the case and gave Shartal three weeks to amend her statement of claim to meet the court’s stringent standards for class action suits.

The plaintiffs are Joy Adams and Janice Wareham.

The two severely disabled women have agreed to put their lives on display to show how hard it is to qualify for disability support and how it takes to get the money. “I needed clients with the emotional courage and strength not to be harmed by the process,” Shartal explained.

No case like this has ever gone to trial in Ontario.

If it is certified to proceed, Shartal will be making legal history. But that’s not what is motivating her. “I just ran out of other options.”

Roughly 25,000 Ontarians apply for disability support every year. Half are turned down. Many more don’t even apply because the process is so onerous.

First, an applicant has to convince a welfare caseworker that he or she is in dire financial need. That requires employment records, bank documents and identification papers.

Once that hurdle is cleared, the applicant has 90 days to get a doctor to fill out a lengthy medical form describing and assessing his or her disabilities.

Anyone who is homeless, illiterate, doesn’t have a health card or doesn’t have a doctor has no hope of meeting this requirement.

Individuals who do manage to complete all the paperwork still face a 5-month wait while the province’s Disability Adjudication Unit determines whether they are eligible for benefits. If the answer is no – as it frequently is – an applicant can request an internal review, then appeal to the Social Benefits Tribunal. But that often takes years.

The reward for reaching the end of this maze is the princely sum of $979 per month – which falls 44 per cent below the National Welfare Council’s poverty line.

A report written for Legal Aid Ontario in 2003 concluded that the program “imposes arduous and unrealistic barriers on the very people it purports to help.”

Since the late ’90s, Shartal has used her legal skills – plus her willingness to go into the city’s shelters and ravines — to obtain benefits for thousands of severely disabled clients. At any given time, she has 120 claims on the go.

But she is no longer content to fight for justice case by case. “The government knows the system doesn’t work,” she says. “But all it does is tinker around the edges. What we’re saying is this is wrong in a basic, democratic legal sense.”

Shartal is seeking damages of $2,000 for each plaintiff, plus $100 for each month the Ministry of Community and Social Services kept a client waiting for a decision.

Wareham, a single mother and abuse survivor, waited 11 months. Adams, who was mistakenly told she didn’t have to provide hospitalization records, waited 18 months.

If Shartal and her clients win, all 230,000 disability support recipients will be eligible for similar payments.

It is little wonder the government wanted to quash the lawsuit.

It is a small miracle that the judge said no.

While most of the thousands of independent medical exams conducted each year are professional and impartial, the field is tarnished by the few substandard assessments that fuel controversy and acrimony

TORONTO | “I have seen the worst side of medicine,” says Melissa Felteau, a Thunder Bay, Ont., resident who was in a car accident in November 1993. It wasn’t her ruptured spleen, internal bleeding, broken ribs, severely damaged left breast and brain injury that broke her spirit, but rather the gruelling series of province-wide medical assessments her insurer ordered her to undergo as she fought for medical benefits.

Before the accident, the then 31-year-old Felteau had been working as the director of public relations at Lakehead Psychiatric Hospital in Thunder Bay. She tried to go back to work three months after the accident, but was horrified to find that she had lost her ability to concentrate and plan, as well as some short-term memory. She stuttered. She could read but not retain information. She could write, but not string sentences together. “It was mortifying; I used to win awards for my writing,” she said. “I went from being a highly functioning executive to being multi-disabled. Yet it was all invisible. You look fine.”

Five attending medical doctors, including her neurologist, diagnosed diffuse axonal brain injury. Two neuropsychological assessments at the time confirmed the diagnosis, and a treatment plan was drawn up.

Felteau’s insurance company, however, ordered her to see assessors hired by them. “So started the nightmare,” she told the Medical Post in an interview at a Toronto hotel. Over the next two years, she was sent to a psychologist, an orthopedic surgeon, a physiotherapist, a behavioural therapist, an internist, a psychiatrist, another psychologist, a psychometrist and a sports medicine doctor.

Felteau said she felt many of the assessors were patronizing. “It’s the patient alone in the room with a medical examiner who has the power to deny or terminate medical treatment. They sit there and they’re cold, impassionate, skeptical.”

Insurance coverage for Felteau’s treatment was denied. That’s when things got ugly. She sued her insurance company for failure to provide timely and adequate rehabilitation, and so began six more years of poking and prodding by many more doctors. All in all, she estimates she had 22 independent medical examiners (IMEs) between those ordered by her side and those for the defence. “It ends up being a (confrontation) between the doctors, while the patient suffers,” she said.

“They snow you under with assessments. Most patients say, ‘I can’t take this’ and they give up.” Felteau kept on going, but paid a high price.

By the time her case was settled out of court eight years after her accident, Felteau said she was traumatized by the IME process. She developed idiopathic anaphylaxis, and has experienced 17 episodes of anaphylaxis, which further damaged her neurological system.

“I have a life-threatening stress reaction,” she said. She is now a volunteer clinical educator at Lakehead University and the University of Ottawa Rehab Research Group and is studying (with help, to accommodate her still-existing deficits) for a Masters degree.

“We are victims twice, first by the injury and then by the system.”

Felteau’s story is not an isolated one. The Medical Post set out to discover more about the world of IMEs. (The acronym IME stands for independent medical examinations, but the “E” loosely refers to both exams and examiners, so it is possible, semantically at least, to be an IME, have an IME or do an IME.) We pored over cases in which IMEs had been used: car accidents, chronic illness, workers’ compensation; we called doctors across Canada who either do IMEs themselves or are knowledgeable about them (not all of them called us back); we spoke to several lawyers; we attended a medico-legal conference; we met Felteau, as well as a doctor who runs one of Canada’s largest IME companies, and a representative from the insurance side.

IMEs, it seems, operate on kind of a wild frontier of medicine. While most of the tens of thousands of independent medical exams conducted each year in Canada are no doubt professional and impartial, the field is tarnished by the few exams that are shoddy and substandard. Without exception, our contacts told us there are some bad eggs in the IME business. Most were quick to add that there are charlatans in every profession. The difference—we thought as we pursued this investigation—is that with bad IME assessments (unlike, say, bad audits) patients can get hurt, and there’s not much that ethical, caring physicians can do about it.

Dr. Beverly Tompkins is one such caring physician. She is medical director of the Burke Institute in Calgary, a clinic for patients who are highly impaired and disabled with multiple sclerosis and other chronic diseases. She has dealt again and again with a handful of insurance-paid doctors who she says give biased assessments.

“(With this group) appropriate physical exams are not being done. Doctors are actually assessing but doing a very poor job. The answer is favourable to the insurance company time after time after time. They are in conflict with other physicians who have no vested interest,” she said.

“Sometimes my treatments are overruled. Their assessments are completely flawed. It is unacceptable. They say the patients either don’t have the health problem or they can work despite it. Or give them an antidepressant and they’ll be back at work in three to six months.

“Every now and then they give a good assessment so that they don’t look like they always give bad ones.”

But the end result, she said, is that many patients “are being profoundly mistreated.” Some IMEs neglect to ask meaningful questions to patients or manipulating the wording of the diagnostic criteria in order to come up with a diagnosis of psychological problems, she said. In one case, Dr. Tompkins said a doctor giving testimony in court deliberately changed the wording of the DSM IV in order to boost the defence argument.

The effect of losing benefits has been devastating for some of Dr. Tompkins’s patients. Many end up in poverty. “Stress makes them much worse; they lose their families; they can’t afford food. This causes not only financial harm but health and psychological consequences. It is so outrageously horrible.”

And Dr. Tompkins can often predict it. “A patient comes in and tells me ‘my insurance company is sending me to Dr. X for an independent medical examination next week.’ I already know what the conclusion is going to be. I don’t tell them they’d better start getting ready to sell their house, but my heart falls for them.”

Calgary is not the only city where physicians working with chronic disease patients complain about IME assessments. “It is like a factory,” said Dr. David Saul, a psychiatrist in Toronto who treats fibromyalgia patients, and has seen dozens of bona fide cases turned down for benefits. “It is easy for the IME doctor to say, ‘I see no objective evidence.’ They say, ‘It’s all in your head.’ They crucify them on the IME. My patients come back and tell me the doctor was demeaning, condescending.” He, too, has seen patients lose their family, their home and their job and have to go on welfare. “They can’t go to work, but they have no income. If they try to go to work, they look like they were faking all along.”

The same thing happens to brain injury patients, said John Kumpf, executive director of the Ontario Brain Injury Association. “It is not malevolence, but ignorance with doctors doing IMEs,” he said. “In the past eight and a half years, I have seen IMEs done on patients with brain injuries that were deplorable in their ignorance. Some were performed by orthopedic specialists who knew virtually nothing about brain injury. Others were done by practitioners whose motives would qualify them for the title of mercenaries. These are the doctors who flatly state there is no such thing as mild brain injury or who state that unless a person has a loss of consciousness, a brain injury has not occurred. These doctors violate the first principle of medical practice: First do no harm.”

The Medical Post spoke to several leaders in the IME field to gather their perceptions of the climate in which they work. Dr. Sheldon Levy is the medical director of one of Canada’s oldest and largest IME companies, Riverfront Medical Services, in Toronto. “My concern as a physician is that the proper information is propagated to the general physician body. A lot of physicians who do this work, do it well; they add value to the insurance company and they add value to patients. That’s lost on some of the physicians who are quick to say it is not right to do IMEs.”

The vast majority of Riverfront’s business is conducted without controversy, the run-of-the-mill work of assessing and quantifying disability. Less than 5% of cases go to arbitration, mediation or court. And Dr. Levy said he is proud of the work Riverfront does.

The president of Canada’s only organized society of independent medical examiners agreed that IME work is most often done with the highest level of integrity. “We believe strongly in using our knowledge in the field, training, skills and experience to make impartial assessments,” insisted Dr. Michael Ross, a Toronto psychiatrist and president of the Canadian Society of Medical Evaluators (CSME). “At the core of our values are evidence-based medicine and the ability to be truly independent and impartial. Outside bodies may view it differently but these are the core values of what we do.”

How many doctors in Canada do IMEs? CSME represents only a fraction of them. It has 74 members who are physicians; Dr. Ross estimated the number of doctors doing IMEs nationally must be in the tens of thousands. Doctors who do IMEs can spend as much as 100% of their work time on them, or as little as an occasional assessment. “Nobody really knows the scope of the market. The scope is massive.”

There is a large middle layer in the field: firms that provide a stable of IME doctors for insurers to choose from. Some of the larger names in Canada are Aim Health Group, Care Point Medical Centres (formerly the Back Institute), Sibley and Associates, Crawford and Company, Medisys Health Group Inc., ACT Health Group Corp., ACTIVE Health Management, Canadian Trauma Consultants and Riverfront.

Though no one knows exactly how big the IME industry is, or how it is apportioned, the bulk of IME work is bought and sold through about a dozen facilities, such as Riverfront, that have a licensed physician in their base office and a roster of physicians on contract. In addition, there are perhaps 50 companies that simply broker third-party services, but are not considered health-care facilities.

Dr. Michel Lacerte is one of Canada’s most prominent IMEs. He said he finds the conduct of some of Canada’s IME brokers to be “distasteful.” He is a physiatrist and associate professor with the department of physical medicine and rehabilitation at the University of Western Ontario in London. “I have a major concern. They go to the insurance company and say, ‘I can get IMEs that you would like.’ They are volume discounters. The doctor only gets 50%.”

He laments the fact that IME brokers are not regulated and that there are “mercenaries” working in the business. He and colleague Dr. François Sestier, a staff cardiologist at CHUM Hôtel-Dieu in Montreal, have started a diploma course in medico-legal medicine at the University of Montreal in an attempt to clean up the IME landscape (see the Medical Post, Jan. 23).

Indeed, there was a wink-wink, nod-nod tone to many of the interviews we did about IMEs, as those in the know agreed there is a dark underbelly in the business. Toronto occupational physician Dr. Gabor Lantos said: “Of course there are cookie-cutter reports and bought opinions. We all know who they are.”

Dr. Ross, CSME president, said he, too, knows of IME physicians who are not impartial. “There are psychiatrists and psychologists in town I can tell you what it says before I read it. I wonder why anyone uses these people? They’re bad apples.” But Dr. Ross doesn’t believe their behaviour reflects badly on other IMEs. “They gave themselves a bad name, not the profession.”

What can be done about the bad eggs? We posed the question to CSME’s Dr. Ross, and he replied: “Even if you know exact numbers, how would you weed them out?”

Dr. Arnold Voth, a specialist in internal medicine in Edmonton, said that one way to clean up the IME landscape would be to control the percentage of insurance income doctors can earn. “Nobody should be earning more as an IME than as a doctor seeing patients in the public system,” said Dr. Voth. “There should be no additional incentive to abandon real patients in favour of seeing patients for insurance companies.” IME fees are routinely five to 10 times what an attending physician earns, he said.

“Actual office IMEs are a necessary part of life, but once you create an entire breed who are making a good living off it, there is a perverse incentive to be nothing more than a handmaiden to the insurance companies. As physicians we can’t allow that to happen.”

Dr. Voth pointed out some Alberta doctors are doing IMEs outside the areas of medicine in which they are competent. “They are just outside the reach of discipline. To whom are they answerable? How are they called to account? What is the college doing?”

The Medical Post called two of the country’s colleges—in Alberta and Ontario—to get a sense of how many IMEs have been reprimanded. The statistics do not seem dramatic. In 2005, for instance, the Alberta College of Physicians and Surgeons received 35 complaints about third-party doctors, up from 21 in 2001. Of the 35, two resulted in advice on how the doctors could improve their practices and avoid further complaints, and one resulted in a physician having to formally acknowledge the issue related to the complaint.

In Ontario there were a 93 matters relating to third-party reports in 2004 and 67 in 2005. Three physicians were counseled about recommended changes, one received a written caution and one received an oral caution. Their names were not available. Several patients told us they had been mistreated by IME doctors, yet complaining to the college had yielded few results. In some cases, doctors had been cautioned repeatedly, but continued to practise as IMEs.

Dr. Rocco Gerace, registrar of the College of Physicians and Surgeons of Ontario, said the college would take a dim view of IMEs providing biased opinions. “A physician has to provide an opinion not in any way based on who requests the opinion.”

The fact that opinions are often controversial does not worry him. “Given a set of circumstances, there may be opinions that differ. Doctors come at it with different perspectives. That doesn’t mean there is anything wrong.” Physiatrists, he said, are good at attracting controversy because of what they do. “Physiatrists have a disproportionate number of complaints. This reflects, we think, the fact that they do a number of third-party assessments.”

IMEs are tough to monitor because objectivity is impossible to measure. As Vancouver solicitor Brad Garside of law firm Paine Edmonds LLP put it, “The party or lawyer whose case is helped by the expert’s opinion might be apt to consider the expert to be both correct and objective; the party or lawyer on the other side whose case is harmed by the opinion might be apt to consider the expert to be not only wrong but also biased and an advocate for the other side. I’m not sure that it is something that could be objectively quantified.”

The Medical Post visited the Toronto offices of the Insurance Bureau of Canada (IBC) to check out why the insurance industry needs doctors to re-evaluate patients, especially to assess injuries after auto accidents. Barbara Sulzenko-Laurie, director of health issues and policy for IBC, has statistics showing the scale of insurance company payouts.

“We figure (auto) injuries . . . Canada-wide, on the private industry side, cost about $4 billion,” she said. This number is up dramatically from $3 billion in 2000.

Insurance companies certainly don’t want to pay benefits for patients who are malingering, and this is a real threat, reported the IBC. According to Sulzenko-Laurie, between 15% and 22% of injury claims are fraudulent (including inflating the severity of an injury), costing the insurance industry more than $430 million a year.

It is up to Canada’s IMEs to figure out who is faking, but the answer is not always black and white. For instance, one of the debates raging among IMEs these days is the exact definition of catastrophic impairment. The stakes are enormous for insurance companies. If a patient is deemed catastrophically impaired, his or her maximum medical and rehabilitation costs rise to $1 million in rehab and $1 million in attendant care, with no time limit.

Yet the law, in Ontario at least, is somewhat open to interpretation. Catastrophic impairment, according to the Statutory Accident Benefits Schedule, results from (a) paraplegia or quadriplegia, (b) amputation of both arms or legs, (c) total and permanent loss of an arm and a leg, (d) total loss of vision, (e) certain brain injuries, (f) injuries that result in 55% or more impairment of the whole person, or (g) impairment due to a mental or behavioural disorder. But here’s the rub: Can you combine mental impairment with physical impairment to get 55%, by adding subsections (f) and (g)?

“We believe there are gamesters trying to increase the number of catastrophic impairments by interpreting the regulations liberally,” said Sulzenko-Laurie. And doctors are caught in the middle.

Physicians and lawyers who attended the recent “Litigating Catastrophic Disability and Damages” medico-legal conference in Toronto are puzzled. Even Dr. Arthur Ameis, a physiatrist and medical director of the Multidisciplinary Assessment Centre in Toronto, and one of Canada’s foremost independent medical examiners, was perplexed by the IME’s role.

“The problem is we’re being asked to act like lawyers and we’re not lawyers. We’ve been slapped on both sides of our face in some cases. Are you combining (f) and (g)? There is yet to be a judicial review of how to use (g),” he told the audience.

A consolation for IMEs, of course, is that they are well paid for their trouble. Dr. Ameis’s clinic charges $3,600 for a basic neuropsychological assessment, $1,300 for orthopedic, physiatric and neurological assessments and $1,870 for a psychiatry assessment. Fees are paid by whichever party orders the independent exam. It is not unusual in any given case to employ many doctors on both sides for many hours. Dr. Ross told us about a case he was working on as an IME with 10 or 12 other doctors. Each time a new doctor was added and gave an opinion, each of the other physicians was asked to provide further comment.

“The case was cancelled Monday. Ballpark, I’d say doctors spent 350 hours on it before court occurred. What did those hours cost? The OMA-recommended minimum for IMEs is $435 an hour,” said Dr. Ross. If a case goes to court, the witness fee is typically $600 to $650 an hour.

The more grave the injury, the more serious the dollars. “A bill from a clinic determining whether a patient suffered catastrophic impairment could run as high as $40,000,” said Sulzenko-Laurie.

For doctors doing IMEs on behalf of insurance companies, is the incentive that getting the company off the hook will result in more work?

Sulzenko-Laurie explained the insurance companies’ role: “They are not allowed to say to the doctor, ‘This is what we want.’ We’re hiring medical practitioners who are bound by standards of practice.”

The Medical Post asked Hugh Brown, a lawyer with Toronto insurance defence firm Bell Temple, about industry norms. He said that while it used to be common practice for law firms to tell doctors what they wanted, and even to write the reports, that is ordinarily not done anymore. “Now, it is proper practice to have a covering letter asking for their opinion on the nature of the injury sustained and the impact on the patient’s working life. Can they work with that type of pain or not? I don’t give prior input. Here’s the file. Good, bad or indifferent, I accept the result,” said Brown.

Dr. Ross has been doing IMEs for more than 15 years and said, “There have been next to no attempts to influence my opinion.”

Sulzenko-Laurie frowned on the idea of interference with an IME physician’s opinion. “If there is an attempt to prejudice the witness, there will be punitive damages. The court can say, this is the award of $100,000 in lost income, $200,000 in pain and suffering and because the company was a bad bastard, X number of dollars in punitive damages to claimant and lawyer. There is a strong incentive for insurance companies not to engage in this type of activity.”

The IME also faces the challenges of cross-examination, as Dr. Darrell Ogilvie Harris noted at the medico-legal conference. He is an orthopedic surgeon at Toronto Western Hospital who is often called upon to provide independent exams. Even after doing many of them, he said he still finds it intimidating to be in court. “I’m attacked personally.” he said. As doctors, “we’re used to having the final word. I don’t like confrontational situations.”

He stressed to the audience of physicians and lawyers that it is very important for IMEs to have proper training for the case at hand. They have to be a specialist in the correct area, have the proper training and practice and carry out useful examinations. “Does this doctor work with quadriplegics or just sit in an ivory tower pontificating?” he asked. Dr. Ogilvie Harris said when he gives an expert opinion, he will often take the middle ground so that he is not susceptible to attack.

Dr. Lantos said that what is often up for debate is whether a patient can go back to work, and that can be a grey zone. IMEs and treating physicians should be as exact as possible about the patient’s capabilities.

“Doctors write notes that say things like, ‘Patient has been off X weeks and can now go back to light duties.’ What are light duties? We don’t know. What are modified duties?” A patient’s resources to find reasonable work after being ill or injured depends so much on context: union involvement, collective agreements, how easily they can be transferred, whether they do shift work, their seniority and geographic considerations, said Dr. Lantos. “If doctors would stick with impairment as opposed to adjudicating disability, we’d avoid 90% of this.”

The National ME/FM Action Network, which supports patients with myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia, keeps a close eye on IME decisions in Canada, as does the Canadian Injured Workers Support. The ME/FM network has made recommendations to change the IME climate in the country, some of which have been tried with success in Colorado.

First of all, they suggest operating IMEs through an independent body outside the insurance industry, and establishing a registry of qualified health-care providers. They also recommend a standard fee for IMEs.

Like Dr. Voth, the network takes a dim view of doctors who only do IMEs and no other clinical work. Doctors cannot spend more than one-quarter of their time doing IMEs, suggested the network, and must have an active patient practice. In addition, the IME must be of the same specialty as the treating doctor, and their practice must be located close to where the patient lives.

On the industry side, Sulzenko-Laurie doesn’t recommend sweeping changes, but a constant vigilance. “The solution is to just keep working at it. The responsibility to monitor the system is incessant without end by industry and regulators. We keep tweaking it.”

Despite the bad rap some IMEs get, Dr. Ross said most are honest, fair and impartial. “The headaches that come with this work surpass most other doctor work,” he said. “We do it because we are interested in the diagnosis process. As independent physicians, we have more data than is usually available. We don’t have a waiting room full of people. Looking at it from an arm’s length, I can see things others haven’t noticed.”

Darrell Powell has worked to bring attention to WCB as a negative social determinant of health and has brought this issue to the attention of the Canadian Senate

Darrell Powell is an influential figure who has tirelessly worked to shed light on the impact of the Workers Compensation Board (WCB) on health outcomes, particularly emphasizing it as a negative social determinant of health​. His work has been so impactful that it captured the attention of the Canadian Senate, leading him to speak at various Senate hearings.

One of the significant milestones in Powell’s career was on June 18, 2009, when he, alongside Dr. Lisa Doupe, addressed the topic of workers’ compensation at the Senate Subcommittee on Cities. This session was particularly noteworthy as it tackled the critical issue of the failing workers compensation system and its association with poverty in Canada​.

Powell’s advocacy didn’t stop at the Senate; he also used his platform on the radio to discuss and dissect the issues surrounding workers’ compensation. An example of this was on April 27, 2009, when he spoke about workers’ compensation on CFRO COOP radio on the eve of International Workers’ Memorial Day​​.

Powell’s commitment to making changes was further highlighted during the Election Show on September 24, 2008. As a Senate Witness to the 2004 Senate Committee on Social Affairs, Science, and Technology, he took the opportunity to present the concerns of disabled workers to the leaders of federal parties, hoping to influence their policies and platforms​.

In his pursuit of justice and equality, Powell frequently collaborated with Charles Boylan on CFRO 102.7 FM Vancouver. Together, they highlighted critical issues like the negative stereotypes created by social marketing campaigns and how they affected vulnerable groups, and the issues stemming from the workers compensation system infiltrating health care and medical research sectors​.

Moreover, Powell emphasized the role of WCB in health care privatization and its potential to lead to the insurance industry dictating the medical system. He went as far as characterizing WCB as a “dangerous insurance company” given its extensive privileges, which he saw as constraining our rights in health care and under the Charter​¹​.

In July 2007, Powell took the time to delve deeper into the theme of WCB as a Negative Social Determinant of Health during a special one-hour show. This show became a cornerstone of his advocacy, showcasing his dedication to breaking the silence around WCB​¹​. This was followed by a series of discussions in May and June of the same year, which further solidified his stance and commitment to the cause​¹​.

I hope this provides a general overview of Darrell Powell’s work and advocacy. However, as I mentioned earlier, the specific content of the radio and video programs could not be accessed directly from the archived webpage, which might limit the depth of the information provided.

Unraveling the Complexities: An In-Depth Look into Law Court Decisions and the Workers’ Compensation Board

Ever wondered about the intricacies of law court decisions involving the Workers’ Compensation Board (WCB)? These decisions have a profound impact on the lives of injured workers, employers, and even the general public. If you’re as intrigued as we are, then you’ve come to the right place. We’ll dive deep into this complex world, making sense of the laws, the decisions, and their implications.

Section 1: The Workers’ Compensation Board: An Overview

Before we delve into the nitty-gritty of law court decisions, let’s first understand what the Workers’ Compensation Board (WCB) is. The WCB is a statutory body that oversees workers’ compensation insurance, providing wage replacement and medical benefits to employees injured in the course of employment. But the WCB’s role doesn’t stop there. It also plays a crucial part in dispute resolution, hence its entanglement with the legal system.

Section 2: The Intersection of WCB and Law Courts

In an ideal world, every WCB claim would be straightforward. However, disputes often arise, and when they do, law courts come into play. They serve as the arena where contested decisions are reconsidered, setting precedents and influencing future WCB policies. This intersection of WCB and law courts is a fascinating aspect of workers’ compensation law that underscores the complexity of our legal system.

Section 3: Influential Court Decisions

Over the years, numerous court decisions have significantly influenced WCB policies. These landmark rulings have shaped the landscape of workers’ compensation law, providing clarity on contentious issues and guiding future decision-making. We’ll explore some of these influential decisions, their rationale, and their impact on the WCB and injured workers.

Section 4: The Impact of Court Decisions on WCB Policies

Law court decisions can bring about substantial changes in WCB policies. They can refine existing policies, introduce new ones, or even overturn previous rules. Understanding this impact can provide insights into the evolution of workers’ compensation law and how it strives to balance the rights and responsibilities of all stakeholders.

Section 5: The Future of WCB and Law Court Decisions

As society evolves, so too does the landscape of workers’ compensation law. With emerging challenges such as the gig economy, remote work, and technological advancements, the interplay between WCB and law courts will continue to be a critical area of focus. Looking ahead, we can anticipate that future court decisions will further shape WCB policies and practices.

The intricate dance between law court decisions and the Workers’ Compensation Board is a captivating facet of our legal system. It illustrates the continual evolution of workers’ compensation law, influenced by societal changes, legal rulings, and the relentless pursuit of fairness and justice. As we continue to navigate this complex landscape, one thing is certain: the impact of these decisions will resonate far beyond the courtroom, shaping the future ofworkers’ compensation for years to come.

This exploration into the world of WCB and law court decisions has been a journey of understanding how rules are interpreted, precedents are set, and policies are influenced. It underscores the importance of these decisions not only in shaping our legal system but also in protecting the rights of workers and maintaining a balanced relationship between employers and employees.

Through these complexities, we glimpse the remarkable adaptability of our legal system, continuously evolving in response to societal changes and emerging challenges. As we’ve seen, the landscape of workers’ compensation law isn’t just about laws and regulations; it’s about people and their livelihoods. It’s about fairness and justice, ensuring every worker’s right to compensation in case of workplace injuries.

So, what’s next for WCB and law court decisions? The future is, of course, unpredictable. But one thing is for sure, as long as there are workplaces, there will be workplace injuries, and thus the need for a fair and effective compensation system. As we move into this future, we can expect law court decisions to continue playing a crucial role in shaping this system, striving towards a balanced and just compensation landscape for all.

This exploration has only scratched the surface of a vast and complex subject. Yet, we hope it’s sparked your curiosity and deepened your understanding of how law court decisions influence the Workers’ Compensation Board. In this ever-evolving landscape, staying informed and understanding these intricacies isn’t just beneficial—it’s essential.

And remember, in the labyrinth of law court decisions and WCB policies, one thing stands clear: the aim is, and should always be, about protecting workers and ensuring fairness. After all, isn’t that the true essence of justice?