A recent investigation by the Globe and Mail identified rampant prejudice in the auto insurance industry involving independent medical evaluations (IME).
The article reviewed more than 300 court and arbitration rulings on auto accident cases in Ontario and B.C. and found that many of the doctors conducting IMEs provide assessments and reports that are biased toward the insurance company that hired them, often claiming that severely injured claimants are fine.
In many situations, the doctor has never seen the claimant in person and has simply conducted a “paper review” by evaluating the person’s medical file. Many doctors’ reports are rejected by judges and arbitrators for providing biased, erroneous and incorrect assessments of claimants. Yet, despite criticism in some cases, these doctors continue to be used in countless others.
Biased, Incorrect Reports and Testimony
According to the article, doctors in Ontario and B.C. earn about $240 million a year compiling injury assessments for auto insurance companies. Those reports are mostly used as leverage to limit what insurers pay in treatment and other benefits to claimants.
For example, Dr. Howard Platnick has reportedly made as much as $800,000 a year as a doctor despite rarely treating patients. In a good year, he says he will handle 1,500 bookings for auto insurance claims assessments.
He has been accused of making false statements in his reports and convincing another doctor to alter her report. He claimed in a summary for the insurance company in one claim that there was consensus among the group of doctors who had seen a patient that she was not catastrophically injured. This was despite a lengthy report from another doctor on the team who concluded that she couldn’t work, required a walker to get around and experienced chronic pain.
Buried in the woman’s file, it was later found that Sibley and Associates, the assessment company that hired the doctors to conduct the assessment, had asked the medical team to remove sections of their assessment and water down or omit certain opinions about the woman’s injury.
When later confronted about the wrongs found in the claim assessment, the company stated that it had input on the assessments from doctors but did not change the substance of their reports. It is not uncommon for these companies to edit and polish assessments before submitting them.
The Globe also uncovered emails from State Farm Insurance to Dr. Platnick thanking him for co-operating with them to get a claim settled, noting that his involvement was “essential to our efforts.” This is despite requirements that doctors provide independent and unbiased assessments.
Another, Dr. Lawrie Rexneck, has also had reports and testimony rejected by judges and arbitrators in at least 10 cases for serious flaws, impartiality, significant problems, incorrect assumptions and cherry picking of information. He has even admitted to using unproven tests to assess accident victims. He has testified to receiving $100,000 a year for assessing auto accident claims.
Lack of Credentials
When reviewing physician rosters from companies that hire doctors to conduct IMEs, the Globe found that many of the doctors have been licensed for more than 30 years, and many are past retirement age.
One neurosurgeon in Ontario has been licensed for 63 years and continues to conduct IMEs. Another neurologist is only allowed to teach and was caught doing insurance assessments without a license, while another doctor was exposed for misrepresenting his credentials.
One orthopedic surgeon gave up his license seven years ago, nine years after he was found negligent for medical malpractice in which he botched routine back surgery and left a patient permanently disabled. He is now restricted to only conducting IMEs.
Lack of Accountability
Although the law says that doctors owe patients a “duty of care” when treating them, this standard of care does not apply to independent medical evaluations. This means doctors are beholden not to the law and their patients, but to whoever hires them.
However, despite the Insurance Bureau of Canada calling the IME system broken (at least in Ontario) and insurance companies expressing concerns about quality, impartiality and costs, questionable practices continue to persist. Even the Canadian Association of Medical Evaluators, which represents doctors who do IMEs, has cited arrogance and lack of training among IME doctors.
These concerns and complaints, however, are not made public. More than 95 per cent of complaints are settled out of court and out of the public eye. Complaints to regulators are also not made public, and doctors whom those complaints are made about are rarely disciplined.
The Globe discovered that although several doctors have been criticized or cautioned by the College of Physicians and Surgeons for disputed practices, none were punished for their behavior. In Ontario, the College could not identify one instance in the last five years in which a doctor was formally disciplined. There were only eight instances in which doctors had been quietly cautioned about inaccurate reports. However, that criticism is not posted for the public.
In one example, the Globe highlighted psychiatrist Dr. Alborz Oshidari who has been investigated at least four times for errors in his assessments, but who was simply told by the College to be more accurate in the future. In at least four other instances, his opinion has been disregarded by arbitrators.
Another example cited Dr. Rajka Soric who continues to testify in court despite previous criticism from judges for “ignoring” her duty to be fair, being an “advocate” for the insurance company, making mistakes and misreading an accident victim’s medical history. She has testified to making as much as $470,000 from insurance companies.
Trusted Car Accident Lawyers in Windsor
This article highlights the difficulties many injury victims experience when trying to obtain fair compensation for their injuries from insurance companies. Because of this, it is vital that anyone who has been injured in a car accident, seek guidance from a trusted car accident lawyer.
Our lawyers have decades of experience working with insurance companies and many of the IME doctors discussed in this article. We are familiar with their tactics for attempting to lower their payments for claims and will do everything in our power to help you get the payment you deserve. We are committed to helping injury victims obtain the compensation they need to cover their medical bills and move on with their life.
Contact Greg Monforton & Partners today to schedule a free, no obligation consultation to learn more about how we can help you.