Reducing Fraud with Transparency in Ontario’s Independent Medical Examinations - Open Letter September 16, 2013
Several months ago FAIR Association of Victims for Accident Insurance reform wrote to you in
respect to the inadequate oversight of Ontario‟s „independent‟ medical assessors.
Several letters were sent out that proposed what we feel might be viable solutions to the
problem of patient safety and the integrity of the professions when it comes to the Independent
Medical Examinations (IME) performed by Ontario‟s medical professionals.
The credibility of the auto insurers‟ preferred IME/IE vendors, whose assessments are often
used to deny and delay seriously injured claimants‟ access to policy benefits is not only affecting
access to treatment, it is affecting our justice system.
Accident victims are lined up by the thousands at the Financial Services Commission of Ontario
looking for hearings to access the treatment they were promised and then denied on the basis
of an often flawed or unqualified „expert‟ medical opinion. Innocent legitimate accident victims,
some cognitively impaired, are treated like criminals, often threatened and intimidated during an
IME and the reports that are generated often of poor quality and of little use except to disqualify
that patient for treatment recommended by other health professionals.
Those in Ontario‟s auto insurance industry have made comments that cry out for better
regulatory oversight and governance and that too is being ignored.
The President of the Canadian Society of Medical Evaluators (CSME) recently wrote that
Ontario‟s auto insurance IME domain is at risk of “public scandal” due to the inferior quality
of “amateurish, biased and fraudulent” medico-legal assessments.
The President of the Association of Independent Assessment Centres (AIAC) said “The value of
these independent assessments is directly proportionate to the independence and quality that
courts and arbitrators attach to them.”
Ontario‟s Arbitrators, who must decide whether or not an injured driver is deserving of treatment
or benefits have called some of these medical reports on which they must rely “„inaccurate,
failed, misleading, defective, incomplete, deficient, not correct and flawed”.
A discussion at a FSCO Dispute Resolution Services Counsel meeting included the comment
“100% of ALL assessments are “doctored” – in that the actual doctors and assessors are not
able to do MOST of the report...” adding a suggestion that “FSCO needs to look at this in a
more systemic way”.
We‟ve put some suggestions out there to various governing bodies and have not received an
answer to a question of public safety. We‟ve proposed several possible solutions to those
whose duty it is to protect the interests and safety of Ontarians.
FAIR would ask that you consider and respond to our suggestions that the annual
public disclosure of fees paid by auto insurers to their medico-legal assessors (as is done in
British Columbia) would improve transparency and accountability. FAIR would like to see an end
to regulators‟ „secret cautions‟ that keep vulnerable accident victims in the dark about their
medical examiners. More importantly, we feel assessors with prior adverse comments by judges
and arbitrators regarding a poor quality IME should be subject to a „three strikes rule‟ that would
purge those who repeatedly abuse accident victims from plying their trade in our court systems.
Public safety should not be sacrificed so that a few rogue assessors can get rich by harming
innocent auto accident victims. Surely the most vulnerable citizens who find themselves injured
on our roadways deserve better treatment and more respect than that.
We look forward to hearing back from you on the issue of transparency, adverse comments and
decisions, and on the ways that might be of use to clean up what has become a harmful medical
system for Ontario‟s accident victims.
Sincerely,
Rhona DesRoches
Board Chair, FAIR Association of Victims for Accident Insurance Reform
email: fairautoinsurance@gmail.com
http://www.fairassociation.ca/wp-content/uploads/2013/03/An-Open-Letter-to-Ontarios-Auto-
Insurance-Stakeholders-March-4-2013.pdf
http://www.fairassociation.ca/wp-content/uploads/2013/03/Open-Letter-to-additional-
Stakeholders-March-11-2013.pdf
http://www.fairassociation.ca/wp-content/uploads/2013/03/Open-letter-to-Stakeholders-March-
19-2013.pdf
FAIR Open Letter Response_Oct3-13
October 3, 2013
Ms. Rhona DesRoches
Board Chair
FAIR Association of Victims for Auto Insurance Reform
579A Lakeshore Road, East, P.O. Box 39522
Mississauga, ONL5G 4S6
Re:
Open Letter dated September 16, 2013 – Reducing Fraud with Transparency in Ontario’s
Independent Medical Examinations
Thank you for including the AIAC in your Open Letter dissemination. We felt obliged to respond.
The membership companies of the AIAC have common ground with FAIR. Both of our organizations are
striving towards an independent medical examination process that serves the Ontario public with fairness,
accuracy, integrity and accountability. We are concerned, however, that your correspondence contains
rhetoric that could be misleading to some of the recipients and the public in general.
As mentioned in your letter, the AIAC does believe that the “value of independent assessments are
directly proportional to the independence and quality that courts and arbitrators attach to them.” This
could be considered a founding principle behind the standards we use to operate our businesses. AIAC
members have incorporated the highest quality standards known to this industry and are continually
evolving to improve our processes. For example, there exists an international body for accrediting health
care facilities known as the Commission on Accreditation of Rehabilitation Facilities (CARF). They have
recently developed standards for the IME industry. The AIAC membership is actively pursuing CARF
accreditation and promoting the process to FSCO and the IBC. CARF accreditation will likely evolve to
replace current quality management accrediting bodies such as ISO that have been in use by most AIAC
members for over a decade. These quality measures are very time consuming and come with significant
expense, but we believe they will focus on the person served, and are worth the effort in order to ensure
the delivery of quality, independent assessments to Ontarians
Your letter unfairly paints the AIAC membership and IME industry with a broad stroke of negative
criticism. The fact is AIAC member companies represent the best-in-class assessment providers in the
industry. To lump all players in the industry into one group fundamentally distorts reality. Your portrayal
is not reflective of the quality of services provided over and over again, every day, by the AIAC
membership. AIAC member companies work hard each day to deliver independent, high quality
assessments.
There has been some discussion in the past between our organizations. We truly believe that FAIR and
the AIAC have common goals. We would be pleased to further discuss these matters as we continue to
move forward.
Best Regards,
Dr. Rocco Guerriero B.Sc., DC, FRCCSS(C), FCCPOR(C), FCCO(C)
President, AIAC- Association of Independent Assessment Centres
Source:http://www.fairassociation.ca/
Several months ago FAIR Association of Victims for Accident Insurance reform wrote to you in
respect to the inadequate oversight of Ontario‟s „independent‟ medical assessors.
Several letters were sent out that proposed what we feel might be viable solutions to the
problem of patient safety and the integrity of the professions when it comes to the Independent
Medical Examinations (IME) performed by Ontario‟s medical professionals.
The credibility of the auto insurers‟ preferred IME/IE vendors, whose assessments are often
used to deny and delay seriously injured claimants‟ access to policy benefits is not only affecting
access to treatment, it is affecting our justice system.
Accident victims are lined up by the thousands at the Financial Services Commission of Ontario
looking for hearings to access the treatment they were promised and then denied on the basis
of an often flawed or unqualified „expert‟ medical opinion. Innocent legitimate accident victims,
some cognitively impaired, are treated like criminals, often threatened and intimidated during an
IME and the reports that are generated often of poor quality and of little use except to disqualify
that patient for treatment recommended by other health professionals.
Those in Ontario‟s auto insurance industry have made comments that cry out for better
regulatory oversight and governance and that too is being ignored.
The President of the Canadian Society of Medical Evaluators (CSME) recently wrote that
Ontario‟s auto insurance IME domain is at risk of “public scandal” due to the inferior quality
of “amateurish, biased and fraudulent” medico-legal assessments.
The President of the Association of Independent Assessment Centres (AIAC) said “The value of
these independent assessments is directly proportionate to the independence and quality that
courts and arbitrators attach to them.”
Ontario‟s Arbitrators, who must decide whether or not an injured driver is deserving of treatment
or benefits have called some of these medical reports on which they must rely “„inaccurate,
failed, misleading, defective, incomplete, deficient, not correct and flawed”.
A discussion at a FSCO Dispute Resolution Services Counsel meeting included the comment
“100% of ALL assessments are “doctored” – in that the actual doctors and assessors are not
able to do MOST of the report...” adding a suggestion that “FSCO needs to look at this in a
more systemic way”.
We‟ve put some suggestions out there to various governing bodies and have not received an
answer to a question of public safety. We‟ve proposed several possible solutions to those
whose duty it is to protect the interests and safety of Ontarians.
FAIR would ask that you consider and respond to our suggestions that the annual
public disclosure of fees paid by auto insurers to their medico-legal assessors (as is done in
British Columbia) would improve transparency and accountability. FAIR would like to see an end
to regulators‟ „secret cautions‟ that keep vulnerable accident victims in the dark about their
medical examiners. More importantly, we feel assessors with prior adverse comments by judges
and arbitrators regarding a poor quality IME should be subject to a „three strikes rule‟ that would
purge those who repeatedly abuse accident victims from plying their trade in our court systems.
Public safety should not be sacrificed so that a few rogue assessors can get rich by harming
innocent auto accident victims. Surely the most vulnerable citizens who find themselves injured
on our roadways deserve better treatment and more respect than that.
We look forward to hearing back from you on the issue of transparency, adverse comments and
decisions, and on the ways that might be of use to clean up what has become a harmful medical
system for Ontario‟s accident victims.
Sincerely,
Rhona DesRoches
Board Chair, FAIR Association of Victims for Accident Insurance Reform
email: fairautoinsurance@gmail.com
http://www.fairassociation.ca/wp-content/uploads/2013/03/An-Open-Letter-to-Ontarios-Auto-
Insurance-Stakeholders-March-4-2013.pdf
http://www.fairassociation.ca/wp-content/uploads/2013/03/Open-Letter-to-additional-
Stakeholders-March-11-2013.pdf
http://www.fairassociation.ca/wp-content/uploads/2013/03/Open-letter-to-Stakeholders-March-
19-2013.pdf
FAIR Open Letter Response_Oct3-13
October 3, 2013
Ms. Rhona DesRoches
Board Chair
FAIR Association of Victims for Auto Insurance Reform
579A Lakeshore Road, East, P.O. Box 39522
Mississauga, ONL5G 4S6
Re:
Open Letter dated September 16, 2013 – Reducing Fraud with Transparency in Ontario’s
Independent Medical Examinations
Thank you for including the AIAC in your Open Letter dissemination. We felt obliged to respond.
The membership companies of the AIAC have common ground with FAIR. Both of our organizations are
striving towards an independent medical examination process that serves the Ontario public with fairness,
accuracy, integrity and accountability. We are concerned, however, that your correspondence contains
rhetoric that could be misleading to some of the recipients and the public in general.
As mentioned in your letter, the AIAC does believe that the “value of independent assessments are
directly proportional to the independence and quality that courts and arbitrators attach to them.” This
could be considered a founding principle behind the standards we use to operate our businesses. AIAC
members have incorporated the highest quality standards known to this industry and are continually
evolving to improve our processes. For example, there exists an international body for accrediting health
care facilities known as the Commission on Accreditation of Rehabilitation Facilities (CARF). They have
recently developed standards for the IME industry. The AIAC membership is actively pursuing CARF
accreditation and promoting the process to FSCO and the IBC. CARF accreditation will likely evolve to
replace current quality management accrediting bodies such as ISO that have been in use by most AIAC
members for over a decade. These quality measures are very time consuming and come with significant
expense, but we believe they will focus on the person served, and are worth the effort in order to ensure
the delivery of quality, independent assessments to Ontarians
Your letter unfairly paints the AIAC membership and IME industry with a broad stroke of negative
criticism. The fact is AIAC member companies represent the best-in-class assessment providers in the
industry. To lump all players in the industry into one group fundamentally distorts reality. Your portrayal
is not reflective of the quality of services provided over and over again, every day, by the AIAC
membership. AIAC member companies work hard each day to deliver independent, high quality
assessments.
There has been some discussion in the past between our organizations. We truly believe that FAIR and
the AIAC have common goals. We would be pleased to further discuss these matters as we continue to
move forward.
Best Regards,
Dr. Rocco Guerriero B.Sc., DC, FRCCSS(C), FCCPOR(C), FCCO(C)
President, AIAC- Association of Independent Assessment Centres
Source:http://www.fairassociation.ca/
FAIR Association of Victims for Accident Insurance Reform
579A Lakeshore Rd. E. P.O. Box 39522 Mississauga, ON L5G 4S6 http://www.fairassociation.ca/ Sent by email to: Rocco Guerriero, President, AIAC drguerriero@nyrc.ca October 22, 2013 Dear Mr. Guerriero, Thank you for your response to our September 16, 2013 open letter "Reducing Fraud with Tansparency in Ontario's IME System". The integrity of the Ontario auto insurance IME/IE system is in a state of disrepair so it is good to hear that AIAC shares FAIR's goal of improving the assessment system. Injured claimants should be able to trust that the assessments to which they must submit will always (not just sometimes) be impartial; and that they will always (not just most of the time) be performed by properly qualified assessors. This is the promise held out in the New Rules of Civil Procedure but it is yet to become the reality injured Ontario auto accident victims experience. To the extent that CARF certification will improve the system - it is the same promise made when, over a decade ago, ISO certification was adopted as the means to clean up the IME system. FAIR supports changes that will improve the quality of Ontario’s IMEs and so we point out that although many assessment firms have ISO certification - injured claimants continue to be subjected to highly partisan and often under/unqualified assessments. That is not to say that CARF certification won't prove to be a useful avenue for those who choose to sign up – voluntary CARF certification need not be an either/or proposition to clean up the system so why not encourage and endorse CARF certification in addition to FAIR's proposed "three strikes rule"? The fact of the matter is that FSCO regulates Ontario auto insurance and it is they who will administer a $500 fine for accident victims who fail to attend an independent medico-legal examination. It is FSCO's enforcement procedures, as they relate to assessments, that needs to evenly address the abuses on both sides - insurer assessors and treatment providers. FAIR wants to see all IME/IE assessors who abuse Ontario’s accident victims by way of shoddy reports purged from the system - whether they sell assessments to the plaintiff lawyers or to the auto insurers. There should not be a double standard in the way FSCO monitors IMEs/IEs - nor should its enforcement procedures differ. It makes no sense that insurer assessment firms/assessors making false/deceptive statements are subject to Administrative Monetary Penalties (AMPs) while treatment provider/assessor misdeeds attract criminal fraud charges. FAIR believes that both the rogue insurer assessors and the rogue treatment providers should be subjected to criminal charges rather than the current FSCO double standard on enforcement which allows insurer assessors to pay an AMP fine rather than face fraud charges. Surely the best “judges” of the quality of the IME/IE assessments in Ontario's personal injury system are the judges and arbitrators who, on a daily basis, must decide the weight they deserve. The fate of injured claimants rests on their decisions in this regard. The fate of professional medico-legal assessors/experts should be determined by the same triers of fact - three strikes and the assessor is out. It is an effective and straight forward approach that might remedy the way in which, according to the CSME, substandard assessors have been "tolerated" for far too long. FAIR looks to FSCO's monitoring and enforcement system to set standards - and to the triers of fact - and to Ontario's health regulatory Colleges - to make the promise of well qualified and impartial IME/IE assessors/experts a reality. There are many good assessors in Ontario who do an excellent job and who would have no problems under a ‘three-strikes’ rule, it is only those assessors whose work product is flawed that need worry that more stringent oversight and enforcement might negatively affect their income stream. The fundamental problem with Ontario's auto accident injury benefits scheme is that it is awash in poor quality IMEs/IEs. Unless the rogue assessors (whether treatment providers or insurer assessors) who proffer highly partisan and/or unqualified assessments are purged from the system - no amount of legislative or regulatory amendments can make this a safe and trustworthy system for the injured claimants for whom it has been set up to serve. We look forward to further discussions with AIAC on this important issue. Perhaps the AIAC could address our "three strikes" suggestion as a possible first step in the process of cleaning up Ontario's IME/IE system? Best Regards, Rhona DesRoches FAIR, Board Chair | ||||||||||||||||||||||||||||||
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