• FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education

IME

CF v HTMD, 2014 CanLII 41239 (ON HPARB)

3.                  The Applicant was involved in a motor vehicle accident on September 17, 2006. Subsequently, she developed a number of symptoms especially related to her neck, left shoulder, left trunk and headaches. The Applicant contends that prior to her involvement in the accident she was asymptomatic regarding these symptoms.

4.                  Superior Independent Medical Assessment Centres requested the Respondent, a specialist in physical medicine and rehabilitation medicine, to perform an independent medical assessment (IME) for the Applicant’s insurance company. The Respondent examined the Applicant on March 8, and June 5, 2007. He subsequently provided two paper file review reports, dated September 12, 2007 and February 27, 2008.

5.                  After assessing the Applicant on March 8, 2007, the Respondent provided a report to the Applicant’s insurer with the following conclusions:

         The restriction of range of movement in her left shoulder girdle cannot be explained by an underlying impairment, similarly her history of no improvement in her pain complaints over the past 5 to 6 months has not been in keeping with an underlying musculoskeletal injury. At this time, the issue is that of ongoing pain, though the source of this is not known.

         I do not believe any further testing is indicated.

•         On the basis of an identifiable musculoskeletal impairment, [the Applicant] does not have a substantial inability to carry on her essential care-giving tasks.

•         [The Applicant’s] limitations are that of her ongoing pain complaints, though there are no objective findings, but rather just subjective findings with respect to pain.

6.                  The Respondent concluded that the Applicant was then able to return to care-giving activities and further expressed the opinion that he did not believe that the Applicant had a substantial inability to perform her pre-accident housekeeping or home maintenance activities given her current findings and history

7.                  The Respondent next assessed the Applicant on June 5, 2007 and was requested by the Applicant’s insurer to offer an opinion regarding whether the proposed Treatment Plan dated April 18, 2007 was reasonable and necessary. The proposed Treatment Plan recommended a cervical epidural injection, a greater occipital neuralgia injection and a soft tissue injection. The Respondent provided an opinion to the Applicant’s insurer that the treatment was neither reasonable nor necessary.

8.                  On September 12, 2007, the Respondent provided a paper review to the Applicant’s insurer regarding whether a proposed physiatry assessment was reasonable and necessary for the Applicant’s treatment and rehabilitation. The Respondent noted that the Applicant was being followed by Dr. A. Kachooie who is a physiatrist and advised the insurer that it was his opinion that the proposed physiatry assessment was neither reasonable nor necessary.

9.                  On February 29, 2008, the Respondent provided a further paper review to the Applicant’s insurer regarding whether another proposed physiatry assessment was reasonable and necessary for the Applicant’s treatment and rehabilitation. The Respondent concluded that there was no new information different from any previous information that he had reviewed regarding this issue and again noted that Dr. Kachooie continued to follow the Applicant on an ongoing basis. Accordingly, the Respondent provided an opinion to the insurer that the requested physiatry assessment was not reasonably required.

10.              In February 2009, the Applicant filed a complaint with the College regarding the conclusions of the Respondent based on his assessments.

11.              The Inquiries, Complaints and Reports Committee (ICRC) investigated the complaint and concluded, “the Respondent’s opinion regarding the Applicant’s condition was informed and based on the clinical information before him at the time.” The ICRC decided to take no action regarding the matter.

12.              The Applicant requested the Board review that decision. In a January 2012 decision (HPARB10-CRV-0073), the Board returned the matter for further investigation. Specifically, they instructed the ICRC “to have an independent physician review the matter and provide an opinion to the Committee concerning the standard of care” and for the Committee to reconsider its decision. In addition, the Board found that the Respondent’s conclusions in his IME report appeared to be inconsistent with and contradicted by information in the Record.

13.              The Committee reconsidered the matter as requested by the Board and issued a new decision dated February 14, 2013. The Applicant requested that the Board review the second decision of the Committee.

Comments are closed.