https://www5.fsco.gov.on.ca/AD/4047
Ms. J. has particularly taken exception to Dr. Hines’ role in the assessment process, claiming that his psychiatric assessment was flawed and that he overlooked key elements of potential evidence. Dr. Hines is also said to have made assumptions about Ms. J.’s recovery that stood in stark contrast to the opinions of her treating health professionals.
In other words, Dr. Hines essentially missed the boat on a woman who had severely disabling depressive symptoms to the degree that she became a suicide risk. She could not on any reasonable examination of her treatment records be said to be in remission, either with regard to her substance abuse or her depression.
I accept Ms. J.’s submissions that Dr. Ahmed, her treating psychiatrist, was better placed to evaluate Ms. J.’s progress or lack of progress over a lengthy period of time, and I would accept that his view of Ms. J.’s psychological state will carry more weight than any brief snapshot by a non-treating assessor, even without the alleged misapprehension by Dr. Hines of the underlying conditions.
Rebuttal reports became important with the paring back of the DACs and other consumer protection inventions that had been intended to provide some degree of objectivity to the assessment and determination process.
With the demise of DACs, the final determination as to entitlement was made by the Insurer, presumably on the advice and with the assistance of its own assessors. Most of these assessors were drawn from an informal roster of professionals who gave their professional opinions to litigants. Not a few of these were characterized as “hired guns” by those disagreeing with an assessor’s opinion.
Thus, when an insurer’s expert conducted an insurer’s examination on a claimant, it made sense that the claimant could commission his or her own report to address the shortcomings, if any, of the insurer’s experts’ analysis…
…In the context of this interim benefit hearing, barring unforeseen new evidence to support Dr. Hines’ opinion of remission, I believe that an arbitrator hearing all the evidence would be inclined to ascribe any evidence of remission to misinformation, wishful reporting or a minor short-term variation of a chronic condition. Indeed, Dr. Ahmed, Ms. J.’s treating psychiatrist, is unequivocal: Ms. J. is not suited to any work.
While many issues which were the subject of I.E’s and rebuttal reports verged on the trivial, others were not. In Ms. J.’s case, she applied for and was denied recognition of catastrophic impairment arising from the accident. Catastrophic impairment would allow her to access further attendant care, housekeeping and medical expenses so that her long-term care needs could be properly addressed.
Ms. J.’s accident happened in 2007. In the absence of a catastrophic designation, access to attendant care and housekeeping benefits would have ended in 2009. Likewise her access to medical benefits would be cut off in 2017. Consequently, access to the catastrophic designation is critical to the availability of what she sees as critical care.
Given Dr. Hines’ apparent misinformation about remission of symptoms, GAF score and psychosocial issues, the importance of a credible rebuttal is critical to Ms. J..
Having a rebuttal report available can assist an insurer in making a fair determination and, to an arbitrator hearing this matter, should streamline the process by drawing together and placing in a medical context the alleged shortcomings of the insurer’s medical legal reports.
In short, a rebuttal report in Ms. J.’s case would be not only reasonable but would facilitate the claims process. Consequently, if there is a basis to fund the report, it should be funded.
…In the context of this interim benefit hearing, barring unforeseen new evidence to support Dr. Hines’ opinion of remission, I believe that an arbitrator hearing all the evidence would be inclined to ascribe any evidence of remission to misinformation, wishful reporting or a minor short-term variation of a chronic condition. Indeed, Dr. Ahmed, Ms. J.’s treating psychiatrist, is unequivocal: Ms. J. is not suited to any work.
While many issues which were the subject of I.E’s and rebuttal reports verged on the trivial, others were not. In Ms. J.’s case, she applied for and was denied recognition of catastrophic impairment arising from the accident. Catastrophic impairment would allow her to access further attendant care, housekeeping and medical expenses so that her long-term care needs could be properly addressed.
Ms. J.’s accident happened in 2007. In the absence of a catastrophic designation, access to attendant care and housekeeping benefits would have ended in 2009. Likewise her access to medical benefits would be cut off in 2017. Consequently, access to the catastrophic designation is critical to the availability of what she sees as critical care
…In the context of this interim benefit hearing, barring unforeseen new evidence to support Dr. Hines’ opinion of remission, I believe that an arbitrator hearing all the evidence would be inclined to ascribe any evidence of remission to misinformation, wishful reporting or a minor short-term variation of a chronic condition. Indeed, Dr. Ahmed, Ms. J.’s treating psychiatrist, is unequivocal: Ms. J. is not suited to any work.
While many issues which were the subject of I.E’s and rebuttal reports verged on the trivial, others were not. In Ms. J.’s case, she applied for and was denied recognition of catastrophic impairment arising from the accident. Catastrophic impairment would allow her to access further attendant care, housekeeping and medical expenses so that her long-term care needs could be properly addressed.
Ms. J.’s accident happened in 2007. In the absence of a catastrophic designation, access to attendant care and housekeeping benefits would have ended in 2009. Likewise her access to medical benefits would be cut off in 2017. Consequently, access to the catastrophic designation is critical to the availability of what she sees as critical care..