Insurance Assessors – Serious Concerns Raised
When you are injured in a car accident, there are usually two parts to your claim – (1) an accident benefits claim; and (2) a claim against the other driver (which is secretly defended by the other driver’s insurer). Both of those companies have the right to not listen to treating doctors and to, instead, hand-pick medical doctors, pay them and send you to see those doctors for opinions. Many insurer’s have “rosters” of assessors and only include (and keep) the doctors that they wish on that roster.
Personal Injury lawyers have voiced concerns about alleged bias in some of the reports and system for many years.
A recent decision from Justice Dunphy of the Superior Court raises serious and disturbing questions regarding the practices. The decision, Platnick v. Lerners LLP et al. (2016 ONSC 7340), was about a car accident injury victim who was sent for medical assessments by TD Insurance Company through an assessment company called Sibley SLR.
Dr. Platnick ultimately sued Lerners LLP for libel and slander, over certain allegations that were made about him. Justice Dunphy ultimately dismissed Dr. Platnick’s case, noting in part that the defendant “….has pleaded the defence of substantial justification, ie: that the words used by her and their import are substantially true. In my view, the credible and compelling evidence before me establishes that it is reasonably likely that [the defendants] will succeed at trial in establishing the defence”. [para 101].
The assessment company that the injury victim was sent to, produced a series of reports that denied his claim for certain benefits saying he did not have injuries that met the test for the benefits.
Justice Dunphy’s December 1, 2016 decision notes that the matter proceeded to arbitration and during cross-examination (questioning) of one of the assessment company’s doctors, it allegedly came out that large and critical sections of the report that the doctor submitted to Sibley had been removed without his knowledge or consent, he never saw the final version of his report and he never signed off on it.
The doctor also said that he had never participated in a “consensus” meeting, nor was shown the executive report that Dr. Platnick said was the consensus of the entire team in his executive report.
It was also alleged that other reports were “altered” and that Sibley had re-written doctor’s reports to change their conclusions.
Justice Dunphy found that the insurance doctor, Dr. Platnick’s claims of a consensus conclusion were “most certainly false and misleading“.
Justice Dunphy also reviewed a previous case where Dr. Platnick had contacted an insurance assessor who said that an injured person did meet the test and then a new report (but dated the same date as the first report and without reference to the first report) was issued that said that the injured person did not meet the test.
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