Concern for professional reps?

Anti-Fraud Task Force Final Report seems focused on protecting health pros from scrutiny



When I first read the Final Report of the Ontario Automobile Anti-Fraud Task Force I was surprised. The report actually contains consumer-oriented proposals, rather than merely proposals to combat the fraud aimed at insurers which ultimately results in higher premiums for all car drivers in Ontario.

Sure, it is important to combat fraud aimed at insurers but the insurance companies are big boys and should have plenty of resources with which to combat fraud. So they need some help from the government to assist them in reducing fraud. That’s fine with me although you’d think they’d already have ample procedures in place to combat fraud, especially since the extent of fraud is now estimated at somewhere between $768 million to $1.56 billion.

Clearly the task force is mindful of the controversy surrounding insurers’ use of “preferred service providers” to provide independent medical examinations of accident victims. The task force went so far as to say such examinations and assessments are “often regarded with suspicion” and some claimants have accused medical professionals hired by insurers of producing reports that are “callous, unprofessional and biased.”

Regrettably, the task force was unable to “reliably test the veracity of such complaints, nor gauge their frequency.”

Yes, the task force is aware of critical rulings by judges and arbitrators but they say the number of such rulings is “minimal relative to the tens of thousands of claims paid and injuries reported after vehicle collisions each year.”

That’s true, but most claims never reach a courtroom or an arbitration hearing. If you compare the number of critical rulings to the number of reported rulings you find that the percentage wouldn’t be as minimal. And if you consider that each health professional hit with a critical ruling by a judge or arbitrator has likely issued dozens, if not hundreds, of reports that were never scrutinized by a judge or arbitrator, the extent of the problem becomes apparent.

Still, the task force has recommended various proposals in an attempt to “help allay suspicion and protect the reputation” of the health professionals who conduct insurers’ independent examinations.

I can’t help but feel the recommendations are but a way of attempting to make it appear as if real protection is being offered to claimants when the objective may be otherwise.

Why is the task force concerned with the reputations of health professionals?

Also, it would be pretty easy to curb the abuses. Permit audio or video taping of all visits. That will cut down on much abuse. Don’t allow any health professional to conduct an insurer examination unless the professional has a real practice where he or she treats patients.

Professionals who earn a substantial amount of their income from insurers are beholden to the insurance companies and if they aren’t biased they certainly appear to be biased.

Require insurance companies to publicly disclose the names of and total fees paid to every health professional they have retained each year, as does the Insurance Corporation of British Columbia.

If a judge or arbitrator has made critical or adverse comments concerning a health professional make the comments public rather than leave them buried in decisions that few read.

Allow adverse comments made about a health professional to be used against the health professional in subsequent cases and disallow the use of any professional who has been the subject of three adverse comments.

We can get rid of shoddy, biased independent medical examinations — but only if we want to.

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