When Doctors Are Actually “Hired Guns”

Would an insurance company be so driven to deny benefits to an injured person that they would spend more on medical assessments than on actual injury compensation?

It sounds too ludicrous to be true. And yet, a recent and revealing article in the National Post summarizes an Insurance Bureau of Canada report that says yes, indeed, this sort of thing happens, and that in 2011, Ontario auto insurers spent on average $10,700 in medical assessments per claim vs. $9,700 in compensation.

The bulk of the article discusses that the prevalence of medical assessments (known as “independent medical assessments” or IMEs) are essentially commissioned by insurance companies to help them determine the nature of a claimant’s injuries.

It comes as no surprise that when it is the insurance company that is paying the doctor’s bill, those assessments almost always come out minimizing or dismissing the claimant’s injuries. For a claimant, the medical opinion contained in one of these reports can make or break their case for compensation.

However, slowly but surely, these experts (“doctors and other experts as ‘hired guns’ whose appraisals inevitably give insurers what they want”) have come under fire by judges.

One recent case involved a psychiatrist, who determined a claimant was “faking” her PTSD. The judge in that case was frank in his critique of this psychiatrist, saying that he “fell far short of his obligation to be fair, objective and non-partisan”. (See Bruff-Murphy v Gunawardena, 2016 ONSC 7).  Sadly, this case is not unusual.  The National Post article cites various other cases where judges were highly critical of experts who were clearly biased against a claimant.

If you’ve been injured in an accident and are now dealing with your insurer, here are two key things to remember:

  1. An insurance company never has your best interests at heart. They will spend more money fighting to deny your claim than they will on your compensation.
  2. Working with an experienced injury lawyer is your best bet at getting the insurance company to play fair.

When you are injured, it can take everything you have just to make it through the day. Dealing directly with an insurance company can be overwhelming, confusing and exhausting, but it is necessary in order to secure the compensation you deserve. In our law practice, being able to take that burden off our clients is one of the most rewarding parts of our work.