Doctor being investigated for ‘misleading’ report
Insurance claim rejected based on physician’s review, but overturned on appeal
The College of Physicians and Surgeons of Ontario is investigating a doctor who a Superior Court judge says wrote a “misleading” medical assessment about a car accident victim, to benefit an insurance company
However, the practice of distorting medical assessments is widespread, according to both the Ontario Trial Lawyers Association (OTLA) and an organization representing car accident victims, both of which are calling for a public inquiry.
Justice Sean Dunphy last week issued a decision in which he described a 2014 “executive summary report” prepared by Dr. Howard Platnick about a woman injured in a car accident as “on the face of it misleading.”
Platnick, a Toronto family physician, had been retained by assessment company Sibley SLR to summarize reports of various specialists who had assessed the woman following the accident. Sibley had been retained to co-ordinate the assessments for TD Insurance.
The woman’s claim for coverage for “catastrophic impairment” was initially rejected by TD, partly based on Platnick’s report.
But she successfully appealed the decision to the Financial Services Commission of Ontario where she was represented by lawyer Maia Bent at a 2014 arbitration hearing.
Following the hearing, Bent, then president-elect of the OTLA, wrote an email to 670 personal injury lawyers, alerting them to problems with Platnick and advising them that they should make sure to get all files from assessors and Sibley in similar cases.
Platnick sued her for libel, charging that his lucrative insurance practice had been severely impacted by her words, which were leaked and found their way into an insurance industry newsletter.
But Dunphy dismissed the lawsuit, writing that Bent’s comments were likely true and expressed in the public interest.
Platnick’s lawyer, Tim Danson, said his client is appealing the ruling.
Danson welcomed the College of Physicians and Surgeons of Ontario (CPSO) investigation, saying it could be a “blessing in disguise” because it could help clear his client’s name.
“Dr. Platnick has done absolutely nothing wrong and has not yet had his day in court,” he said.
Danson said if there is a public inquiry, he hopes that it would also look at the “army of plaintiffs’ doctors” who author reports that are favourable to their clients and lawyers.
Bent’s email stated that Platnick’s report omitted observations from a neurologist that were favourable to her client.
The neurologist testified at the arbitration hearing that “critically important sections” of a report he had submitted to Sibley had been removed without his knowledge or consent, Bent wrote.
Bent stated that other doctors’ reports prepared for Sibley on the case had been rewritten, with conclusions changed from saying her client had a “catastrophic impairment” to not having one.
She also wrote that she represented a client on another case in which Platnick had “changed the doctor’s decision from a marked to a moderate impairment.” CPSO spokesperson Kathryn Clarke confirmed Platnick is the subject of a probe, but was restricted by regulations from revealing the nature of it.
She explained that the college has a “third-party reports policy” that applies to physicians preparing reports and conducting examinations on behalf of third parties such as insurance companies.
“When we receive a complaint that a physician has prepared a report or conducted medical examination for a third-party report in a manner that may have contravened the policy and expectations set by the college, we investigate thoroughly, and take action as required,” she said. OTLA president Adam Wagman said his organization has for years been expressing concerns about medical assessments being distorted by doctors in favour of their insurer clients. A public inquiry would “shine a light on the type of thing we fear has been going on for a very long time,” he said.
Rhona DesRoches, board chair of the FAIR Association of Victims for Accident Insurance Reform, said a public inquiry is necessary because a system that supports “shoddy medical opinions for hire” is clearly broken and punishes victims.
Kelsey Ingram, press secretary to provincial Finance Minister Charles Sousa, said the government has commissioned a review of the auto insurance system, which is ongoing. It’s aimed at identifying ways to improve health outcomes and lower costs.
TD and Sibley declined to comment, but Andrew McGrath, spokesperson for the Insurance Bureau of Canada, said: “Medical professionals are often retained by claimants and insurers to provide independent medical assessment. Insurers and consumers rely on the advice of medical professionals when assessments are required. It is imperative that these professionals adhere to the codes and standards governing their profession and provide honest and accurate medical assessments.”