Licensed to bill. How doctors profit from injury assessments that benefit insruance companies
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Licensed to bill. How doctors profit from injury assessments that benefit insruance companies

By anonymous following x   2017 Dec 3, 6:58am 600 views   6 comments   watch   quote     share    


Doctors are taking in millions of dollars a year by putting their names to accident injury reports for the insurance industry. Some of these reports unfairly discredit injury claims, leaving victims intimidated and exhausted. But because the majority settle out of court, the practice is hidden from public scrutiny. Kathy Tomlinson investigates.

He seldom treats patients, but Howard Platnick still brings in as much as $800,000 a year working as a doctor.

The Toronto practitioner makes his living compiling reports on accident victims for auto-insurance companies. A review of about three dozen of Dr. Platnick's cases by The Globe and Mail shows he usually finds the injuries suffered by claimants aren't significant.

In a good year, Dr. Platnick has said, he gets roughly 1,500 bookings, which suggests he assesses six accident victims in an average workday. Approximately 300 of those are "paper reviews" in which he's sent a person's file and evaluates their condition without ever seeing them.

Dr. Platnick is among a raft of physicians whose reports have been rejected by judges and arbitrators – some repeatedly – for being inaccurate, unfairly biased against the injured person, or written by someone else. And yet those doctors continue to get work.

Case records show Dr. Platnick talked another doctor into altering her report in an insurance company's favour, then had her back-date it to when she wrote her initial assessment. In another instance, he made no mention of two car crashes the victim actually had, but referenced an earlier accident that never happened.

He declared a truck driver could go back to work, after noting the man could no longer handle driving long distances.

Rules governing doctors stipulate any such assessment should be independent and unbiased. However, records show State Farm e-mailed Dr. Platnick last year, thanking him for "co-operating with us" to get a claim settled, saying "your involvement was essential to our efforts."

In Ontario and B.C. alone, hundreds of Canadian doctors take in roughly $240-million a year collectively, putting their names to accident injury assessments for the auto-insurance industry. Insurers primarily use those reports as leverage, to limit or cut what they pay for treatment and other benefits.

Laura Carpenter found out how seriously those practices affect victims, after Dr. Platnick wrote a brief "summary" for her insurance company declaring there was "consensus" among a team of doctors that she was not catastrophically injured. He came to that conclusion without ever meeting her. That is a common, accepted practice among doctors doing these assessments.

TD Insurance ended Dr. Carpenter's coverage, a month after it received Dr. Platnick's summary. A family doctor herself, Dr. Carpenter then went five years without full treatment for her injuries, before she had a chance to show TD – at a long-awaited arbitration hearing – the "consensus" his report cited didn't exist.

"Because I did not receive as much treatment as I needed, I believe that my injuries and impairments worsened significantly," Dr. Carpenter said in an affidavit.

Dr. Platnick was paid though Sibley and Associates, one of several assessment companies that hire the doctors on behalf of insurance firms, then edit and polish the medical reports. Those middlemen take a cut of the fees, which come from premiums paid by drivers.

According to an 85-page report by another doctor on the team that examined her for Sibley, Dr. Carpenter couldn't work or even get around without a walker, had chronic pain all over and was in "constant distress" – from injuries that had been "inadequately treated."


Long Read: https://www.theglobeandmail.com/news/investigations/doctors-insurance-independent-medical-examinations/article37141790/

#Medicine #Insurance #Billing


1   Tenpoundbass   ignore (6)   2017 Dec 3, 8:37am   ↑ like (1)   ↓ dislike (3)     quote      

It sure would have been nice if some Liberals took me serious when I was warning about this predatory behavior when it was happening to us in 2012.
Perhaps they could have nipped it in the bud, and Obamacare could have turned into something nice.

Those Bastards milked us out of $35K in one year.
2   anon_4460e   ignore (0)   2017 Dec 3, 11:45am   ↑ like (1)   ↓ dislike (1)     quote      

But insurance companies are great investments MAGA deregulate all of it. If they can't make you wait through 10 years of legal fees having your life's conduct turned into a series of accusations, then commies have already won!

Conservative shills like you just love to crucify the injured too. "Fraudsters," fakers, then after they get cheated out of treatment finally, lo and behold "opioid addicts."

Sucks to be on the receiving end of deregulated industries.
3   HEYYOU   ignore (4)   2017 Dec 3, 2:38pm   ↑ like (0)   ↓ dislike (1)     quote      

anon_4460e says
Sucks to be on the receiving end of deregulated industries.


Republicans suffer from their Free Market,cost you out the ass,Capitalism ideology.
They are getting exactly what they deserve.
President Nothing will do nothing.
4   bob2356   ignore (1)   2017 Dec 3, 3:10pm   ↑ like (1)   ↓ dislike (3)     quote      

Tenpoundbass says
It sure would have been nice if some Liberals took me serious when I was warning about this predatory behavior when it was happening to us in 2012.
Perhaps they could have nipped it in the bud, and Obamacare could have turned into something nice.

Those Bastards milked us out of $35K in one year.


Anyone out there that can translate this into some form of english?

Everyone realizes the article about auto accidents in CANADA don't they?
5   KimJongUn   ignore (0)   2017 Dec 4, 11:31am   ↑ like (1)   ↓ dislike (0)     quote      

Explain something to me: why in the wonderful land of free unlimited healthcare Canadians go untreated for 5 years after an accident because some doctor representing some car insurance company made a wrong assesment of their injuries? Why do they even need to deal with some car insurance company? Why couldn't her own doctor diagnose and prescribe the necessary treatment or refer her to relevant specialists? Isn't Universal Healthcare about getting all treatment you need and not having to pay for it (outside of taxes you're already paying, of course)? Something doesn't add up.
6   KimJongUn   ignore (0)   2017 Dec 5, 1:38pm   ↑ like (1)   ↓ dislike (0)     quote      

KimJongUn says
Explain something to me: why in the wonderful land of free unlimited healthcare Canadians go untreated for 5 years after an accident because some doctor representing some car insurance company made a wrong assesment of their injuries? Why do they even need to deal with some car insurance company? Why couldn't her own doctor diagnose and prescribe the necessary treatment or refer her to relevant specialists? Isn't Universal Healthcare about getting all treatment you need and not having to pay for it (outside of taxes you're already paying, of course)? Something doesn't add up.


Anyone? Bueller? Bueller?!!! BUELLER?!!!!!!!

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