Disclosure and independent medical examinations
CMAJ 1997;156:977
Re: "Independent medical examinations and the fuzzy politics of disclosure" (CMAJ 1997;156:73-5 [partial text / en bref]
At our disability-management company, insurance companies and employers often call on us to arrange IMEs and submit a report when there is a dispute regarding an employee's benefit payments. Following a careful review of the law, our company formulated IME report guidelines that are at times contrary to the advice given by Dorothy Grant.
A 1992 Supreme Court of Canada decision (McInerney v. MacDonald) established a common-law right of access to one's own medical record, with very limited exceptions. This decision made clear that the patient (or in our case, the employee) can upon request obtain a copy of the IME report. If we believe the report contains information that could harm the employee's or another person's health, the report is provided to the employee's family physician. The Ontario government's recently released consultation paper "A Legal Framework for Health Information" (July 1996) also supports this position.
Physicians should remember that a patient's medical record can be revealed to a person other than the patient only with the consent of the patient (or his or her authorized representative) or as required by law (a court order or a specific provision in a statute). Accordingly, the IME report can be released to the insurance company or to the employer only if the physician preparing the report obtains the employee's written consent. Employees will not usually withhold consent if this means that their benefits will be discontinued. In the absence of written consent, the physician can provide the third party with information on the employee's functional restrictions, the requirement for investigations, consultation or therapy, and the prognosis, if known.
To protect employers against possible human-rights complaints, it is generally advised that they not obtain a copy of the IME report. Employers should be provided with summaries that explain employees' ability to work and their need for accommodation in relation to the verified medical condition.
If the employer and the employee are involved in legal proceedings and the employee has not consented to the report's release, then the rules of the courts or the relevant administrative tribunal (such as a workers' compensation board) should govern the release of medical information to the employer. We hope this information dispels some of the myths surrounding IMEs.
Helene Guilmet-De Simone, RN, LLB
Lorne Greenspan, MD
Medcan Health Management Inc.
Toronto, Ont.
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