Case Summary : Decision-Making Process
Independent medical examinations
Two workers complained to the Commission about the WSIB’s decision to send them for an independent medical examination (IME) when there was already considerable current medical information on file.
In one case, the WSIB found the worker was not entitled to benefits for a psychiatric condition, based solely on the IME’s report. The IME’s report was contrary to the other reports on file. The WSIB decision did not say why the IME’s report was preferred.
In the other case, the worker complained about the same IME’s unprofessional treatment during the assessment. The worker also complained about the WSIB’s decision to terminate his benefits based solely on the IME’s report without analyzing the other medical evidence on file.
The Commission inquired into the processes for selecting IMEs and making referrals to them. A Commission specialist spoke with the manager, the sector director and the vice-president. The commissioner spoke with the associate medical director of Clinical Services. As a result of these inquiries, the WSIB’s operating area clarified that, where a medical assessment is needed, referrals will be made to WSIB-contracted services such as regional evaluation centres and specialty clinics, and not to IMEs.
In each case the Commission reviewed, the WSIB arranged to have the worker re-assessed at a WSIB specialty clinic.