Third Party Medical Reports

The College is asking for feedback on its proposed expectations on its Third Party Medical Reports policy.

The draft reflects the range of physician participation in third party processes — from treating physicians filling out forms for their patients to physicians providing testimony as medical experts.

The current Third Party Reports and Medical Expert policies have been combined and their expectations have been consolidated in this draft policy.

A number of new expectations are proposed in the new draft, including a requirement to obtain express consent for the collection, use and disclosure of personal information for a third party process and for conducting an examination for a third party process. Express consent is direct, explicit, and unequivocal, and can be given in writing or orally.

“We recognized that subjects may be confused about the nature of the physician’s role in the third party process,” said Dr. Angela Carol, a CPSO medical advisor and member the policy review working group. “And subjects familiar with the traditional doctor-patient relationship may not understand the physician’s role in an Independent Medical Examination. That is why it is so important to ensure that you explain the purpose, scope and rationale of the examination and ensure that express consent is obtained and documented” said Dr. Carol, a Hamilton family physician.

The consent process will vary depending on the circumstances of each case: however, at minimum, physicians must ensure the following points are conveyed: consent can be withdrawn at any time; limits may be placed on the information that physicians can disclose in writing and/or orally; and if consent is withdrawn or limited by the subject, physicians may still be permitted or required by law to collect, use and disclose the subject’s personal information or personal health information.

Dr. Carol pointed out that physicians can rely on consent obtained by someone else, such as a lawyer, employer or insurer. In addition, physicians can rely on a pre-signed consent form if they are satisfied that the consent applies to and authorizes the full spectrum of acts they will conduct in order to prepare the third party medical report (e.g., to collect, use and disclose personal information, to conduct an examination).

If physicians have any doubts as to the validity or scope of the consent obtained by someone else or the pre-signed consent form, they can raise their concern with the requesting party and consider obtaining consent from the subject directly.

Dr. Carol also noted that while consent does not expire, it can be withdrawn. “Some third party processes may take a long time so we believe that it is best practice for physician to make a reasonable effort to confirm that the consent obtained at the beginning of the third party process is still valid and hasn’t been withdrawn in the interim.”

Things to Know

The draft policy proposes that:

• Physicians must only accept a request to conduct an independent medical examination (IME) or act as a medical expert if they have an active certificate of registration, and have actively practiced (within the past two years) within the requisite scope of practice and area of expertise.
• IMEs and third party medical reports must be completed in a timely manner, within the following maximum timeframes:
  • 60 days for third party medical reports that require IMEs.
  • 45 days for third party medical reports that do not require IMEs .
• Physicians who become aware of clinically significant findings in the course of an IME must take specified actions, including disclosing to the subject’s family physician (with the subject’s consent).
• Physicians must be transparent and clearly identify anyone who may have assisted them in conducting the IME and/or who contributed to the writing of the third party medical report.

What to Document

Physicians must document the following for all professional encounters or services provided for a third party process, where applicable:

1. Identification of the subject and their contact information;
2. Identification of the requesting party;
3. Date of professional encounter or service;
4. Consent that has been obtained for the collection, use and disclosure of information;
5. Consent that has been obtained for examinations;
6. Information regarding the IMEs that have been conducted;
7. Consent that has been obtained with respect to the presence of observers and/or recordings of examinations; and
8. Any clinically significant findings and any action taken with respect to the findings.