Canadian Society of Medical Evaluators Guide to Third Party Medical Evaluation

(Adapted from the Guide de L’Expertise Médicale de la  Société des Médecins Experts du Québec) Revised April 2004


The Guide to Third Party Medical Evaluation provides rules of ethical conduct to be used by all CSME members for the purpose of third party medical evaluation.



General Duties

1.1          Medical evaluators shall conform to the code of ethics, scope of practice and regulations of their professional college.

1.2          Medical evaluators have the responsibility to provide high quality services.          They shall take into account their knowledge, skills, qualifications, training and experience, and shall recognize their limitations.      Medical evaluators shall abstain from performing evaluations or providing opinions outside their area of expertise and respect the mandate provided by the referring source.

1.3          Medical evaluators shall abstain from participating in inappropriate publicity or promotion.

1.4          Medical evaluators must retain absolute professional independence from     the referring source requesting the evaluation. Medical evaluators have an obligation to remain impartial and must have no stake in the outcome of the medical evaluation.

1.5          Medical evaluators shall not issue any report or document containing information that they know to be false or inaccurate.

1.6          Medical evaluators shall request remuneration fro their services commensurate with the duration and complexity of the evaluation. Other forms of financial arrangements are not acceptable.


Medical Evaluation Standards

1.7          Before agreeing to perform a referring source medical evaluation,  it is highly advisable that medical evaluators obtain a referral letter outlining the scope and purpose of the evaluation along with the relevant documentation.

1.8          Medical evaluators shall refrain from providing opinions on the degree of permanent impairment resulting from bodily  injury  or illness that has yet to have reached maximal medical improvement.

1.9          Medical evaluators who render opinions before the residual effects (sequelae) of an injury or illness become stabilized and permanent shall indicate that such opinions are preliminary.

1.10      If no impairment is found in the course of the medical evaluation, medical evaluators shall indicate it in their report.

1.11      A final opinion on impairment shall not be made until the impairment has consolidated and stabilized.

1.12      Medical evaluators shall establish their conclusions and opinions based on the objective findings of the evaluation with reference to recognized medical standards approved by the SCME. If the medical evaluator         judges that it is appropriate to depart from these standards, mention of such action must be made in the report, stating the reason for the decision.

1.13      Medical evaluations should be written within a reasonable time following the examination and fall within the legislated prescribed time frame.

1.14      Medical evaluators who perform medical evaluations also accept the responsibility to act as expert witnesses in court or in administrative tribunals upon the request of one of the parties or   the court in order to explain or defend their evaluations. Remuneration should be commensurate with the duration and complexity of services provided.

1.15      Medical evaluators must demonstrate the greatest possible objectivity by taking into account all elements obtained at the time of the evaluation and contained in the documentation     provided     from any source. If medical evaluators realize that they were not provided with all documents, they should ask for them or at least mention the fact in the report.

1.16      Medical evaluators must ensure that any conflict of interest must be declared prior to agreeing to perform a medical evaluation. The referring source and claimant, after being made aware, must agree to the assessment.

1.17      If medical evaluators disagree with the treatment or diagnosis provided by treating physicians, they must not assume a role in the treatment. However, if facts or errors are identified which could jeopardize the life or health of the claimant, medical evaluators have the duty to inform the treating physician(s) of the situation after having  obtained the appropriate authorization. In such circumstances, medical evaluators remain subject to the code of ethics and regulations of their professional college.

1.18      Medical evaluation reports can only be provided to the referring source that made the request unless legislation requires otherwise.

1.19      Medical evaluators accept that their opinion may be disputed, even in court. To defend their   opinions,  they  must  use  only  the  objective facts and scientific arguments in keeping with the             generally accepted medical knowledge.



Duties Toward Claimants

2.1          Medical evaluators must inform claimants of the nature, process and purpose of the medical evaluation. The referring source requesting the medical evaluation should also be identified to the claimant. The difference between the role of medical evaluators and treating physicians should be explained to claimants.

2.2          Medical evaluators shall abstain from discussing with claimants information or opinions irrelevant  too the evaluation.

2.3          Medical evaluators shall abstain from making any comments or actions during the evaluation that could jeopardize claimants’ trust in their treating physicians and other health professionals.


Preamble: Medical evaluators may be required to be alone with a claimant          at some time during the history taking or the examination

2.4          Medical evaluators must respect the modesty and dignity of claimants. In this regard, guidelines of the Colleges of Physicians and Surgeons should be followed.

2.4.1    Medical evaluators must avoid any use of unprofessional comments or gestures, sexual or  otherwise.

2.4.2    Medical evaluators must demonstrate and maintain a professional attitude and behavior   throughout the evaluation.

2.4.3    Medical evaluators shall identify themselves and their evaluation staff to the claimants.



Duties Toward other Physicians

3.1     In their reports, medical evaluators shall address the issues relevant to the purpose of the evaluation. Disagreements with medical colleagues or other health professionals should be clearly based on and confined to objective evidence and inferences drawn from it and only          in keeping with the generally accepted medical knowledge.




Duties Toward the CSME

4.1          Medical evaluators shall support the goals and standards of the CSME.

4.2          All CSME members shall participate in and be subject to a regular peer review process. All CSME members shall be required to evaluate the medical evaluation  reports  of  membership applicants or peers to determine their conformance to the CSME standards. They shall do no less than two peer reviews per year upon request by the Executive.

4.3          Any active CSME member endorsing applicant for membership in CSME shall:

a)    have  sufficient  knowledge  of  the  applicant  to  know  that  the individual will be compliant with the        standards, and

b)    review in depth two medical evaluation reports of the membership applicant and certify that they comply with the CSME standards.



September 22, 2013