SAAQ - follow the money

The woman was quite seriously injured in a car accident. As a matter of fact the first medical expert appointed by the SAAQ evaluated the patient to have level III Severity for mobility indicating that this category of severity is temporary; in addition he recommended further investigation and additional treatments.  Since there is hope of improvement, the SAAQ does not yet give a final decision on the aftereffects, but they inquire about the medical follow-up to determine when consolidation will occur.

Almost a year later, suspecting a stabilization of her condition, the SAAQ is having the patient reassessed by a new medical expert who concludes that her injury is now a category of Severity I permanent because of the aftereffects resulting from the car accident.

There is an important financial difference between a Severity I and Severity III category.  The first corresponds to a 2% rate, the second, to a 12% rate; in the second case the compensation is six times higher than in the first.

The SAAQ of course made the final decision based on the most recent evaluation.

The client then came to consult with me.

The action to take is obvious: to have her reevaluated by a doctor of my choice. The client is advised of the costs with no guarantee that the expert will conclude in her favor, even if, for me, the choice of the medical expert is not innocent; indeed, medical experts have one thing in common with the Tower of Pisa, they usually lean on the same side.

The client agreed to the reevaluation and the doctor concluded her condition to be a Severity III category.

Finally the hearing was held before the Review Officer: thanks to her testimony and to my arguments highlighting the limitations and constraints associated with mobility according to my customer’s rating scale,  the decision was made, granting the injured person a Severity III category.

You can always ask to meet with the Review Officer, which was done in this case. The request for a meeting is almost always systematic in my files; it is, indeed, easier to convince a decision maker in person than on the phone; you can answer his objections and decode his non-verbal language.

Often the weightless intangible weighs heavily on the balance.