Sunday, March 02, 2008

Court of Appeal considers insured's right of access to IME notes

Last month, the Federal Court of Appeal issued its decision in Wyndowe v. Rousseau, 2008 FCA 39 (CanLII). This case involved an individual's request for access to information generated by a physician hired by his insurer for the purposes of an independent medical examination. At trial, Justice Tietelbaum held the information was "personal information" for the purposes of PIPEDA and that it was not covered by litigation privilege (See Rousseau v. Wyndowe, 2006 FC 1312 (CanLII) and Canadian Privacy Law Blog: FCA grants stay of judge's order for disclosure of personal information). The question of litigation privilege was not appealed.

The Federal Court of Appeal has some interesting things to say about the interplay of the common law and PIPEDA, the definition of personal information, the nature of "commercial activities".

On the question of "commercial activities", the Court was clear that the collection of the applicant's personal information was in the course of commercial activities:

[35] The question is whether the IME transaction was of a “commercial nature”, as defined in section 2. The transaction between Dr. Wyndowe’s corporation and Maritime Life, who was paying for the IME, is of a commercial nature. Mr. Rousseau’s relationship between himself and Maritime Life is also clearly of a commercial nature: it is governed by a contract between Mr. Rousseau and his insurer, where Mr. Rousseau presumably paid some premiums (or his employer paid the premiums as part of Mr. Rousseau’s compensation for employment) and he therefore may or may not be entitled to benefits.

[36] In the context of these two commercial relationships – between Dr. Wyndowe’s corporation and Maritime Life on the one hand and between Mr. Rousseau and Maritime Life on the second hand – I find it hard to believe that by introducing a third relationship – between Dr. Wyndowe and Mr. Rousseau – the commercial nature of the overall transaction is defeated. In my view, Dr. Wyndowe is merely the medical agent of Maritime Life. If Dr. Wyndowe worked as a full time doctor for Maritime life, there would be no question the transaction is commercial; being examined by him would merely be a step which Mr. Rousseau had to follow to collect his benefits. In that sense the examination would be akin to filling out a form required by Maritime Life in order to begin collecting benefits. Just because Dr. Wyndowe is an independent consultant hired by Maritime Life does not change the fact that the overall transaction retains its commercial nature. It also does not change the fact that Mr. Rousseau was only doing what his contract with Maritime Life required him to do to maintain his benefits, i.e. submitting to an IME.

With respect to whether the information is "personal information" of the applicant, the Court concluded it was:

[49] In light of the Privacy Commissioner’s recognition that there are in the notes information which is personal to Mr. Rousseau and information which is not, it may be said that in the end, Mr. Rousseau has a right of access to the information he gave the doctor, and to the final opinion of the doctor in the form of the report to the insurer. In accordance with Principle 4.9.1. of Schedule I to the PIPED Act, this enables Mr. Rousseau to correct any mistakes in the information he gave the doctor or which the doctor noted, as well as any mistakes in the doctor’s reasoned final opinion about his medical condition. But the process of getting to that final opinion from the initial personal information of Mr. Rousseau belongs to the doctor.

[50] This Court, in Canada (Information Commissioner) v. Canada (Minister of Citizenship and Immigration) (above, at para. 8), has recognized that “the same information can be “personal” to more than one individual” (at para. 15). It may well be, in the end, that some information in the notes will be personal to both Mr. Rousseau and Dr. Wyndowe. A balancing exercise similar to that proposed in our ruling in Canada (Information Commissioner) would then need to be performed.

And on the interplay between the common law and PIPEDA:

[26] A) the common law

The appellant first submits that as the PIPED Act does not clearly and unambiguously override the common law respecting the right of access to one’s personal health record, the common law should apply. At common law, as the argument goes, the right to inspect one’s medical records is only recognized where there is a fiduciary relationship between physician and patient (see McInerney v. MacDonald, 1992 CanLII 57 (S.C.C.), [1992] 2 S.C.R. 138. As there is no fiduciary relationship between the insured and the insurer’s doctor performing an IME (see X(Minors) v. Bedfordshire County Council, [1995] 3 All E.R. 353 (H.L.), the insured has no right of access to his medical records.

[27] I am not persuaded that at common law an insured has no right of access to his medical records. In any event, it is my view that the common law should not prevail where the very purpose of the PIPED Act is to provide new privacy protections to Canadians not otherwise enjoyed under the common law.

In the result, the Court of Appeal held that the applicant/insured had a right of access to the notes of the examining physician under PIPEDA.

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