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Third Party Reports

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Approved by Council: November 2002
Reviewed and Updated: November 2009, May 2012; May 2018


Policies of the College of Physicians and Surgeons of Ontario (the “College”) set out expectations for the professional conduct of physicians practising in Ontario. Together with the Practice Guide and relevant legislation and case law, they will be used by the College and its Committees when considering physician practice or conduct.

Within policies, the terms ‘must’ and ‘advised’ are used to articulate the College’s expectations. When ‘advised’ is used, it indicates that physicians can use reasonable discretion when applying this expectation to practice.



Third party reports: Forms, letters or reports physicians are asked to complete or prepare in relation to a third party process that are not for the purpose of the provision of health care; for example, for insurance benefits, or in respect of workplace issues, attendance in educational programs, or legal proceedings. Third party reports may:

  • relate to a physician’s patient or to individuals with whom physicians do not have a treating relationship; and
  • be requested by the physician’s patient directly or an external party, such as a representative from an insurance company or a lawyer.

Treating physician: A physician who provides a third party report about their own patients, with whom the physician has a treating relationship.

Independent medical examiner: A physician who provides a third party report about an individual with whom the physician does not have a treating relationship.

Independent medical examination: An examination which is conducted strictly for the purpose of a third party report. It is distinct from a regular physician-patient encounter and, as such, it does not obligate the independent medical examiner to treat, or to provide health care to the examinee.

Examinee: An individual who is the subject of a report, but who is not in a treating relationship with the reporting physician.1



  1. This policy does not provide an exhaustive catalogue of every requirement that may apply to specific third party reports requests.2 As such, physicians3 are advised to keep informed of any additional requirements4 that may be applicable in their particular circumstances, including those set out in statute or regulation so they can ensure that they have complied with their obligations.
  2. Physicians must act with the same high level of integrity and professionalism when preparing a third party report, or conducting an examination for a third party report, as they would when delivering health care.

Before a Third Party Report is Prepared

Obligation to Provide a Report

  1. Treating physicians must provide reports about their own patients when proper consent is provided.5
  2. Independent medical examiners are not obligated to provide reports about examinees or about former patients. When asked to provide a report about a former patient, physicians are advised to disclose the existence of the previous treating relationship before accepting the request in order to allow all parties to consider whether objectivity will be a concern in the specific circumstances and to evaluate whether the report should be provided by another independent medical examiner.


  1. To avoid misunderstanding, physicians must communicate clearly the nature of their role in providing a third party report.6
  2. In discussing their role, physicians must explain to patients that:
    1. while the specifics of the information provided will depend on the circumstances of each case, they are obliged to disclose relevant and accurate information in the third party report; and
    2. where required, consent will be obtained and documented.
  3. Physicians are also advised to convey that the final outcome (for instance, decisions regarding eligibility for benefits) are not made by the physician but rather by the relevant decision makers in the third party process.


  1. Physicians must discuss any requirements or arrangements with respect to fees (including cancellation fees for missed appointments) with the requesting party before proceeding.
  2. Physicians must comply with any legal obligations they may have in relation to fees for third party reports.7
  3. Where there are no legal requirements with respect to fees, physicians must consider the recommendations set out in the Ontario Medical Association’s Physician’s Guide to Uninsured Services and must notify the requesting party if fees in excess of these recommendations are to be charged.8
  4. While it is generally permissible for physicians to request receipt of payment in advance for reports and examinations, physicians are advised to refrain from doing so on compassionate grounds, when the patient or examinee is responsible for payment directly, and the report relates to basic income and health benefits.

Consent for Disclosure of Information

  1. Physicians must obtain appropriate consent9 for disclosing personal health information to the third party.10
  2. The consent process will vary depending on the circumstances of each case; however, at minimum, physicians must ensure the following points are conveyed:
    1. consent can be withdrawn at any time; however, this will prevent the physician from completing and submitting the report;
    2. limits may be placed on the information that physicians can disclose in a report; however, such limitations may prevent physicians from proceeding with the reports process; and
    3. physicians have obligations to be truthful and accurate when detailing information in the report, and when forming a professional opinion about the patient’s or the examinee’s condition or functional abilities.
  3. Physicians are strongly advised to document that consent has been obtained.
  4. Physicians are advised to seek independent legal advice where they are uncertain about the specific information that should be conveyed through the consent process.

Consent for Medical Examination

  1. Physicians must obtain appropriate consent for conducting a medical examination.
  2. Physicians must ensure it is understood that the examination is being conducted to prepare the report.
  3. Physicians must outline what the examination will entail.This includes:
    1. an indication of what areas of the body will be examined,
    2. what functional capabilities the physician will be testing, and
    3. what types of questions the physician may have to ask.
  4. Physicians are strongly advised to document that consent has been obtained.
  5. Physicians must be satisfied of the following, if relying on a pre-signed consent form:
    1. the form meets the criteria of a valid, informed consent; and
    2. the consent form applies to, and authorizes the full spectrum of acts they will conduct in order to prepare the third party report11.
  6. If physicians have any doubts about the validity of the consent provided, or if limits have been imposed on the consent that will prevent physicians from completing the report, they must discuss the matter with the requesting party before proceeding.

Presence of Observers & Audio/Video Recording

  1. If physicians are conducting an examination for the purposes of a legal proceeding and one or more parties wish to have an observer present, they are advised to discuss the matter with the lawyer involved, as specific rules may apply.12,13
  2. Physicians must ensure any arrangements with respect to observers or recording are mutually agreeable to the parties involved.
  3. Should the parties disagree over whether the examination will be recorded, or will be conducted in the presence of an observer, physicians are advised to postpone the examination until these matters can be discussed and a resolution reached.

Proceeding with the Request for a Third Party Report


  1. Physicians must take steps to obtain and review all available clinical notes, records and opinions relating to the patient or examinee that could impact the findings of the report, including the physician’s final opinion and/or recommendations.
  2. If physicians have not been provided with all available information despite reasonable requests, they must explicitly note this fact in the report, and clearly indicate that the findings made were based on the information available to them.


  1. Physicians must ensure that the information contained in the third party report is accurate.
  2. If physicians rely on information which they cannot substantiate independently, such as employment history or previous medical history, physicians must note in the report the source of the information and the fact that it has not been independently confirmed.


  1. Physicians must state any findings or opinions contained in a report in a way that is objective and free from personal bias.
  2. Physicians must not include comments unrelated to the physician’s professional opinion, or that are extraneous to the requesting party’s stated objectives.


  1. To allow for optimal clarity, physicians are advised to outline the basis for their professional opinion, and the information or observations on which they have relied in forming that opinion.
  2. Physicians must use language and terminology in the report that is appropriate for the intended audience.
  3. Physicians are advised to avoid using medical short forms or jargon. Where this is not possible, physicians must include, in addition to technical medical terminology, more colloquial terms or explanations to ensure the reader understands the report’s contents.


  1. Physicians must only include information in the third party reports which they deem necessary and relevant.


  1. In some instances, timelines for providing reports will be set out in legislation.14 Absent a specific legal requirement, physicians must complete and submit third party reports within 60 days.
  2. If, in rare circumstances, physicians are not able to comply with this timeframe, either due to the complexity of the report, or for another appropriate reason, physicians must discuss the matter with the requesting party and reach an agreement for a reasonable extension.15

Scope of Expertise & Knowledge

  1. In situations where a physician is asked to answer questions, or provide an opinion that is beyond their expertise or experience, or which requires access to information they do not have, physicians are advised to discuss the matter with the requesting party, and explain that they may not be able to answer every question asked, or provide the opinion sought.
    1. If the party will not amend their request, or is otherwise unresponsive to the concerns expressed, physicians must:
      1. restrict their statements to matters that are within their area(s) of expertise and about which they have sufficient information, and
      2. indicate clearly the reasons for which they are unable to fulfill all the elements of the third party’s request.

Independent Medical Examinations: Suspicious Findings

  1. If, in the context of an examination, the independent medical examiner discovers a suspicious finding where it is unclear whether it has been previously identified, such as an unexpected significant clinical finding, a condition which raises serious concern or a symptom or condition which requires essential intervention,16 they must advise the examinee or their substitute decision maker of this fact to enable timely medical attention.
  2. Independent medical examiners are advised to seek consent to share the results with the examinee’s treating physician.
  3. Independent medical examiners are advised to convey the findings in written form as soon as possible to that treating physician, and not to merely send the treating physician a copy of the third party report.17
  4. If the independent medical examiner is conducting the examination in the context of a legal proceeding, they must use their professional judgment to determine whether to seek independent legal advice based on the circumstances of the particular case, before disclosing the findings to the examinee.

After the Report is Prepared

Retention of Reports, Notes and Documents

  1. Physicians must retain third party reports and related documents in accordance with their legal obligations.18
    1. Physicians are advised to familiarize themselves with the specific obligations that are applicable to their circumstances and seek independent legal advice where necessary.
  2. In circumstances where there are no applicable legal obligations with respect to the information that needs to be retained, physicians are advised to retain the following:
    1. consent obtained;
    2. contract with the third party, outlining scope, purpose, timelines and fee arrangements;
    3. audio or video recording of the examination, where applicable, if the recording was made by the physician;
    4. documents, or information not created by the physician, which the physician relied upon when preparing the report; and
    5. a list of sources of ancillary information, and any audio or visual information recorded by another person.
  3. In the absence of a specific statutory retention requirement, physicians may be inclined to return or destroy ancillary information but are advised to take these steps only if they are satisfied that this information will be retained by others, and will be available for their own review should they be required to discuss the third party report in the future.
    1. As an alternative, physicians are advised to consider options to address storage concerns such as retaining information electronically.

Access to Reports

  1. Where, after the report has been submitted, patients or examinees contact physicians directly to request copies of the report, notes or documents relied upon when preparing the report, physicians must comply with any statutory obligations they may have to provide access to reports, documents or notes.19
    1. Physicians are advised to seek independent legal advice where they are uncertain how to respond to a request for access, or what obligations they may have.


1. For the purposes of the provisions of the Health Professions Procedural Code (Regulated Health Professions Act, 1991, S.O. 1991, c.18., Sched. A. Patient criteria, O. Reg. 260/18) concerning sexual abuse of a patient, the College will consider examinees to be patients. As outlined in 1(6) of the Health Professions Procedural Code, the physician-patient relationship continues for a minimum of 1 year after the date upon which the individual, in this case the examinee, ceases to be the physician’s patient. A physician who engages in sexual relations with an examinee before the minimum 1 year timeframe will have sexually abused a patient and be subject to mandatory revocation provisions.

2. Policy expectations specific to the role of medical experts are provided in the College’s Medical Expert: Reports and Testimony policy.

3. Unless otherwise noted, any references in this policy to a physician or physicians apply to both treating physicians, and independent medical examiners.

4. These include, but are not limited to solicitor client and litigation privilege and requirements contained in the Rules of Civil Procedure, R.R.O. 1990, Reg. 194, enacted under the Courts of Justice Act, R.S.O. 1990, c. C.43.

5. The obligation to provide reports about patients may also be contained in statute. For example, see the Workplace Safety and Insurance Act, 1997, S.O. 1997, c.16, Sched. A., ss.37(1), 37(3).

6. In particular, patients may be more apt to confuse the encounter with a typical appointment for health care when it is their own treating physician that is providing the report.

7. For instance, see Workplace Safety and Insurance Act, 1997, S.O. 1997 c. 16, Sched. A., s.37(5). The Professional Misconduct regulation (Section 1(1), paragraph 21 of O.Reg. 856/93 Professional Misconduct, enacted under the Medicine Act, 1991 S.O. 1991. C.30.) also specifies that it is an act of professional misconduct to charge a fee that is excessive in relation to the services performed.

8. Section 1(1) paragraph 22 of the Professional Misconduct Regulation.

9. Appropriate consent may be obtained from the patient or examinee, or from a substitute decision maker.

10. Personal Health Information Protection Act, 2004, S.O. 2004, c.3, Sched A.,  and/or Personal Information Protection and Electronic Documents Act, S.C. 2000, c.5.

11.  For example, if physicians will need to conduct a medical examination, the signed form must contain consent for an examination.

12. For example, for court-ordered examinations, the Rules of Civil Procedure R.R.O. 1990, Reg. 194, enacted under the Courts of Justice Act, R.S.O. 1990, c. C.43. Rule 33.05 states that observers shall not be present during examinations unless the court orders otherwise.

13. If the matter is not related to a legal proceeding, physicians are not obligated to conduct an examination in the presence of an observer or to record an examination, but they are permitted to do so if they wish.

14.  For example, see sections 32 and 42 of the Statutory Accident Benefits Schedule – Accidents on or after November 1, 1996, O.Reg. 403/96, enacted under the Insurance Act, R.S.O. 1990, c. I.8.

15. Under the Professional Misconduct regulations (section 1(1), paragraph 17 of O.Reg. 856/93,Professional Misconduct, enacted under the Medicine Act, 1991, S.O. 1991, c.30) it is an act of professional misconduct to fail, without reasonable cause, to provide a report or certificate relating to an examination or treatment performed by the member to the patient or his or her authorized representative within a reasonable time after the patient or his or her authorized representative has requested such a report or certificate.

16. This includes but is not limited to undiagnosed conditions and conditions for which immediate diagnostic intervention is required.

17. Sending a letter will enable both the treating physician and the independent medical examiner to have a record of the finding and its disclosure. Independent medical examiners are advised to not merely send the third party report for two reasons: first, the consent may not extend to disclosure of the entire report, and second, provision of the entire report will not give the treating physician specific information about the unexpected finding, and therefore the treating physician may not obtain the information necessary to intervene or follow up in the requisite manner.

18. Requirements relating to the retention of reports, notes and documents will vary depending on the context in which a physician has provided a third party report and may be specified in legislation. For instance, requirements with respect to the length of retention periods are contained in O.Reg.114/94 General, enacted under the Medicine Act, 1991, S.O. 1990, c. 30., Part V, Records ss.18, 19, and the regulations under the Occupational Health and Safety Act, R.S.O. 1990, c.O.1 also contain requirements for retention of records. Requirements with respect to the type of information that must be retained are included in O.Reg. 114/94, General, enacted under the Medicine Act, 1991, S.O. 1991, c.30., Part V., Records, s.18 which requires that the information retained include a record of assessments, including notes of examinations and investigations, and written reports provided by other physicians or other health-care professionals.

19. This includes but is not limited to applicable obligations under Ontario and Canadian privacy legislation.