Private MRI vs. Public MRI – Reimbursement

We have previously written an article on the topic of whether a private MRI should be funded by an insurer.

The article referenced Ieraci v. Gallo, 2016 BCSC 1611 and raises the issue of whether a privately funded MRI ought to be paid as a special damage by the Defendant when a publicly-funded MRI is available to the Plaintiff.  There are some key points that were successfully argued in this case.  You may review our article here:  Private MRI v. Public MRI.

Based on a review of a number of decisions, a few important points are identified that should be put in evidence to argue that a privately funded MRI should be reimbursement:

  1. Identify the basis for the request of the private diagnostic test being ordered;
  2. The request should be documented in a consult or referred by a physician, not requested by counsel;
  3. Provide evidence on the wait times for a public MRI. If the Plaintiff has been waiting for months for a public MRI, this should be documented;
  4. Reasons why the private MRI should proceed.  Identify any urgency that may exist;
  5. The reason why and the need to go privately should be offered to justify reimbursement of the cost;
  6. Identify medical need vs. litigation need; and
  7. The results of the MRI should be disclosed if you are seeking reimbursement.

Seeking reimbursement of a privately funded MRI as opposed to waiting for a public MRI is also raised in a recent decision referenced as Sidhu v. Alton, 2020 BCSC 1802.  This case resulted in partial success of seeking reimbursement for a privately funded MRI and is the topic of this article.

In this decision, the following private MRIs were undertaken as referred by the Plaintiff’s physician:

  • MRI of shoulder, cervical spine, and lumbar spine on July 9, 2015 – $2,700.
  • MRI of lumbar spine on Nov. 25, 2016 – $888.28

Total cost of private MRI:  $3,588.28

Plaintiff’s Arguments

  • The private MRIs were recommended by the Plaintiff’s physician;
  • The Plaintiff should not have had to “languish” on a wait list;
  • The private MRI was requested to assist the physician with the assessment of the Plaintiff; and
  • Private MRI is needed to reassess her disc herniation

Objections by the defence

  • Urgency has not been established for the need to schedule a private MRI
  • Publicly funded MRI is available
  • Insufficient evidence to justify recovery of the cost of a private MRI

Case Law in support of objections

Scelsa v. Taylor, 2016 BCSC 1122

The plaintiff failed to show an urgent need to obtain a private MRI when a publically funded option was available: Cooknell v. Quinn, 2013 BCSC 1653.

Lewis v. Rubboli, 2018 BCSC 17

There is no evidence that there was any medical necessity or urgency to do so (indeed, Dr. Van Zyl’s evidence appears to indicate there was none).  I agree with Mr. Hauer that the evidence is insufficient to justify recovery of the cost.

Owen v. Peljhan, 2017 BCSC 423

There is insufficient evidence of why Ms. Owen needed to obtain a privately funded MRI, as opposed to having one conducted using the public health care system.

Cooknell v. Quinn, 2013 BCSC 1653

Dealing firstly with the MRI disbursement, the facts of this case are somewhat analogous to those described by then Registrar Blok in Phelan v. Newcombe.

Although Dr. Smith did recommend an MRI in this case (it is not clear exactly when), there is no explanation offered for proceeding to a private clinic when a publicly funded scan was available — or at least no evidence to suggest that such a process was unavailable. As the MRI charge is disallowed on this basis, I do not need to consider whether such an investigation was necessary or proper.

The Court’s Analysis & Conclusion

[307]     I note in the consult report of Dr. Nadeau dated November 4, 2016 that a repeat MRI of Ms. Sidhu’s lumbar spine was needed to reassess her disc herniation. Dr. Nadeau notes: “We have given the patient a FHA MRI request. This is an ICBC claim and there she will get an expedited MRI through her case manager/lawyer”.  I accept that the November 26, 2016 MRI was done to assist Dr. Nadeau in her assessment of the patient.

[308]     It is not clear to me on what basis the July 9, 2015 MRIs were ordered. There was no evidence adduced on the wait times for MRIs in the summer of 2015, or any reason why these MRIs had to be performed privately. If a plaintiff wishes to use the private MRI clinics and seek reimbursement for their costs, some evidence should be adduced to support the need to go privately.

[309]     As such, I am of the view there was some evidence before me to justify the costs of the private lumbar MRI conducted on November 26, 2016, but not the MRI on July 9, 2015.

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