MEDICINE AND INSURANCE

In the insurance industry medical examiners are involved in the operations of a large number of organizational units where they perform duties related to various lines of insurance, accidents, illnesses, surgical procedures, non-material loss, representation in court and passenger insurance. In consideration of the fact that the criteria for the evaluation of physical damage, disability and non-material loss are not of an exact but of an orientationalcharacter, the differences in evaluation derive from the very object of expertise. This poses a problem in cases where a person has several accident policies with major insurers and where there are discrepancies between assessments of the same insured eventcarried out by several medical examiners. These differences are minimal where a medical examinerconscientiously performs his duties, but they may be potentially disadvantageous to sale and marketing. Incomplete doctor’s reports render the assessment of the accident consequences more difficult, for which reason additional documents are required and the claim settlement procedure is prolonged, or decisions are made on the basis of enclosed documents and the assessor’s personal experience.
Before the stipulation of a life insurance contract, doctors assessthe health-related eligibility of the applicant. Huge sumsinsured and unfavourable risk spread in certain cases of special-purpose life coverages impose particular responsibility and urge medical examiners to use extra caution.
In view of the moral hazard and prevention ofloss, amedical examiner needsto have a critical attitude asregards health details provided by the applicant and reports made by doctors. When the insured event occurs, the problem regarding the procuring and concealing of medical documents may arise and hinder the disclosure of undisclosed circumstances.