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October 28, 2016updated 13 Apr 2017 8:24am

Fix medical reporting and insurers can save money

Using better medical evidence will enable insurance companies to save money and reduce premiums, according to Phillip Kizun, the founding partner and CEO of Beacon Independent Medical Examiners. Kizun sets out his view.

By Verdict Staff

Using better medical evidence will enable insurance companies to save money and reduce premiums, according to Phillip Kizun, the founding partner and CEO of Beacon Independent Medical Examiners. Kizun gives his view below.

Insurers are saying there is far too much exaggeration and fraud.  It appears that whiplash and other hard-to-diagnose injuries are the supposed culprits.   Insurance companies have been pushing for reforms for years. 

During the [UK] coalition government, insurers said the reforms they pressed for would address exaggeration and fraud.  The reforms happened, but exaggeration and fraud is still a problem and consumer savings has been nominal at best.

Insurers were pressing for further reforms, suggesting that legislation which does away with cash compensation for soft tissue injuries will bring savings. 

The reality now is that the proposed reforms are not going ahead.  The Ministry of Justice has put the brakes on former [UK] chancellor George Osborne’s personal injury reforms and the cost of insurance premiums has continued to grow.  

It is against this backdrop that we have introduced Beacon IME to the UK market, recommending scientific facts as a solution.  

As a wholly independent company we have no financial stake in how the personal injury system works.  We use the knowledge and experience gained in other countries where science has proved valuable in tackling exaggerated and fraudulent personal injury claims.  

The United States and Australia have been practicing this method for some time with positive results.  Using science helps ensure those genuinely injured reach a fairer claim outcome.  

Medical science

Over the past four decades, medical science has made many extraordinary developments.  Through collecting injury, illness and recovery evidence, we know more now about human health than ever before.

Our highly connected society and the use of huge databases make collating and analysing large amounts of information much easier.  

The ability to access medical information and best practices has also improved.  Gone are the days when doctors treated patients based solely on their individual knowledge and experience. 

Now, when you see a GP they use compilations of data from the treatment and results in tens of thousands of patients.  Thanks to this process, patients get better recovery outcomes as a result.

It appears that the problem in the UK is how claim outcomes are evaluated.  The process used allows doctors to base their findings on what a claimant tells them and on their past experience. 

The problem is that claim handlers need this information to be accurate in order to correctly determine the legitimacy and value of a personal injury claim.  Things would be much easier for everyone if doctors based their evidence on science.  Claim handlers could then use this evidence to evaluate a claim. 

When an insurer, lawyer, or judge gets what is called a medicolegal report, they need to understand the doctor’s opinion around key issues, for example, did the accident cause the injury? 

If a doctor bases their opinion on the information provided by the claimant, who may be subconsciously incentivised by a potential financial reward, the report will be biased and the entire claim evaluation process becomes distorted.

Rise of fraudulent claims

The number of fraudulent claims raised by insurers has gone up dramatically in the last three years.  

Insurers can no longer rely on opinions in current volume medicolegal reports.  Due to this, lawyers and barristers have to work overtime and end up charging extortionate fees to defend bad evidence. 

Honest consumers have to cover the cost through higher premiums.  The facts are that the reforms enacted over the past five years or so have done little to change the fraud and exaggeration trajectory.  It is the quality of medical evidence that needs addressing. 

The distortion of medical opinions has become quite extreme.  Those that provide medical opinions have been very focused on selling the opinions their customers want.

That means those that are claimant focused, deliver more often than not claimant friendly reports. 

The same for those who work to defend claims.  If and when a claim gets to court it becomes difficult due to the claimant’s strong medical opinion supporting the claim.  

The defendant’s medical opinion would be supporting their version of the facts.  The truth is the courts are left having to decide if they trust the claimant and which medical evidence they understand and trust.  The fact is that science is there and can be relied upon to be far more objective.

Our experts use scientific information, which is readily accessible, to confirm a reported injury and the expected recovery.  If there is no injury or the extent of injury is exaggerated, Beacon IME’s report will explain the gap between what is claimed and what the science tells us.

The time taken in gathering information and coming to a concluding opinion is also costing insurers and their clients valuable time, driving prices higher. 

The best practice would be for claims to be evaluated and settled on scientific facts. This way claims could be more accurately settled and fraud and exaggeration weeded out, even in cases where things appear complicated.

It’s 2016, medical science has come a long way and we need a modern solution to modern problems.  It’s time someone finally came clean with consumers and our elected officials.  If we want to get the cost of insurance lowered and made more affordable for the Great British public, we need to get medical reporting fixed.

 

 

 

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