Dr F Sestier, Dr A Naslafkih
Program of Insurance medicine, University of Montreal, Canada
Several European Universities, through their department of Forensic Medicine programs, offer a formal training and a post-graduate Insurance Medicine diploma for Physicians wishing to work as Medical Officers for Insurance Companies. In most English speaking countries, Medicolegal Institutes or University Forensic Medicine Departments do not offer such training.
This was the case in North-America where the Universities did not consider teaching Insurance Medicine. For many decades the only training offered was during the annual scientific sessions of insurance Medicine associations: The American Academy of Insurance Medicine (AAIM) annual scientific meeting, at fall, in the USA, and the Canadian Life Medical Officers Association (CLIMOA) annual scientific meeting, at spring time in Canada. The AAIM offered a one-week triennial course leading to American Board of Insurance Medicine certification. Further informal training was offered internally by senior medical officers of Insurance and Re-Insurance companies. This led to a long apprenticeship with inequalities in the level of knowledge acquired among Insurance Medical Officers, and differences of opinion given to Insurance Underwriters.
In January 2000, University of Montreal, with the help of grants-in-aid offered by major Canadian Insurance Companies launched a post graduate program in Insurance Medicine, in either English or in French. A basic microprogram led to a University certification and a more elaborate program to an Insurance medicine post-graduate diploma. Master and PhD programs in Insurance Medicine were offered as well. Due to geographic considerations, the lectures were initially recorded on VHS video-cassettes, the mailed to the students across the country; after 2006 the lectures became available through an entirely web-based program. Formal lectures, panel discussions, reading materials were either downloaded from the web, or offered on USB keys. At the same time International Programs in Insurance Medicine, either in English or French were offered to students around the world; the tuition fees were often covered by the Insurance Companies.
Our programs offer a thorough coverage of what a medical officer should master to either underwrite complex cases of Life, Disability, Travel, Critical Illness Insurance, and long term care insurance or adjudicate
complex disability claims. The program review the mortality data and disability issues of the main medical conditions met for each system: diabetes, coronary artery disease, valvular diseases, EKG and arrhythmias, congenital heart diseases, cardiomyopathies, respiratory disorders, kidney and urinary tract disorders, gastro-enterology, Ear-Nose and Throat, ophthalmology, skin diseases, blood disorders, cancers and tumors, neurologic disorders, psychiatric disorders, rheumatology, gynecology, and infectious diseases. It also includes lectures on diverse other topics of interest for the medical officer, such as: adjudication of permanent total disability, principles of pharmaco-economy, laboratory test assessment, build and blood pressure, and orthopedics. The Insurance medicine program also covers topics as Principles of Insurance Law, Genetics and Insurability, mortality analysis, Life Expectancy calculation.
It is also requested that the future medical officer shall master key elements in the medico-legal field, to be able to choose appropriately medical experts when requested, and acquire the capacity to evaluate the quality of written reports of any medical expert. The curriculum therefore offers lectures on topics such as: ethics and medico-legal expertise, duties of the medical expert, disability evaluation in the context of the ICF, critical thinking and reasoning, medico legal causal analysis, Work Compensation Boards issues, maximal medical improvement (MMI), recovery and rehabilitation, pain pathophysiology, evaluation and treatment, evidence based medicine and legal evidence, IME templates for different specialties, difficult claimants issues.
It has been our experience that such training makes the Insurance medical officer very efficient as he knows exactly what he should know, and is effective immediately when selected for a new position as Insurance Medical Officer. The training uniformity is associated with similar decisions of all medical officers within Insurance Company.
It has also been our experience that an Insurance Company hiring such well trained medical officers will, within a few years, decrease the load of litigious cases, therefore decreasing the Company’s legal fees by 50 to 90%.
The curriculum can be tailored to build Country specific programs. This is part of Master degree memoires or PhD degrees thesis for some of our students. We have over 10 years of experience in this field, and we are able to offer a flexible and thorough training in Insurance Medicine, in 4 months, of at a slower pace, according to the student’s time available for study.
Web-based program for Insurance Medicine Medical officers
Dr F Sestier, Dr A Naslafkih