UK P&I Club medicals cut down on claims

Insurance claims arising from pre-existing medical conditions among seafarers are almost non-existent from those passing the UK P&I Club’s Crew Risk Management Project medical examination.

The 42,000 successful crew candidates have yielded just 106 repatriation cases in the six years since the programme started. In only one case was the claim related to a pre-existing medical defect.

According to Daniel Lee, the programme’s director, this has been a major achievement. It had helped control P&I costs, minimised operational disruption, improved safety,
provided a free health check for seafarers and advice on treatment for the unfit.

He was speaking to delegates from some of the world’s leading ship managers at the Lloyd’s Ship Manager Conference in Cyprus on October 10th.

‘People’ incidents cost the P&I industry approximately US$400 million a year in third party liability claims for injury, illness and death. Real direct costs are significantly higher, as many incidents fall below owners’ deductible levels. Further intangible costs stem from operational disruption.

Compensation and medical benefits under employment contracts are considerable. A shipowner’s legal obligations towards a seafarer who becomes ill on board ship include immediate treatment, medical care at the port of disembarkation and the seafarer’s own port, repatriation, sick wages and disability compensation. Crew replacement costs are extra.

In providing fit for duty medical certificates to seafarers to obtain exit visas, many examining clinics continue to adhere only to the minimum standards required by national and local authorities. These vary but do not generally provide for comprehensive medical screening or sufficient tests to screen out unfit candidates. Nor are these clinics accountable to shipowners for failing to spot medical defects which would have been apparent from better examination standards.

By the early 1990s, continued Mr. Lee, the incidence and size of crew claims had become particularly worrying as there was ample evidence attributing the high number of repatriations to pre-existing medical defects. Following extensive investigation into the

conduct of pre-employment medical examinations in a range of clinics, a limited programme was launched in the Philippines in August 1996.

It has evolved into the worldwide Crew Risk Management Programme, offering a quality control system for pre-employment examinations, aimed at minimising the exposure of UK Club members to crew claims from pre-existing medical defects.
Mr. Lee said the Club programme utilises a comprehensive range of tests as provided by the ILO’s Convention of Seafarers Examination 1946 C73 and the UK DTI’s Merchant Shipping Notice 1765 (M). Crew candidates must not be suffering from any disease likely to be aggravated by or render the subject unfit for service at sea or endanger the health of others on board. This dovetails with the mandatory requirement for seafarers to be medically fit, following the implementation of STCW ’95 earlier this year.

Accredited clinics are fully accountable for excluding any examinee if in any doubt about fitness.

A seafarer should be adjudged unfit if suffering from malignant neoplasms; infectious, endocrine, metabolic, blood or tropical diseases; disorders of the nervous, cardiovascular, respiratory, digestive, urinary and musculo-skeletal systems; mental disorders, skin conditions and eyesight deficiencies.

Examinations to date total 44,000. In the mid-1990s, around 10 per cent were found unfit for duty. This year, it is only 4.4 per cent. The main reasons for rejection have been Hepatitis B, heart, lung, liver and kidney disease, hearing loss, pulmonary tuberculosis, diabetes, failed drug tests and sight defects.

The programme operates through 20 clinics around the world: five in the Philippines, three in Australia, two each in India, the UK and South Africa, and one each in Indonesia, Croatia, Hungary, Ireland, Thailand and the USA. Others are being considered.
There are 30 shipowners, operators and managers in the programme and the number is growing. Clinic selection is driven by their requirements.

The average cost of an examination is insignificant in the context of a repatriation claim costing between US$10,000 and US$25,000, and sometimes considerably more.

Mr. Lee concluded: “The Crew Risk Management Programme has proved an effective risk management tool, serving the interests of shipowners, managers and seafarers. We plan to expand steadily in terms of members and clinics, while maintaining tight quality control. A further stage involves looking more closely at individual cases, from incident to full medical recovery.