To help mitigate Member’s exposure to crew illness claims, the majority of the International Group of P&I Clubs (IG) have put in place an Enhanced Pre-Employment Medical Examination (EPEME) for crew members.
These medicals are in addition to, and are more thorough than, the medicals required by the Maritime Labour Convention (MLC) 2006 (regulatory medicals) and any industry medicals that maybe undertaken e.g. Oil and Gas UK). In cases where the examinations are combined, each particular requirement will have its own certificate issued by the clinic.
In 2017, the Club undertook a review of the illness claims it had handled over a five-year period (from 2012 to 2017). The review highlighted that, on average, the Club dealt with over 300 crew illness claims annually with costs equating to US$ 5.6 million per year, an average of US$17,266 per claim.
Further analysis of the claims identified that heart related problems and strokes accounted for the majority of the annual cost, which are further exacerbated by the need to repatriate these patients and compensate them accordingly. Although not as high in both frequency and financial terms, cancer, high blood pressure and kidney problems accounted for a large proportion of the claims received.
Upon concluding the review, it was evident that many of the illnesses recorded would have been investigated during an EPEME and therefore many of these claims could have been avoided had one been carried out.
Data provided by the IG Clubs shows, that the fail rate for seafarers undertaking an EPEME was on average 4%. Given the number of seafarers assessed, this 4% represents a large saving if illness claims are avoided. According to data provided by participating clinics, the number of repatriations that are undertaken for seafarers who have undergone a EPEME is a little over 1% which is due to illness symptoms or indications that were not evident at the time of the medical. Of the 21 types of illness that resulted in claims during the study period, 10 are recognised and investigated during the EPEME examination and of these, three (heart problems, Strokes and Cancer) have resulted in claims exceeding twice the combined cost of all the remaining incidents.
It is because of the benefits an EPEME scheme provides, that the Club has decided to employ this scheme for its Members. The scheme will be implemented in phases initially focusing on the crews, regions and vessel types producing the highest number of illness claims. The programme will begin with Filipino crews employed on offshore vessels trading in SE Asia in October 2018.
The scheme will be implemented on a voluntary1 basis for all crews meeting the afore mentioned criteria from the 1 September 2018 until such time as existing Members renew their cover. Following renewal, participation will be a condition of cover as it will be for all new Members joining the Club after the 1 September 2018. The Club is acutely aware of the need to avoid exposing Members to higher operating and insurance costs and therefore the Club will bear 50% of the combined cost of the statutory medicals required by the MLC and the EPEME.
As the EPEME is only valid for one year and the statutory certificates are currently valid for two years, the Club will pay the full cost of the combined medicals each alternate year. The Club has also negotiated a cost with its accredited clinics to ensure that Members financial exposure does not increase.
Due to the importance placed on the EPEME scheme and the need for crews to participate, any illness claims received after the scheme has been implemented where the seafarer has not undertaken a EPEME will be subject to a double deductible for that claim and if a repatriation is required the deductible will be increased to US$ 25,000.
To ensure consistency, the Club’s accredited medical clinics have been careful audited by a trained medical practitioner who is experienced in EPEMEs. The clinics will be audited annually. Only clinics on the Club’s List of Accredited Clinics should be used.
The Club has issued each of the accredited clinics with a Designated Medical Examiner’s Handbook compiled by Nigel Griffiths, Chairman of The Marine Advisory Medical & Repatriation Service who has assisted the Club with the initiation and implementation of this scheme. This handbook states what is and is not considered medically acceptable by the Club’s standards. It is issued purely for the avoidance of doubt and there are no unusually strict limits other than medical norms.