Causes of disability as applied under accident and health insurance policies, with special chapters on policy forms

Front matter

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Preface

The casualty insurance business as exemplified by the issuing of poHcies providing indemnity against disability resulting from accidents and diseases is acknowledged by experts as the form of insurance which will in time far surpass all other kinds. Already an enormous number of accident and health policies are being written annually by many reliable and well managed casualty insurance companies on wage earners who know by precept or experience the value of such insurance.

Practically every man desires to leave his family provided for in case of unexpected death, and it is absolutely necessary for honorable men to provide for them during life. This can be done in a more or less satisfactory manner as long as the head of the household is able to work. AVhen accident or illness causes a temporary or permanent period of disability, the income usually ceases at once unless the individual has protected that income with an accident or health policy, and as a large number of men are now carrying such policies, an already vast amount of examining for casualty insurance companies by physicians and surgeons is being done every day, but nothing in comparison to the number of examinations that will be necessary within the next few years. For this class of work which is now required and which will enormously increase in the coming years, it behooves medical men to prepare themselves to render proper services to the company they represent, the claimant and themselves, thereby improving their social standing and materially increasing their income.

It is a well recognized fact that nothing can be done well without instruction and experience, the greater the knowledge of any special line of work possessed by a doctor the larger the amount of success will he acquire in his chosen vocation. Years of experience have shown the great need that exists among doctors for a book oivino- information concernino- accident and health insurance examinations. It hardly seems pix^sible, nevertheless viii PREFACE

it is true, that the majority of American physicians are not familiar with the demands which are now existing for medical examinations and reports from casualty insurance companies. As the medical profession has never had a book on accident and health insurance for instruction and advice, this book was undertaken and is now given to those concerned in this great field with the hope that whatever is contained therein will prove of interest and value.

The author takes this opportunity of extending sincere thanks to many who have contributed suggestions and advice, and especially is he indebted to Mr. John Guy Monihan, President of the Monihan Company; Mr. R. W. Greene, Vice President of the W. B. Saunders Company; Mr. A. H. Lea, of Lea & Febiger, and Mr. Milton Campbell, President of the H. K. Mulford Company for many courtesies granted during the actual preparation of the book. For the splendid index with which this volume is equipped special mention is due my secretary, Miss Florence E. Tunney, whose services have been invaluable in many ways.

C. H. H.

1 143 South Broad Street, Philadelphia, Pa.

Chapter I

ADVANTAGES OF MAKING ACCIDENT, HEALTH AND LIABILITY INSURANCE EXAMINATIONS

Page 1 Demand for Examinations — Time of Examination — Urinary and Microscopic Examinations — Anxiety — Accident Insurance Physician's Welcome — Additional Fees in Court Trials — Examination Before Policy is Issued — Physician's Time — Increasing Acquaintance — Diagnosis and Prognosis — Adjusting — Compensation.

CHAPTER 11

NECESSARY QUALIFICATIONS FOR A SUCCESSFUL INSURANCE EXAMINER

Page 9 Personal Appearance — Age — Graduation — Experience — A Specialty — Tact — ■ Method — Accommodating — Promptness — Conciseness — Relations With Agent — Inspection — ^Age, Height and Weight — Differential Diagnosis — . Cross-examination of Claimant — Impartial Reports — Explanations — Good Impression by Examiner — Responsibility — Fees and Bills.

Chapter III Examining For Accident Insurance Companies

ACCIDENT EXAMINATIONS Page 23

Purpose of Examination — Place of Examination — Examination Without Attending Physician— Examination With Attending Physician — Examination—Company Requirements— Medical Terms— No Prescribing by Examiner—No Criticism of Attending Physician— Diagnosis and Prognosis- Remarks — Blank.

HEALTH EXAMINATIONS P^?^ ^^

Purpose of Examination— Place of Examination— Examination Without Attending Physician— Examination With Attending Physician— Examination— No Prescribing— No Criticism of Attending Physician— Blank- Diagnosis — Prognosis — Remarks.

ix s CONTENTS

LIABILITY EXAMINATIONS Page 37

Permission to Make Examination — The Purpose of the Examination — Place of Examination — Relations of Examiner — Blank — Explanation of Blank — No Prescribing by Examiner — No Criticism of Treatment.

Chapter IV Policy Forms Part I

ACCIDENT POLICIES Page 47

Accidental Death— Loss of Two Limbs or Eyes— Loss of One Limb or One Eye — Indemnity for Total Disability — Indemnity for Partial Disability — Combination Benefits — Elective Indemnities — Fees for Surgical Operations — Accumulations— Special Death Indemnity — Change of Occupation — Advanced Payments — Notice of an Accident — Identification — Beneficiary Insurance — Cancellation — Medical Attention — Medical Examination — Remarks.

HEALTH POLICIES P^^e 56

The General Health or Disability Policy— The Special Health Policy— Combination Policies— Permanent Disability— Total Disability— Partial Indemnity for Total Disability— Surgical Indemnities— Quarantine Indemnity.

Chapter V Injuries And Diseases Of The Head And Neck

CAUSED BY ACCIDENTS AND RESULTING IN

DISABILITY

SCALP P^^^ ^1

Abrasions— Contusions— Incisions— Lacerations— Punctui-ed Wounds— Burns

and Scalds.

PART H

FACE P^Se 70

Abrasions— Contusions— Incisions— Lacerations— Punctured Wounds— Burns

and Scalds.

EYELIDS P^^^ ^^

Abrasions— Contusions— Incisions— Lacerations— Punctured Wounds— Burns

and Scalds.

PART IV CORNEA AND SCLERA P^S® ^^

Ulcers of the Cornea and Sclerotic Coat— Conjunctivitis.

CONTENTS xi

PART V EARS Page 90

Injuries of the Auricle — Abscess of the Middle Ear.

PART VI SKULL Page 94

Fractures of the Skull — Punctured Wounds of the Skull.

PART VII

BRAIN Page 100

Abscess of the Brain — Concussion of the Brain.

Chapter VI Injuries And Dislocations Involving The Joints And Bones Of The Face

Page 105 Dislocation of the Temporo^Maxillary Articulation — Fracture of the Nasal

Bones — Fracture of the Malar Bones — Fracture of the Superior Maxillary — Fracture of the Inferior Maxillary.

Chapter VII Injuries To The Neck Including The Larynx

AND TRACHEA

NECK Page 115

Abrasions — Contusions — Incisions — Lacerations — Punctured Wounds — Burns

and Scalds. ^

LARYNX AND TRACHEA Page 124

Injuries of the Larynx and Trachea. '

Chapter VIII Accidental Injuries Involving The Chest

ABDOMEN AND BACK WHICH RESULT IN

DISABILITY

CHEST Page 127

Abrasions— Contusions— Incisions— Lacerations— Punctured Wounds— Burns

and Scalds— Dislocation of the Sterno-Clavicular Articulation- Fracture

of the Clavicle— Dislocation and Fracture of the Sternum— Dislocations of

the Costal Cartilages— Dislocations and Fractures of the Ribs.

ABDOMEN • • ^'^^"

Abrasions— Contusions— Incisions— Lacerations— Punctured Wounds— Hernia

—Suppuration of the Inguinal Glands.

xii CONTENTS

BACK Page 15&

Abrasions — Contusions — Incisions — Lacerations — Punctured Wounds — Burns

and Scalds — Fractures and Dislocation — Concussion of the Spinal Cord.

Chapter IX Injuries And Diseases Of The Male Sexuae Organs And Surrounding Parts

Page 175 Abrasions — Contusions — Incisions — Lacerations — Cancer of the Penis or Testes — Epididymitis and Orchitis — Fistula in Ano — Gonorrhea — Hemorrhoids — Hydrocele and Hematocele — Ischio-Rectal Abscess — Enlargement of the Prostate Gland — Injury to the Male Urethra — Urethritis — Varicocele.

Chapter X Accidents And Diseases Of The Upper Extremity

INJURIES TO THE SOFT TISSUES Page 201

SHOULDER AND ARM — Abrasions— Contusions — Incisions — Lacerations — Punctured Wounds — Burns and Scalds.

EILBOW AND FOREARM — Abrasions — Contusions — Incisions — Lacerations — Punctured Wounds — Burns and Scalds.

WRISTS, HANDS AND FINGERS — Abrasions — Contusions — Incisions — Lacerations — Punctured Wounds — Burns and Scalds — Palmar Abscess.

INJURIES TO THE ARTICULATIONS OF THE UPPER EXTREMITY

Page 22a Sprains of the Acromio-Clavicular and Shoulder Joints — Dislocation of the Acromio-Clavicular Articulation — Dislocation of the Shoulder Joint — Sprains of the Elbow Joint — Dislocations of the Elbow Joint — Sprains of the Wrist Joint — Dislocations of the Wrist Joint — Sprains of the Hands and Fingers — Dislocations Between the Joints of the Hands and Fingers.

FRACTURES AND AMPUTATIONS INVOLVING THE UPPER EXTREMITY

Fractures of the Scapula— Fractures of the Humerus— Amputations of the Upper Extremity— Fractures of the Radius and Ulna — Colles' Fracture — Amputation of the Forearm— Fractures of the Carpal Bones— Amputations Through the Carpus— Fractures of the Meta-Carpal Bones— Fractures of the Phalanges— Amputations of the Phalanges.

CONTENTS xiii

Chapter XI Accidents And Diseases Of The Lower Extremity

INJURIES INVOLVING THE SOFT TISSUES Page 259

HIP AND THIGH— Abrasions— Contusions— Incisions— Lacerations— Punctured Wounds— Burns and Scalds— Contusions of the Knee Joint. LEG — Abrasions— Contusions— Incisions— Lacerations— Punctured Wounds- Burns and Scalds.

FOOT AND TOES— Abrasions— Contusions— Incisions— Lacerations— Punctured Wounds — Burns and Scalds.

ACCIDENTS TO THE ARTICULATIONS OF THE LOWER EXTREMITY

Page 282 Sprains and Dislocations of the Pubic and Sacro-Iliac Articulations — Sprains of the Hip — Dislocations of the Hip— Sprains of the Knee Joint— Dislocations of the Knee Joint — Dislocation of the Patella — Dislocation of the Semi-Lunar Cartilages — Sprains of the Ankle Joint — Dislocation of the Ankle Joint — Sprains of the Foot and Toes — Dislocations of the Bones of the Foot and Toes.

FRACTURES AND AMPUTATIONS INVOLVING THE PELVIS AND LOWER EXTREMITY

Page 306 Fractures of the Pelvis — Fracture of the Femur — Amputation of the Thigh — Fractures of the Patella — Fractures of the Tibia and Fibula — Amputation of the Leg — Fracture Involving the Ankle Joint — Fractures of the Tarsus and Metatarsus — Amputation of the Foot — Fractures of the Phalanges of the Toes — Amputation of the Toes.

Chapter XII Illnesses Causing Disability Diseases Of The Skin

Page 327 Furunculus — Carbunculus — Eczema — Felon — Herpes Zoster — Varicose Ulcer.

Chapter XIII Diseases Of The Brain And Nervous Syste^i

Page 3o0 Apoplexy — Epilepsy — Locomotor Ataxia — Progressive Muscular Atrophy — Spinal Hyperemia — Migraine — Acute Cerebral Leptomeningitis — Hemorrhagic Pachymeningitis — Acute Myelitis — Neuralgia — Neurasthenia — Neuritis — Multiple Neuritis — O'ccupation Neurosis — Facial Paralysis — Sciatica — Spinal Meningitis — Sun-Stroke — Tetanus.

xiv CONTENTS

Chapter XIV

Page 371 Anemia — Angina Pectoris — Acute Endocarditis — Dilatation of the Heart — Leucocythemia — Acute Myocarditis — Chronic Myocarditis — Pericarditis — Phlebitis — Valvular Diseases of the Heart.

Chapter XV Diseases Of The Lungs And Respiratory

SYSTEM

Page 389 Abscess of the Lung — Asthma— Hay Asthma — Acute Bronchitis— Acute Nasal Catarrh — Diphtheria — Emphysema — Hemoptysis — Influenza — Acute Catarrhal Laryngitis— Congestion of the Lungs— Pharyngitis— Pleuritis— Catarrhal Pneumonia — Croupous Pneumonia — Pneumothorax — Acute Tonsilitis — Pulmonary Tuberculosis — Whooping Cough.

CHAPTER XiX

Page 477 Cerebro-Spinal Fever — Dengue — Intermittent Malarial Fever — Remittent Fever — Pernicious Malarial Fever — Measles — Relapsing Fever — Scarlet Fever — Simple Continued Fever — Typhoid Fever — Typhus Fever — Yellow Fever.

CONTENTS XV

Chapter XX

Page 503 Ascites— Cholera— Diabetes Mellitus— Erysipelas— Gout— Hydrophobia— Parotiditis— Peritonitis— Acute Articular Rheumatism— Muscular Rheumatism — Smallpox.

Chapter XXI Disability Due To Poisons And Gases Part I

MINERAL POISONS Page 527

Antimony — Arsenic — Bismuth — Carbolic Acid — Copper — Hydrochloric Acid —

Hydrocyanic Acid — Lead — Mercury — Nitric Acid— Phosphorus — Sulphuric

Acid.

VEGETABLE POISONS Page 555

Acetic Acid — Aconite — Belladonna-Stramonium-Hyoscyamus — Cocaine — Col-

chicum — Ivy Poisoning — Mushroom Poisoning — Nux-Vomica-Strychnine —

Opium and Morphine — Oxalic Acid.

MISCELLANEIUOS POISONS Page 574

Acetanilid-Antipyrin-Phenacetin — Methyl Alcohol — Ammonia — Cantharides — Caustic Alkalies — Chloral — Iodine — Ptomaine Poisoning — Snake Poisoning.

PART IV

GASES Page 590

Carbon Dioxid — Carbon Monoxid — Hydrogen Sulphid.

Chapter XXII Adjusting Claims For Disability Resulting From Accidents Or Diseases

ACCIDENT CLAIMS Page 597

Definition of an Accident— Knowledge of Policy Forms— Early Adjustment- Manner of Adjustment— Provisional Settlement— Ability to Detect Fraudulent Claims.

HEALTH CLAIMS P^^'® ^^''

Definition of Disease— Knowledge of Policy Forms— Adjustment— Manner of Adjustment— Fraudulent Claims— Differential Diagnosis.

Part III Liability Claims ^^^^ ^'^^^

Definition of Liability Examination— Competency of Examiners as Liability

Adjusters.

xvi CONTENTS

CHAPTER XXni I

METHODS OF SECURING APPOINTMENTS AS EXAM- |

INER FOR INSURANCE COMPANIES AND WHEN |

APPOINTED, HOW TO COMMAND EXAMINA- |

TIONS IN COMPETITION WITH OTHER |:

PHYSICIANS I

Page 613 '

Becoming Well Known — Papers on Medical Subjects — Papers for Insurance ;

Journals — Influence With Medical Director — Influence With Agent — ^

Writing Medical Director — Personal Acquaintance — Mutual Need — Ap- I

pointments — Bureau of Information. t

INDEX . . Page 625 \

CAUSES OF DISABILITY

Chapter I

ADVANTAGES OF MAKING ACCIDENT, HEALTH AND LIABILITY INSURANCE EXAMINATIONS

Physicians throughout the United States are almost without exception anxious to make examinations for Hfe insurance companies and take every opportunity of securing appointments for the purpose of doing this class of work which is remunerative and at the same time can be done in conjunction with other professional duties. Doctors who examine for these companies know that in making a life examination, the appointment is usually made by the agent and the examiner is expected to keep it, irrespective of any inconvenience it may cause to himself or to his patients. They also know that an agent expects every risk to be recommended for acceptance and if not accepted by the home ofifice, the examining physician is blamed for not passing the individual; the agent becomes very angry and if there is another examiner in the same locality, the doctor who has aroused ill feelings on the part of the agent simply because he has done his duty, is side-tracked and another physician is secured who perhaps will not be so conscientious in his work and efforts to protect the company. Yet with all these drawbacks and many others, physicians strive in every way possible to become examiners for life insurance companies and after getting an appointment continue to use every effort to secure examinations from agents. The great majority of doctors are not familiar with the demands for examinations by accident insurance companies and seem to think that the work is not as remunerative as that furnished by a life company. In this they are very much mistaken and many reasons

2 ADVANTAGES OF MAKING INSURANCE EXAMINATIONS

can be advanced to show that examining for accident insurance companies is preferable in ahnost every way to examining for life insurance companies.

DEMAND FOR EXAMINATIONS: Accident, health and liability insurance as sold to-day has been developed practically into its present proportions in the past fifteen years, and as this kind of insurance pays indemnity for disability due to an accident or disease, insurance companies doing this class of business are obliged to have medical examinations of individuals who have sustained an accidental injury or have suffered from an illness. This demand for examinations dates from the beginning of accident and health insurance and is being increased every day on account of the greater number of persons carrying this form of insurance, and as the number of policies increase so also do the number of accidents and illnesses; consequently, the necessity for examinations by medical men is daily growing larger and this demand will continue for years to come, as every insurance company Avill enlarge its business, some by spurts, others by gradual extension, but whichever way of extending the business prevails, the necessit}^ of having reports from medical men will be constantly on the increase.

The number of examinations will also be increased on account of the developments of the more rapid forms of transportation which are now not confined as formerly to the large cities, l)ut may also be found in the smaller towns and even extending between towns and villages. The electric trolley, together with the large number of automobiles that are being operated throughout the country, tends to greatly increase the number of accidents; and as these accidents are the most complicated ones for insurance companies, the demand for competent medical examiners is greater. It is therefore very important that physicians prepare themselves to handle this class of work in a satisfactory manner and thereby increase their value, not only to the community at large, but also to themselves.

TIME OF EXAMINATION : In examining for an accident insurance company, a physician is usually not requested to make .the examination until after the individual suffers from an accident or illness, and at this time the doctor knows positively that the claimant is either totally or partially disabled. If totally disabled, he is almost invariably confined to the house and can be seen at the convenience of the physician. If partially disabled, he is gene-

URINARY AND MICROSCOPIC EXAMINATIONS 3

rally attending to the inside duties of his occupation and therefore can be found at his place of business and at a time which is convenient and suitable to the examiner for making, the examination. As is well known in life insurance examinations, the doctor has to make the examination at a time convenient to the applicant or agent, the time of the doctor not being considered of any value whatever, and in many of these cases several visits are necessary before the examination can be made. Examinations for accident insurance companies can be made during the day in conjunction with other visits of the physician; thereby requiring less time and trouble than if the».examination was for a life applicant.

URINARY AND MICROSCOPIC EXAMINATIONS: An accident examination rarely requires a urinary analysis, while, as is well known, this is almost invariably the case when the application is for life insurance, and in these cases the examiner must make the physical examination, secure a sample of urine — and this alone often requires the second trip — and then complete his report at his office or the office of the company when he examines the specimen. Som.e life insurance companies even require a microscopic examination of this excretion when the application is for certain amounts and do not allow any additional compensation for this work. A microscopic examination to be properly made requires from fifteen minutes to a half-hour, and this, with the time necessary for making a trip or trips for a life examination and the time required for making it, counts up to more than an hour and the fee is seldom over Five Dollars. If this time would be employed for making examinations for accident insurance companies, the doctor could make several of them and double the amount of his pay.

ANXIETY: Every physician in active practice is continually worried more or less over his patients who are very ill and no sooner does he get some of these serious cases off his mind, than others come up and take their places. In life insurance examinations, every applicant who is rejected or who passes only a fair examination causes considerable anxiety to the doctor, for the reason that he is constantly in fear of the agent taking his applicants to another physician and thereby cutting oft' a part of his income. In accident, health or liability insurance examinations, the doctor makes the examination and reports the exact conditions as he finds them and as soon as he sends his report, he is through with the case and has absolutely no reason to

4 ADVANTAGES OF MAKING INSURANCE EXAMINATIONS

worry about it or any complications that it may cause between the agent, the company or the claimant. Should the company decHne to pay indemnity, the doctor gets no blame, he has had no voice in deciding as to the liabiHty or merits of the claim and therefore he is not brought into any controversy with any one when indemnity is refused in any case.

ACCIDENT INSURANCE PHYSICIANS WELCOME: Claimants expecting indemnity for accidents or diseases are always glad" to see the examiner for the insurance company and he is welcome in every case; while in life insurance examinations it is a well known fact that physicians examining for these companies are often considered a bore, — as well as the agent — and sometimes are given scant courtesy.

ADDITIONAL FEES IN COURT TRIALS : In liability insurance examinations there is always a chance that the case may reach a court trial and if it does, the insurance company almost invariably calls on the examining physician to secure additional information before the trial, and when this takes place he is subpoenaed as an expert witness and in such cases is entitled to the fees usually paid for expert testimony in the locality in which the case is tried. This amount varies from Twenty-five to One Hundred Dollars per day.

EXAMINATION BEFORE POLICY IS ISSUED : Accident and health insurance companies frequently ask for an examination of an individual before insurance of this character is granted, and in such cases the examining physician of the company is requested to make the examination and report the exact condition of the individual as he finds it. In these cases, companies expect a recommendation from the doctor as to the desirability of insuring the applicant and this is the only time that the agent may become dissatisfied with anything that the physician may do, as he may think that the applicant is a good risk, while the doctor after making the examination knows that the individual is not insurable for the kind of insurance desired. These cases are not sufficient in number to be considered as even a slight disadvantage, while every case examined for life insurance comes under this category. Physicians who devote a considerable part of their time to insurance work are capable of making three accident examinations in the same time required for one examination for life insurance. This is due to many reasons, the majority of which have been stated above.

PHYSICIAN'S TIME 5

PHYSICIAN'S TIME : Doctors in general practice are considered public servants and to be successful they must be ready and willing to answer calls from old or prospective patients at any time of the day or night, and in cases of serious illnesses or accidents are expected to drop all other work and give attention to the one most needing it, which of course is perfectly right and proper, but nevertheless such a condition makes a doctor's life a burden, his time is never his own to devote to his family or to pleasure that he may desire for himself. If he is making a sufficient number of accident insurance examinations he can afford to let his younger or less fortunate confrere answer the calls of the ill and give his attention to insurance work, when he will examine cases during the day, sometimes in the evenings or Sundays, but every day he is master of his own time, coming and going as he wishes and should he desire to take a vacation of a day or a part of one, no one is in a position to say that he neglected a sick person, for such has not been the case. Physicians who have been in practice for some years and have then given it up for various reasons, consider this one of the greatest advantages gained in the change of occupation.

INCREASING ACQUAINTANCE is to be desired by every physician who is practicing medicine, whether he is in general practice or confining his work to a specialty of some kind. The better known a physician becomes, the more practice does he secure in the line in which he is working and therefore any method which he takes to increase his circle of acquaintance will react to his benefit. Examining for accident insurance companies permits a physician to become known in various directions and with a class of people that he would probably have no way of meeting. Accident insurance as sold by most companies is placed among the best class of men in the community, and therefore when these persons suffer disability from an accident or disease, the examining physician of the company .makes their acquaintance and if he is at all aggressive, he can usually increase this acquaintance among the friends of the claimant by reason of having had an introduction from his company in making the examination for the accident or sickness, — as the case may be. This manner of increasing acquaintance also holds good with companies doing an industrial accident or health business in which the policy-holder pays for his insurance by the month; while these individuals are not of the same social standing in the community,

6 ADVANTAGES OF MAKING INSURANCE EXAMINATIONS

nevertheless, a practice among any class of people is desirable and this acquaintance can be made to yield valuable returns if the examiner will make himself better known, after having once made an examination for his company.

DIAGNOSIS AXD PROGNOSIS: Physicians examining for this kind of insurance and especially when they do any amount of this work, always become proficient in diagnosis and prognosis, as these are the two important points desired by an insurance company. AH companies expect their examiners to make a proper diagnosis on the first visit and at the same time they want a prognosis which is as nearly correct as it irs possible for a physician to give. Physicians in large cities who do much of this work are always considered good diagnosticians and must be in order to hold their position with the companies they represent. The fact that a doctor does much of this work and becomes able to make a diagnosis in difficult cases assists him greatly in his private practice, as it is wxU known that after a diagnosis is made of an accident or disease, the treatment is not difficult.

ADJUSTING: Physicians who examine for accident and health insurance companies and who become proficient in this branch of medicine, can develop themselves into adjusters for the companies they represent. Insurance companies find great difficulty in securing men who can properly adjust accident and health claims; therefore, a physician who is a competent examiner and can make a proper diagnosis and estimate the length of time that disability will last, can make a good adjuster if he has any tact and business training. He already has an advantage over an individual who is not skilled in medicine and all he need do is to develop the part required for adjusting a claim. If a doctor learns this part and can adjust accident and health cases, — even though he does not have authorit}^ to pay the claim — he becomes of much more value to his company. Physicians who examine for accident insurance companies develop themselves into adjusters by recommending to the company the time that they consider the individual is justly entitled to. If this judgment is correct in the majority of cases, the company soon learns to depend on any recommendation oft'ered and in time the doctor will be permitted to adjust small claims, and authorized to draw sight drafts in settlement of them. The amount of these drafts will usually be limited to a small figure at first, but as experience is gained, the limit is raised until the doctor is adjusting and paying

COMPENSATION 7

accident claims of any amount. When a physician is able to adjust and settle accident or health claims for an insurance company and is permitted by his company to do this part of the work, he has a higher standing with his company than a physician who simply makes the examinations, and is better able to protect his interests and retain the examinations than if he was not competent to make the adjustment at the same time A doctor who adjusts for an accident insurance company is so well intrenched with his company that it is almost an impossibility for another physician to secure any examinations from that company, — provided the examiner continues to do his work in a satisfactory manner. Physicians who are competent to adjust cases for one company soon get a reputation among all companies of being able to do this work and are frequently asked by other companies to make an examination, and adjustment if possible, when the company has its own examiner. It will thus be seen that a doctor who takes up this work and becomes a good examiner and then in turn develops into an adjuster, is sure of holding the work with the company which he represents and is also in line to increase this work by the reputation he gets from his ability to examine and adjust properly the different cases that he sees.

COMPENSATION : Insurance companies of all kinds pay for any services rendered them at the end of thirty or ninety days; therefore, a physician who is examining for insurance is sure of his pay and does not need to count on collecting only a certain percentage of it. Doctors practicing medicine in different parts of the country collect from twenty-five to seventy-five per cent, of their bills; while with work from an insurance company, they are sure of collecting one hundred per cent. Life insurance companies usually pay from Two to Five Dollars for ordinary examinations; while accident insurance companies seldom pay more than Two to Three Dollars for each examination. Even though an accident company does not pay more than Three Dollars, yet a physician who is doing this kind of work is capable of making more money than if he was examining for a life companv. Accident insurance examinations are made during the day at a time convenient to the ph3^sician and usually do not require more than ten to fifteen minutes and probably very little time is necessarv in arriving at the place of the examination, as his work often takes him in the vicinity in which the claimant lives: while in a life insurance examination, althou^-h he mav o-et a Five Dollar

8 ADVANTAGES OF MAKING INSURANCE EXAMINATIONS

fee, he must make one or more trips for the examination, do the work at a time usually inconvenient to himself and often must leave his office during office hours while he has patients waiting for him, not only taking a chance of not being able to make the examination, but also losing the amount that he would receive from his office practice. The advantage of doing accident, health and liability examinations is so much greater than making examinations for life insurance companies, that it seems if physicians were familiar with all these advantages, they would endeavor to secure more of this work than they do, thereby materially increasing their income and enlarging their reputation among insurance companies and the community in which they practice medicine.