Volume 1

Report of the departmental committee on sickness benefit claims under the National Insurance Act.

  • Great Britain. Sickness Benefits Claims Committee.
Date:
1914
Catalogue details

Licence: Public Domain Mark

Credit: Report of the departmental committee on sickness benefit claims under the National Insurance Act. Source: Wellcome Collection.

    80/108 (page 66)
    consideration as a solution of the problem. For the present it is desirable that experi- ence should, if possible, be obtained of the actual working of each. of these systems and that no rigid line of policy should be laid down as regards the system. ‘The general conditions existing throughout the country are so varied that a scheme suited to the needs of one area may not satisfy the requirements of another. While on the whole, therefore, a system of whole-time referees may be the most desirable solution and indeed the only possible solution, in large parts of the country, the general scheme should be made sufficiently flexible to permit of the adoption of any other well- considered arrangement, where local conditions or the desires of the practitioners or societies concerned render this possible. Remuneration of Medical Referees. 220, With regard to the sources from which the funds for the remuneration of medical referees should be drawn, it may be observed that the creation of a service of medical referees is designed to meet two ends. While Approved Societies have advocated the appointment as a protection to the society against improper payments, and in order to safeguard the sickness benefit funds from depletion through illegiti- mate claims, from the point of view of the medical practitioner, the object of the referee is partly to assist the panel practitioner in arriving at a decision as to incapacity in doubtful cases, and partly to share any odium that may be incurred in refusing certificates, and thus assist the doctor te maintain friendly relations with his patients, and free him from the anxiety which many practitioners undoubtedly feel with regard to the effect on their practice of the adoption of a proper attitude. It has been suggested that the cost of a system of referees should be drawn jointly from the funds of approved societies, and the funds available for the remuneration of medical practitioners, in proportion to the urgency of their respective demands for the appointment of referees, and the benefit ‘which they hope to derive from the establishment of such a system (Pimble, Q. 37,145 ; Daniels, Y. 13,953). Such a basis of calculation is, however, impossible of computation. ‘To apportion the cost on the basis of the number of cases referred by societies and doctors respectively would also be impossible, as the adoption of such a system might engender a tendency for each side to defer referring cases in the hope that they would be referred by the other. From the point of view of the approved society there is the further point that the only fund available for defraying the cost of medical referees is the administration fund. So far as the societies are concerned the utmost that could be required would probably be a charge, sufficiently large to act as a deterrent against unreasonable reference of cases by any one society, but not so large as to prevent any society sending necessary cases to the referee. Probably in practice this may be obtained by making a charge of approximately 2s. to the approved society for each case reported on by the medical referee. 221. ‘rom the point of view of the practitioner, after making every allowance for the cases of genuine difficulty in which the guidance of a second opuuion is desired, and allowing for the argument that the appointment of medical referees would be of universal utility i in helping to standardise the meaning to be attached to the phrase “incapacity for work,’’ the Committee are satisfied that a large part of the demand is based on the desire to have someone who will relieve them of their responsibility in the unpleasant task of declaring insured persons off the funds. ‘That this difficulty would be so intense was not foreseen at the time the original arrangements for medical benefit were made. It was not anticipated that medical practitioners would experience such searching of heart'in discharging the duties undertaken by them in their contract with the Insurance Committee. In so far as the appointment of medical referees is made to enable medical practitioners to discharge with an easier mind the duties which they have undertaken to perform, it appears to the Committee equitable that some portion of the expense required for the remuneration of the medical] referee should be borne by the practitioners to whom’ his presence brings ease of mind (IV. Duncan, Y. 17,798-9; Paget, Y. 24,110). In view, however, of the fact that the present financial arrangements for practitioners have been made for a term of three years, the Committee do not feel in a position to suggest that any part of the cost of medical referees should be immediately borne by the medical practitioners in the area. When the matter comes under review at the expiration of the period of three years, the questién should, however, receive consideration, having regard to the possible modifications and extensions which may then be given to medical benefit.