Skip to main content

Full text of "Medical combinations against life insurance companies"

See other formats


MEDICAL COMBINATIONS 



AGAINST 



LIFE INSURANCE COMPANIES, 



" That our strike mu^t be a wrong to the persons we strike against, call them Company or 
Public, seems pretty plain." — Houtehold Wordt. 



LONDON: 

ORR AND COMPANY, PATERNOSTER-ROW. 



1851. 

[PRICE SIXPENCE.] 



LONDON: 
RICHARD KINDER, PRINTER, 
GREEK ARBOUR COURT, OLD BAltKT. 



MEDICAL COMBINATIONS 

AGAINST 

LIFE INSURANCE. 



A DISPUTE has arisen between some Members of the Medical Profes- 
sion, who have combined together to attain their object, and Life 
Insurance Companies, as to the payment of fees to Medical Men, whose 
Patients, in applying for Insurances, refer to them for information 
as to their health; and as the Public are interested in a pecuniary point 
of view in the proper settlement of the matter, and their opinion, if 
unequivocally expressed, may lead to the termination of a discussion, 
which has been carried on for some time with more warmth than can- 
dour, we propose to examine the natm-e and merits of the quarrel. 

The utility of Life Insurance has become so generally known and 
appreciated since the commencement of this century, and its practice 
so much extended, that there are very few persons whose present inte- 
rests or expectations are not affected by any question which involves its' 
stability, or diminishes its powers of usefulness. Considering it, also, 
in the magnitude of its operations, as controlling and managing many 
millions of money accumulated for the welfare of our fellow-country- 
men, or regarding it as one of the noblest emblems ar^l proofs of 
British forethought and industry, and family attachment, everything 
connected with its progress must be matter of general interest. 

The procedure taken to procure a Life Assurance is this : The 
applicant lodges at the office of the Company, from whom he wishes to 
obtain the Assurance, a Proposal containing a statement of his age, and 
of his past and present state of health ; with a reference to a Friend, and 
to his Medical Attendant, to confirm these statements. The Referees 
having returned answers to the questions sent to them from the Com- 
pany, and the applicant having been examined by their appointed 
Medical Officer, his Proposal is accepted or declined. The Examiner 
receives his remuneration from the Company who employ him, and the 
question in dispute is, whether they shall also pay a guinea to the' 
Medical Referee of the party, when they ask him for information as to 
his Patient. 

The associating Medical Men object to answer any question unless 
on receipt of a guinea from the Company. They contend that trouble 
and responsibility are incurred in giving the information required from 
them, that it is of great value to the Company, and that the Company 
therefore, as the parties deriving benefit, ought to remunerate them 
liberally for it. The Companies, on the other hand, maintain that the 
persons on whose behalf the service is rendered are the Patients who 
apply for the Insurances ; to whom, from the relation subsisting between 
them, the Medical Men are bound by every consideration of fairness and 
courtesy, to render it without asking for any special remuneration ; that 



4. 



tlie trouble is so slight as to be scarcely appreciable, and not more than 
the parties applying for it have a right to expect ; that there is no re- 
sponsibility except what every man incurs in answering a question,— 
and avoids, by speaking what he believes to be the truth ; that the 
information afforded neither is nor is expected to l)e of the kind for 
which, as a professional act, a Medical Man is entitled to a fee ; and 
that, besides, it is rarely of any consequence ; and that the amount of 
remuneration demanded is, in most cases, extravagant, and such as 
materially to retard the progress of Life Assurance. 

^ Now, as to the trouble and time necessary to reply to the questions 
of the Company, much depends upon the na'ture of the questions, and 
the mode of replying to them. If the Medical Man were asked for a 
professional report upon the state of his Patient's health, involving the 
necessity of an examination, it would no doubt be reasonable that he 
should be paid for the visit which he must make, and for the time 
occupied in answering the several questions in detail; and the amount 
of that remuneration we shall afterwards consider. But the examina- 
tion of the Proposer is the duty of the Medical Examiner, appointed 
and paid by the Company, and it is not expected that the Proposer 
should submit himself to another examination by his own Medical 
Eeferee, nor that the Referee should put himself to the trouble of ob- 
taining any more information regarding the Proposer's health than he 
already possesses when the question reaches him. All that is wanted 
from him is an expression of his opinion, founded upon his past expe- 
rience, as to the Applicant's state of health ; and although it is not 
unusual to seek that information by sundry interrogatories, which can 
generally be answered by adding Yes or No to each, the Company are 
perfectly satisfied with one sentence, to the effect, — " I have no reason 
to suppose the life objectionable," or the reverse; and the most emi- 
nent Medical Men generally make their responses in that way. It is, 
thei'efore, not requisite that the Medical Attendant should see his 
Patient on the subject. He receives a letter by post, which he answers 
by one sentence, communicating an opinion which he must have pre- 
viously formed, or by annexing the words "Yes" or "No" to the 
printed questions submitted to him. There is no expenditure of time, 
or more than a passing thought required, and no need for inquiry ; for 
if he has not had opportunities to enable him to judge whether the 
party is a good or a bad life, he is not in possession of that informa- 
tion which the Interrogators were led to believe that he had, and he 
has only to state so ; he refolds the letter, and his work is completed. 
Persons desirous of employment, or of a better excuse for demanding a 
fee than the writing of a few words, may endeavour, as is not un- 
common, to change the nature of the inquiry, and assume the office of 
Medical Examiner for the Company ; but the real amount of trouble 
they are expected to take is very much less than that demanded from 
the Friend who has been referred to, and who, in answering questions 
as to habits, employment, health of relatives and other matters, under- 
takes, and always gratuitously, a task that requires consideration and 
time, and frequently inquiry ; while the Medical Attendant has already 
been, paid by his Patient for visits which have enabled him to arrive at 



tlie conclusion which the Patient, by referring to him, asks him to 
communicate. 

In their pleadings for remuneration, Medical Attendants constantly 
mistake their position and duties. They are not Officers of, nor se- 
lected by, the Companies. A Proposer for Assurance makes a state- 
ment as to his health, and refers to a Medical Gentleman in confirma- 
tion of it, and the Company has a right to expect that the Referee is al- 
ready acquainted with the state of health as to which he is asked ; but 
if he is not, his duty is to say so, — and not to assume the position of 
the Company's Medical Examiner, who in every case performs his own 
appropriate duties. 

It is important to keep this distinction, between a Referee and a 
Medical Examiner, steadily in view; for it is by assuming that the 
former is called upon to perform all that is required of the latter, that 
a plausible case is presented on behalf of the Medical Associations. It 
is surely not difficult to perceive that the two kinds of services are 
totally different, although both are called into requisition, to ascertain 
the truth or falsehood of the same statement. 

The fact that professional men are paid, not for any palpable com- 
modity which can at once be distinguished and identified, but for ser- 
vices rendered in a form not always easily distinguishable from the or- 
dinary intercourse of society, has tended to throw a haze around the 
principle on which their right to remuneration rests, which it is diffi- 
cult either for themselves or for those who are to pay them, to clear 
away. Being accustomed to be paid for wi-itten or spoken advice, there 
is always a tendency, natural enough perhaps, to put a money price 
upon every word they speak and every paper they sign. Because they 
have a right to charge for professional trouble, they are apt to think 
themselves entitled to charge for every act, in which any trouble is in- 
volved. But the distinction between the cases in which payment 
ought to be made, and in which it ought not to be asked, though less 
obvious perhaps, is as real with professional men as with the most me- 
chanical tradesmen. To illustrate tliis, and to apply it to the present 
case ; let it be supposed that an Insurance Company to whom an appli- 
cation for an Insurance was made, considered it important to ascertain 
what quantity of wine and spirits the Applicant consumed in his family 
in the course of a year, and required a reference on that subject to his 
Wine Merchant. Would any Wine Merchant, if satisfied that he was 
at liberty to give the information asked, ever dream of charging a fee 
for It, on the ground that it involved some trouble and was valuable 
to the Company ? He would consider his taking the trifling trouble 
involved as an act of courtesy due from him to his customer ; his o-ivino- 
tis testimony to a fact lying within his knowledge, as an act of Uistice 
to a man to whom the verification of the fact was important What 
real dillerence is there between this case and that of a Medical Man 
asked to state what sort of health a Patient has enjoyed durin- the 
time thnt he attended him P In either case the thing asked for is 
essen ,al y distinct from the article in which the party deals, and 
for winch he receives payment, although in the one it bears a greater 
external resemblance to it than in the other. Or suppose a Mcrcliant 



6 



desirous of entering into commercial transactions, requiring confidence 
in his means of payment, refers to his Banker ; a person offering a 
House for sale refers to the Builder of it — a testimony to moral cha- 
racter is necessary, — a proof of having acquired information in some 
particular j^rofession or trade is demanded : in none of these cases do 
the Referees stipulate for remuneration for their services in giving 
the information needed. The Banker, the Builder, the Clergyman" 
the Lecturer, and the Artist, in communicating the information re- 
quired of them, give a portion of their time, and incur some respon- 
sibility ; without grudging or endeavouring to make gain of the lighter 
and reciprocal duties of life. Their conscientious scruples sometimes 
oblige them to baulk the wishes or endanger the interests of customers, 
friends and pupils, or break up valued friendships, but they ne^er bar- 
gain to receive money for their information. 

Cases sometimes occur which are not decidedly good, iior so bad as 
to justify the conclusion that the life is unassurable ; and when, in such 
cases, the attendant is asked for detailed information, his duty to the 
Company and his Patient is very clear. He may follow either of two 
courses, — he may describe the nature of the disease from which his 
Patient has suffered, and the reasons for his hesitation in recommend- 
ing the life to be accepted or rejected, trusting to the Company for 
remuneration for the trouble he has had in re-considering and recording 
the circumstances ; or he may state, in answer to the queries, that 
there are matters connected with the past or present state of the health 
of the Proposer, of importance to them to know, and which on their 
employment and remuneration he will communicate. This would be 
acting, if not liberally, at least fairly to the Company, who on their 
part may be expected to believe that such an answer would not be 
given for the mere purpose of obtaining a fee, when there was nothing 
important to communicate. A proper amount of remuneration woidd 
be the result, and that suggests the inquiry, what is the proper amount 
of remuneration ? 

This is a question that interests the Public, those who receive 
Assurances, much more than the Companies who grant them; for 
Medical fees, although paid in the first instance by the latter, truly 
come out of the pockets of the former. In Mutual Offices, where the 
Assurers and Assured are the same pai'ties, the truth of this is self- 
evident ; but it is not less true when applied to Proprietary Companies 
who sell Life Policies to their Customers, and retain the profits ; for 
there is competition in the business of Life Assurance as in all other 
trades and employments carried on for the purpose of making money ; 
and the premiums charged, like the price of articles of manufacture or 
commerce, are computed so as to realise a profit after payment of all 
necessary drawbacks and expenses ; consequently if two, and sometimes 
three Medical fees are to be paid, one to the Country Medical Exami- 
ner, another to the Medical Attendant, and another to the Medical 
Adviser at the Head Office, and to form charges on the business ; the 
Assured must pay them, in one shape or other, by a diminution of 
Bonus, or an increase of Premium. It is important that this obvious 
truth should be kept in mind ; for in most of the pleadings for the 



7 



Medical Associates, complaints are made against t^ie Proprietors cf Life 
Companies, for attempting to benefit theinselyes at the expense of the 
Medical Profession, by withholding adequate remuneration, as if they 
were the parties, both primarily and ultimately affected by the proposed 
increase of fees. They are described as amassing money for themselves, 
by defrauding others, and as alone intej.-ested in the amount of charges 
and expenses attending the business they conduct ; as if it were possi- 
ble, in these days of pressing competition, for any set of men to carry 
on a business independently of, and not regulated by, the amount of 
the expenses attending it ; as if Life Assui'ance was different from all 
other concerns, and exempted from the influence of competition. Were 
Assurance to be confined to the higher classes of society, and employed 
only for seeming large sums of money, some useless or extravagant 
payments might be overlooked ; but its principles and its usefulness are 
becoming daily more widely known, and its operations are extending 
amongst the industrious classes, who resort to it for the investment of 
small sums of money, — the savings set apart to provide for old age, or 
defend Widows and Children against penury. It is only by provident 
and economical management, and periodical accumulations, that those 
advantages can be realised, and there can be no excuse for saddling the 
funds devoted to, and necessary for, the accomplishment of such objects, 
with unnecessary expenses. Nor is it proper for a Company, with the 
view of procuring an accession of business, to hold out, that the legiti- 
mate and full benefits of Life Assurance can be secured to small Policy 
holders, if any considerable portion of the first payments is given to 
Medical Men, 

As an illustration of the incubus which the Associates would place 
upon Life Assurance, the following figures are taken from a Eeport of 
the business of an Office established a little more than a year ago. The 
number of Policies issued were 1,218; the sum assured £103,717 ; 
and the premiums received £3,475. 2s. lit?. Now, supposing these 
Assurances to have come from the country, as most of them did, and 
that fees had been paid to the extent requii-ed by the combinations, the 
account would stand thus : — 

£ s. d. 

Pees to Medical Examiners .. 1,278 18 0 
Pees to Medical Attendants , . 1,278 18 0 



£2,557 16 0 



And to this must be added remuneration to the Medical Adviser of 
the Company for examining the Medical returns, and reporting to the 
Board ; and supposing that to be rated at one fourth of the claim of 
the Associates, we have thus £3,397. 5s. 

But we have not yet arrived at the total Medical expenses of the 
Uthce, for the preceding calculation is on the supposition that every 
person who was examined was accepted, and that every Proposal for 
Assurance resulted in one of the 1,218 PoHcies paid for and completed 
by the Company. But that is not the case; for the rejected cases, and 
tiie accented but not completed, cannot be estimated at under 150, 



which by the same rate of payment, would have cost £375. We have 
hitherto supposed that there was only one person examined for each 
Policy, but as at least 50 of the 1,218 Assurances may be assumed to 
be on joint lives, we have to add the Medical expenses attending these 
additional fifty lives ; and the result is,— Company's expenses for Medi- 
cal assistance alone £3,884. 15«., while the whole annual receipts 
amount to £3,475. 2«. lid. 

If therefore, as it is contended, the business of Life Assurance 
cannot be fairly conducted, except by the payment of such expenses, it 
must be relinquished. The public will certainly not be disposed to 
acquiesce in that result, without ascertaining whether these charges are 
proper or necessary ; and we are thus led to inquire, under what 
circumstances, and in what cases, Medical Men can, with propriety, 
insist on being paid, and the proper amount of their remuneration. 

It will be conceded by every impartial inquirer, that in cases of 
decidedly good or decidedly bad health, where the Medical Attendant 
has nothing to communicate except the simple fact, and supposing the 
inquii-y to be limited to the question, whether the state of health be 
good or bad, there is no ground for insisting on payment of a fee. In 
order, however, to bring the practice to this state. Life Companies 
ought to confine their inquiry in words as well as meaning, so as to be 
embraced by that general question. Then again, when professional 
assistance is required, either in personally examining a party, or in 
giving a detailed history of a disease, it is not denied that Medical Men 
are entitled to be paid for time and trouble ; but we are not aware of 
any reason for fixing upon a guinea as the proper measure of remune- 
ration. There are grades of the Profession, and difi'ereut rates of 
payment, as well understood as if they were scheduled by Act of Parlia- 
ment ; and it is neither proper nor fair for a man of a lower status to 
endeavour to usurp the remuneration belonging to a superior rank of 
the Profession. By far the greater number of Medical Men, and all 
those who have combined against Life Ofiices, with scarcely an excep- 
tion, are what are termed General Practitioners; whose known and 
accredited charge is a few shillings for a visit and a phial of Physic. 
As an excuse for endeavouring to raise their charges, it is often said by 
Medical Men, as by persons of other caUings, that their's is a poor Pro- 
fession — they are badly paid. But, were it so, that would form no 
valid reason for attempting to procure more than the understood 
charges in any insulated case, or for a system of combination to concuss 
a particular class of employers into the payment of higher than the 
common rates. These medical combiuations, like all other strikes 
against employers, have, as their effect, if not their object, to place the 
most inefficient and ignorant upon a level with those of the greatest 
merit and ability; to place the whole upon one sterile level; the man of 
learning and ability with the most ignorant ; the rawest assistant of a 
Colliery Surgeon, who could call himself an Apothecary, on an equality, 
as to fees, with a Queen's Physician ; for the combinations have ruled 
that their charges shall be one guinea for every report, irrespective of 
the status or acquirement of the lleporter, or the amount of the sun? 
to be assured. 



9 



There arc others, uot Members of any Association, who endeavour, 
single handed, to make the most of their position when they are 
so fortunate as to find that a Patient has applied for a Life Assurance. 
They remind us of the boatman of a ferry, who insisted upon being 
paid his regular charges by ordinary travellers, and yet contrived to 
get more from strangers by dilating upon the risk of the passage, his 
responsibility, anxiety and trouble, when persons of a higher grade 
happened to cross. His proper remuneration, though well known to 
his ordinary customers, he tries to conceal from the casual employer ; 
and either takes what is offered, provided that it be more than the 
proper charge, — or contrives to elicit, as a perquisite or gratuity, what 
would be paid for better and diflerent accommodation. 

We have the consulting Physician, the consulting and the operating 
Sm-geon, and a host of Apothecaries or General Practitioners, living by 
the sale of Drugs — and all attempts by this last class, by means of 
combinations, to force the Public, or any part of it, to pay more than 
ordinary charges, or to raise the acknowledged standard of Apothecaries' 
fees to those of the higher grades of the profession, will be found to 
be impolitic, as it is improper. Conceive the case of an Assurance 
Office, extending its operations into the dense masses of some of the 
manufacturing towns ; and superseding to some extent the ill-regulated 
schemes of the Odd Pellows, and other Friendly Societies, and observe 
the class of Medical Men to whom constant reference would be made 
as Medical Attendants, — it would surely be iniquitous were the small 
premiums of the Assured to be lavished in guinea fees on the Apothe- 
caries to be found in such places ; — and yet these are the people who 
are chiefly active in forming and arranging schemes against Life 
Offices, to enforce the payment of fees which they long for the more, 
that they have not been accustomed to receive them. 

Professor Christison, in a temperate article in the Monthly Journal 
of Medicine for October last, written with the avowed purpose of 
reconciling Assurance Companies and the Medical Profession, makes 
the following suggestions for that purpose. He proposes that an 
Applicant should see his Medical Attendant before lodging a Proposal 
of Assurance, so as to ascertain the nature of the report he will make 
to the Company when applied to ; that the Medical Attenuant should 
receive a fee direct from the Company, but that no fee shall be j^aid 
unless the sum assured exceeds a certain amount, — which however he 
does not specify. Although there is a complete intention of fairness 
on the part of the Professor, a natural leaning in favour of his Pi'ofes- 
sion runs throughout the article : for instance, in referring to an Edin- 
burgh Company, whose business he states would be materially restricted 
m its range were fees to be paid to Medical Attendants, he limits the 
observation by making the restriction apply only, if the fee were at 
the Patient's expense; as if the busmess would not be equally restricted 
in Its range, if the Company were chargeable with the fee. His 
notions of the value to be attached to Medical reports are very large, 
and the possibility of their being positively hurtful to Companies by 
inducing the acceptance of bad lives, has not occurred to him; or at 
/oust he has not noticed that subject, although most important, in 



10 



considering the relation subsisting between Life Offices and his Profes- 
sion, and the aggregate value of the information to be obtained. 
Whatever may be thought of Mr. Christison's plan, there is no cliance 
of its being adopted by the combinations, for they have already passed 
resolutions condemnatory of one of the most important of his sugges- 
tions, — and one in which the Public, and especially persons desirous 
of promoting provident habits amongst the industrious classes, are 
most interested, — that which refers to small Assurances. The com- 
binations resolve, that as there is the same trouble with small as large 
Assurances, fees must be paid in all cases. 

Another reason alleged as a justification for insisting upon a fee is, 
— that if the proposal be rejected there is a chance of the loss of a 
Patient. But for such a misfortune it cannot surely be argued that 
the Life Company is responsible, or that they should pay for the effects 
of the deficient judgment or ill-regulated temper of the Patient. The 
risk of such an occurrence is one of the incidents of the Profession, 
which the receipt of a fee would do little to remove, or alleviate ; and 
we would ask whether there is not a greater likelihood of the loss of 
practice from declining to assist a party in a laudable object, than by 
honestly replying to a question which the Attendant has been requested 
by his own Patient to answer. This argument of pecuniary loss in 
business, in consequence of an honourable discharge of duty, is scarcely 
compatible with the high position the combinations take, in arguing 
for liberal remuneration to a learned and liberal Profession ; nor is 5 
tenable in a merely money-making point of view ; for observe how the 
case stands. The Medical Attendant resolves that he will answer no 
question as to a Patient, unless on receipt of a guinea, — the guineas 
forming a stock purse as an indemnity for the loss of the business of 
such Patients as shall leave him in consequence of rejections by As- 
surance Offices. But he forgets that his Patients may be guided by 
connect and liberal notions, rather than caprice and injustice. There 
are few persons illiberal enough to discard a Medical Man, because in 
acting according to the dictates of his conscience, in a matter placed 
before him on their account, he had given an opinion diflferent from 
what they anticipated. In that case there can be no suspicion .of 
sinister design on his part, and no reasonable pretext for visiting upon 
him the inconvenience or disappointment arising from the rejection of 
a Proposal for an Assurance, — and such cases will rai*ely happen. But 
if a Patient should be denied the advantage of an Assurance from a 
Company selected by him, solely in consequence of his Medical 
Attendant refusing to certify as to the state of his health, he would 
have some reason, and most persons would be disposed under such- 
circumstances, to make a change of Medical Attendant. The relation 
subsisting between a Patient and his Doctor is always of an amicable, 
generally of a friendly description, and nothing can tend more effectu- 
ally to sever the connexion, than a want of willingness on the part 
of the latter, to promote the temporal welfare of his Patient, 
when that can be done without much trouble, and at no expense. 
Medical Practitioners ought to be aware that it would be a difficult 
task to persuade a person, who for half a crown can command the 



n 



willing services of an Apothecary at any Lour of the day or night, that 
the same Apothecary is justified in demanding a guinea for merely 
stating whether his state of health is good or bad. Yet the combining 
Medical Men lay much stress upon their influence, as being sufficient 
to enable them to persuade their Patients to patronise one Life Office 
rather than another ; and they thus endeavour to concuss Companies 
into their terms. They avow their determination to use that influence 
in favour of fee-paying Companies, and against those who refuse to 
comply with their demands ; although, in thus seeking to work out 
their own interest, they totally disregard the welfare of their Patients. 
In this they commit a double mistake. In the fii'st place they entirely 
overrate their power to injure Insurance Companies. Their chief 
influence is over valetudinarians, whom an Insurance Company will 
only thank them for persuading not to apply to their Office. Over 
those whom the Companies desire to gain as customers, the vigorous 
and healthy, Medical Men have no pecuh'ar influence — not half so 
much as Clergymen and Attornies, who are frequently the parties 
referred to as Friends, but are never understood to make a charge 
for their information. In the next place, they are strangely blind to 
the means which Offices have of interrupting the connexion between 
them and their Patients ; — and this power is the greater, that it is 
neither sought for nor vaunted, but arises naturally from the position 
of the parties. Every Life Office has a Medical Examiner, attached to 
each of their Agencies, to whom the Proposer is introduced ; and who 
is not unhkely, seeing that he is generally the most accomplished 
practitioner in the locahty, to become acceptable to the Proposer as a 
Medical Attendant, without any intention on his part, of trenching 
upon the business of another ; his more refined manners, and the very 
nature of the confidential communications that are made by the 
Proposer, will, in many cases, lead to a preference of him as a future 
confidential attendant ; — and if in any of their communications with the 
Proposer, the Company should choose to inform him, either that the 
Proposal had been rejected in consequence of his Medical Eeferee 
refusing to report on his health,— or that it had been accepted notwith- 
standing the want of such report, the loss of the Patient would be 
almost certain. In a warfare of this kind, Medical Men would find 
that even in a pecuniary point of view, their crooked policy would not 
aid them. The influence and patronage with which, for their own 
selfish purposes, they are attempting to frighten Companies into the 
payment of unreasonable charges, are too weak for that purpose ; and 
the boast of such weapons of oflence will only damage those pecuniary 
interests, for -which they are so unscrupulously contending. We 
happen to know of several instances where Patients have changed their 
Medical Men in consequence of their refusing to give reports, although 
the Assurances were obtained ; and it cannot be doubted that in many 
cases of refusal of Proposals, in which the Medical Attendants have 
declmed to give reports, their future services have been dispensed with, 
although the Offices' rejections of the Proposals have arisen from totally 
clittei'ent reasons. As Applicants for Assurance are seldom or ever 
lutormed ot the gi-ounds of iheir rejection, they will naturally attribute 



13 



their disappointment lo the person who declined to assist them by a 
certificate, when they know that it has been applied for, and refused 

Amongst otlier mistaken reasons, alleged for payment of fees in all 
cases, a false and exaggerated estimate of the value of Medical Ser- 
vices is brought forward. There are comparatively few Medical Men 
capable of properly examining and reporting on a person, so as to 
meet the inquiries of an Office ; and when persons inexperienced in that 
kind of business, enter into details in answering special questions, they 
generally show by their own statements, that their information cannot be 
relied upon ; while it is undoubted that the wish of medical attendants 
to make their Patients' health and constitution appear as good as pos- 
sible, greatly detracts from the value of their services. So much is 
this the case, that many persons of experience in Assurance practice, 
consider Medical Attendants' reports, taken in the aggregate, as fraught 
with more mischief than utility, — improving the favourable points of a 
case, and removing or plausibly accounting for circumstances that have 
excited suspicion ; and certainly if that confidence were placed in them, 
that Medical Men contend they deserve, most disastrous results would 
follow. This has been proved in the course of the legal investigations 
that have occuiTed in several of the disputed cases of Life Assurance ; 
and the fact is, that the oldest Managers of Companies place the 
least reliance upon Medical Attendants' reports ; or rather they treat 
them as waste paper, except when they contain some fact unfavourable 
to the Patient's chance of longevity. There are, no doubt, many 
highly honourable men in the profession, whom neither a fee, nor 
apprehension of the loss of a Patient, could induce to practise a decep- 
tion either by statement or suppression ; but these are not the persons 
who unblushingly boast of employing their influence in favour of either 
one or other Office, as may best promote their own mercenary ends. 
The latter belong to the class of Medical Practitioners, whose fame 
is chronicled in the annals of the English and Irish Courts of Justice, 
as either influencing or influenced by their Patients, to deceive Life 
Offices. Besides, we find from recorded statistics that Medical advice 
has not enabled Life Companies to keep out of their lists of Assured, 
a larger proportion of bad lives than are to be found in the population 
taken as a whole; that Medical Aid does not enable Assurance Offices 
to get better lives than the average of the population ; and we have 
the important fact, that the only Life Company who have taken no 
assistance from Medical Men, have on their books a class of lives 
much superior to the average of other Offices. That is proved by the 
experience of fifteen different Offices, who take the assistance of Medical 
Men, compared with that of the Equitable, who do not. Of those 
who were insured at the age of 20, in the fifteen Offices, 1 in 58 died 
within the first year; and of those in the Equitable, of the same age, 
1 in 242 died: of the age of 40, the fifteen Offices lost 1 in 162, 
the Equitable 1 in 256, within one year after they were assured; and 
at the age of 60, the fifteen Oflices show a mortality of 1 in 35, 
and the Equitable 1 in 84, within the first year of Assurance. Other 
reasons, or rather conjectures, have been advanced to endeavour to 
account for these remarkable differences; but at all events, these 



13 



observations are sufficient to show that the combinations overrate the 
importance of Medical Attendants' reports, when they describe them 
as being absohitely necessary to Life Offices, as being theii- best and 
only safety and protection. These statements are made from interested 
motives, — and are not correct. 

On the supposition of the preceding remarks being well founded, it 
may appear strange that within the last few months, several Companies 
have advertised that they pay Medical Attendants for their reports, — 
and some explanation appears to be required to account for that change 
in practice. In the competition for business which is now enriching 
all vehicles of advertisement, and no doubt to some extent benetitting 
the Public, the ingenuity of Directors and Managers is exerted to 
place in the best Hght, the vaiious advantages which may be found 
exclusively, or more strongly developed, in their respective Establish- 
ments ; and whether it is owing to this or to other causes, the practice of 
Life Assurance, in its facilities of attainment and its adaptation to a 
much larger range of beneficent purposes, has become more generally 
useful than it used to be. But unless with the view of purchasing, at 
a cost quite disproportionate to its value, the active influence of the low- 
est portion of the Medical Profession, it is difficult to see any propriety 
or advantage in putting forward such advertisements. One of the 
latest in the field has out-stripped all others, in its advertised munifi- 
cence, by oflering to pay the Medical Attendant of a Proposer, two 
guineas for every report, together with five per cent, upon all the 
Premiums on Policies obtained through his recommendation, so long 
as the Policies subsist. 

Now the explanation of all this is very simple. These Offices adver- 
tise that they practice, what they do not, and never intended to per- 
form ; just as some Proprietary Offices head their Prospectuses with a 
Capital of " One Million," although they have not the hundredth part of 
that sum, and never expect to have it, except from the contributions 
of the Assured. In the latter case the deception is played off against 
the Public; in the former the lower grades of the Medical Profession 
are deceived. In the one, the notice should be, " A part of One Millioa 
is subscribed for," and in the other, "The Medical Attendant will 
receive a fee, — when he is consulted," and as that is likely to occur 
only in cases of strong suspicion which are generally declined, without 
a report from a Medical Attendant, — or where it is necessary to leant 
the nature of some past occult disease, under circumstances when all 
other Offices would consult and pay the Medical Attendant, it would 
appear that the combinations will not gain much by tliis supposed 
change of practice. As to the Company that has started upon the 
peculiar and golden idea of double fees, and perpetual commission ; it 
was originated in a laudable, though we think mistaken feehng, for 
the supposed injuries of less affluent Medical brethren ; and it may be, 
that in the partial junction of the interests of a Life Office and a 
Weekly periodical, the latter advocating the benevolence and generosity 
ot the former, the loss of the Capital of the one may be expected to 
be compensated by the proceeds arising from the increased circulation 
01 the other. A want of acquaintance with the business and prac- 



14 



tical working of Life Assurance, — the failure to procure from other 
Offices the use of their reports, which, if obtained, might lessen their 
Medical expenses without detracting from their renown, as the Cham- 
pions of the Profession, — and the total inability of a Company to struggle 
against expenses exceeding receipts, may come to be considered suitable 
reasons for abandoning a more generous practice than the constitution 
can bear; — and were that wholesome resolution speedily adopted, 
without first attempting to evade obligations voluntarily undertaken, 
by endeavouring to procure second-hand reports from other Offices ; 
—pleading the unreasonableness of two guinea fees in individual cases 
bf small amount, when the fee exceeds the Premium ; and above all, by 
the withdrawal of the temptation of commission offered to the Medical 
Adviser, — (a profi'ered boon, which a well-regulated mind will repudiate 
as incompatible with the disinterested position he ought to hold ; which, 
if accepted, must impair the influence for the use of which it is paid ; 
which, under any circumstances, must raise a suspicion as to the 
grounds of the Assurance, and impair the value of the Policy, as a 
marketable security,) — then the character of the Office, good in 
other respects, will not be materially damaged, — except in the eyes of 
those Members of the Medical Profession, whose influence is in the 
inverse ratio of their boasting. 

But the Medical Men who concocted, and are carrying on the com- 
binations, would have it believed, that not only they, but the Medical 
Profession in general, are inadequately compensated for their services, 
and have reason to complain of the treatment they receive from 
Assurance Companies. In order to test this, it may be well to con- 
sider and estimate, as correctly as the limited information on the subject 
will permit, the amoimt of money annually awarded to the Medical 
Profession for their share of work in Life Assurance business. 

As there is no public record of Policies, or any means of ascertain- 
ing the exact number annually issued, or the sums assured, we can only 
approximate to the truth in these matters ; but we shall endeavour in 
our estimate, rather to underrate than exaggerate the amount of busi- 
ness done. Prom the " Post Magazine Almanack," of this year, we 
learn that, at the termination of 1850, there were in operation upwards 
of 1 5 0 Societies or Companies for granting Assurances on lives. To each 
of these there is attached a Medical Officer, acting as an Assessor or 
Adviser of the Board, in reference to the health and constitution of the 
persons proposed for Assurance ; and one half or more of these Institu- 
tions have two Medical Gentlemen acting in that capacity. There 
are thus 325 Medical Gentlemen employed. There are instances 
of one acting for more than one Company, but in these cases 
there are a corresponding number of salaries paid. The average amount 
of the honorarium may be taken at £105 to each Officer, or for the 
whole £33,625. Very few Companies are without Agencies, but most 
of them have several hundred, and supposing them to average 150, 
there is thus a staff of 7,000 Medical Men for the different Agencies ; 
and including the Medical Advisers at the Chief Institution, 7,225 of 
the Profession, who must be understood to be satisfied with the terms 
of their remuneration, as no complaints come from that quarter. The 



15 



total amount of tlieir receipts may be approximated by taking as our 
"•uide, an ordinaiy rule of practice amongst Companies to pay one 
guinea for an examination and report in cases of Assurance for £300 
and upwards, and half a guinea when the amount is under £500 ; and 
supposing that 300 lives are proposed for Assurance annually to each 
Office, and that one-half of these are for sums under £500, the 
total Medical Tees amount to £35,437,— to which add the Medical 
Advisers' Salaries, £22,500,— and the result of this proximate calcu- 
lation is, that the Medical Profession in Great Britain receives from 
Assurance Offices the annual sum of £57,937. Now, giving the ut- 
most weight to the quantity of time employed, the nominal I'esponsi- 
bility, and the value of the work performed ; impartial persons will, we 
think, conclude, that these circumstances will not justify a complaint at 
the instance of, or on behalf of. the Profession. 

It is quite true, that the persons with whom we are arguing have 
little interest in these matters, for those who receive that large sum of 
money are the ilite of the Profession, chosen by the Offices for their 
Chief Establishments and Agencies, on account of their abilities and 
trustworthiness. The combiners are those whom accident alone throws 
within the sphere of Life Assm'ance, a Patient occasionally happening 
to be an applicant for a Life Policy. But viewing the question as in- 
teresting to those parties, as merely involving money, it may be well to 
consider how far it is prudent for the combinations to endeavour to 
make head against the Companies and their own Patients; and impede 
the progress of economical habits and independence amongst the in"- 
dustrious classes, for the sake of a very trifling number of guineas. 
Opposed to them there are the ablest and most popular members of 
the Profession, selected by the Companies, and by whom their Patients 
ar6 examined, who are not unlikely to displace them frdm attend- 
ance upon those Patients, if their conduct at an important crisis of 
acceptance of rejection by an Assurance Office is such as to give 
umbrage or to weaken confidence. But further, considering the 
pecuniary and honorary value of the offices of Medical Adviser, and of 
Medical Examiner of a Life Company, as proved by the personal and 
sought-out influence exerted to procm'e every vacant appointment, 
and that the Mnnagers of Companies are now engaged, with the aid of 
the Medical Directory, in marking the names of those who refuse every 
little assistance asked of them, as ineligible for such appointments ; is 
it wise to shut themselves out from this valuable field of professional 
employment ? Would it not be more prudent in a Medical Man to 
sacrifice the few fees wliich any one individual' can obtain, and by faith- 
ful reports show himself qualified to fulfil the duties of one of the 
7,000 Medical Officers ? A single report expressive of an opinion, and 
the reasons of that opinion, is generally sufficient to prove whether the 
Eeporter can be trusted as a Medical Examiner ; but so little attention 
have Medical Men hitherto bestowed upon Life Assurance, or statistics 
in connexion with that subject, that even the most conscientious and care- 
fully-prepared reports are frequently of little real use, if not dangerous ; 
whereas the perusal of a few Authors on the theory and practice of As- 
surance, and a due consideration of the points upon which information 



16 



is required for cu..bling a Board to decide upon the eligibility of a 
life for Assurance, added to a desire to improve the temporal comforts, 
and promote habits of economy and forethought among our fellow-men 
by embracing Life Assurance, would enable many men, now struggling 
in low practice, to become Medical Examiners ; and as no feeling of 
exclusiveness, or jealousy, prevents Companies from appointing as Ex- 
aminers, qualified persons attached to other Offices, there is a lucrative 
field open to Medical Men, competent and willing to occupy it. 

The continuance of these Associations, and the extent of annoyance 
they may occasion, mil much depend upon the opinion of the Public 
and Life Offices ; and it is thought that viewed in their proper light, 
they must be looked upon and treated, as other strikes or combi- 
nations, as public nuisances, got up to serve mercenary purposes. 
We appeal with some confidence to the higher classes of the Medical 
Profession ; to those of the higher grades and reputation ; to assist in 
defeating all selfish and mercenary schemes, tending to damage a Pro- 
fession whose character should be based upon a high standard of edu- 
cation, a desire to extend amongst all and particularly the industrious 
classes, every means for improving their social condition, — and upon 
the absence of a mercenary spirit. In that light the Public are disposed 
to treat Medical Men : they allow them, with a small share of learning, 
to take the title of a learned Profession. At their instigation, and 
without scanning minutely their motives, they build and endow Hos- 
pitals and Dispensaries, by means of which Medical Men may acquire 
distinction and wealth. There are undoubtedly, however, many of its 
members individually entitled to the utmost admiration and esteem, 
and whose characters should not be permitted to be compromised by 
disreputable combinations, formed by the more numerous and less 
respectable portion, upon principles and for objects which no liberal or 
enlightened Medical Man can approve. 

In conclusion, while we dispute the right of Medical combinations 
to claim for their members the remuneration which has been the 
subject of this discussion, and have shown how such attempts can be 
defeated, we would suggest, that if Medical Men would be satisfied 
in every case of a reference to them, involving a personal examination, 
with a reasonable fee regulated in its amount by the extent of the 
transaction about to be entered into. Assurance Companies should 
submit to the charge ; — which they might do without serious injury 
to the Assured. But if the extravagant and undistinguishing fee of a 
guinea is still to be demanded in every case, then the Companies must 
just fall back upon the remedy which they hold in their o^vn hands — 
that of deciding on cases without the Medical Attendants' reports. 
Experience has j-r'rv-^d their value to be almost infiuitesimally small, 
and Companies would incur but a trifling additional risk by accepting 
and rejecting Proposals without them. The Associates would thereby 
sufler the loss of many Patients, and the usual penalty of extortion 
too long persevered in — that of losing the moderate gain which they 
might otherwise have secured. • 



Printed by lUcharO Kinder, Green Arbour Court, Old Bailey, London.