The duties and responsibilities of an insurance medicine specialist are as follows:


To the clients:

            Attend his clients faithfully and conscientiously;

            Call his colleague into consultation/share information where warranted:

            Be moderate in charging professional fees (refer to 1978 guide, signed by PMA a

            affiliate members).


To the insurance industry:

Cooperate with government agencies in the observance of health laws and      regulations;

Refrain from abetting or being a party to illegal practices or other unethical acts;

Exercise ethics and prudence in clients' assessment/insurability.


To colleagues in the profession:

Maintain good relations with colleagues at all times;

Expose corrupt or dishonest conduct of members of the profession and aid in safe guarding the medical profession against admission to its ranks of those unfit or unqualified;

Keep abreast with and contribute positively to the progress of insurance medicine.




The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the company. As a member of this profession, an insurance medicine specialist must recognize responsibility to the company as well as the society, to other health professionals, and to self. The following Principles adopted by the Philippine Society of Insurance Medicine (PSIM) are not laws, but standard of conducts which define the essentials of honorable behavior for the insurance medicine specialist.


Principles of Medical Ethics


I.                     A specialist shall be dedicated to providing competent medical underwriting evaluation.


II.                   A specialist shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report specialist engaging in fraud or deception, to appropriate bodies.


III.                  A specialist shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of both clients and company.


IV.                A specialist shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.


V.                  A specialist shall continue to study, apply, and advance scientific knowledge, maintain commitment to medical insurability, make relevant information available to underwriters and colleagues, and obtain consultation, and use the talents of other health professionals when indicated.


VI.                A specialist shall recognize a responsibility to participate in activities contributing to the improvement of the insurance industry and the betterment of fair decision in assessing insurability.


ISSUES:             There is no patient-doctor relationship here.

Clients are not necessarily patients




This Opinion is limited to the conduct of individual specialist and does not refer to specialists acting as a collective.


1.                  Personal conduct, whether verbal or physical, that affects or that potentially may      affect colleague negatively constitutes disruptive behavior. (This includes but is not limited conduct that interferes with one’s ability to work with other members in the industry). However, criticism that is offered in good faith with the aim in improving risk assessment should not be construed as disruptive behavior.


2.                  Each specialist should develop and adopt bylaw provisions or policies for intervening in situations where a specialist’s behavior is identified as disruptive. The provisions of policies should contain procedural safeguards that protect due process. Specialists exhibiting disruptive behavior should be referred to a ______________ committee.


3.                  In developing policies that address physicians with disruptive behavior, attention should be paid to the following elements:


a.      Clearly stating principal objectives in terms that ensure high standards of professional practice and in handling applications as well as in dealing with colleagues and promoting a ____________________ work environment.


b.      Describing the behavior or types of behavior that will prompt intervention.


c.      Providing a channel through which disruptive behavior can be reported                                      and appropriately recorded. A single incident may not be sufficient for action, but each individual report may help identify a pattern that requires intervention.


d.      Establishing a process to review or verify reports of disruptive behavior.


e.      Establishing a process to nolify a specialist whose behavior is disruptive that a report has been made, and providing the specialist with an opportunity to respond to the report.


f.        Including means of monitoring whether a specialist’s  disruptive conduct improves after intervention.


g.      Providing for evaluative and corrective actions that are commensurate with the behavior such as self-correction and structured rehabilitation. Suspension of responsibilities or privileges should be a mechanism of final resort.


h.      Providing clear guidelines for the protection of confidentiality.


i.         Insuring that individuals who report specialists with disruptive behavior are duly protected in that way ________________.


Doc Mac,


           Here’s the copy of the draft. I change the word “physician” to “insurance medicine specialist” as suggested by Doc Emil.

           For your comments/suggestions please.

           Thank you.


                                                                Anna Bustria-Santos



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