What is a medical consultant? How does her work contribute to making insurance more accessible? Gaëlle Bergot, senior medical consultant at BNP Paribas Cardif, answers our questions.
Gaëlle, you are Senior Medical Consultant at BNP Paribas Cardif. To get to know you better, let’s take a quick look at your background.
I trained as a general practitioner, with a specialty in adult and paediatric medical emergencies. I worked at a private home-emergency medical group for 17 years. In 2003, I took a diploma course as an insurance and legal compensation doctor for personal injuries¹, in order to practice medical and insurance consultancy.
How did you get into the insurance business?
My first role as a medical consultant in the insurance sector involved the analysis of medical files for medical leave and disability, in the context of insurance coverage claims. Then, after various assignments as medical consultant at various insurance companies, I was appointed chief medical officer of a personal insurance company, specialising in group insurance. I continued my career, moving to a major reinsurer, and I now work at BNP Paribas Cardif, which I joined in June 2020.
So why exactly does a company like BNP Paribas Cardif call upon a medical consultant?
Because from the moment when a company holds medical documents, in order to guarantee the application of medical secrecy, it is obliged to have a contractual relationship with a medical consultant. All of the medical data of their clients are under their responsibility. I should also point out that we have an independence clause in our contract. This allows us to study dossiers in a purely medical manner, and totally independently, vis-à-vis the insurer, and without any commercial standpoint. Also, in a company like ours, the level of technicality of the medical information needing to be analysed often requires professional expertise.
Going back to medical confidentiality, could you tell us a bit more about that?
Bear in mind that in France we have to respect the legislative rules on the application of professional medical confidentiality, and a medical consultant, just like any other doctor, is subject to the Code of Medical Ethics of the Conseil de l’Ordre des Médecins. Of course, we don’t deal directly with patients, but we deal with customers who entrust us with their personal medical information. We have to obey the same duties of protection as we would for any other patient. The application of medical confidentiality by the insurer allows customers to feel protected when they entrust us with information about their health. In a nutshell, we are the communication relays for all exchanges of medical data relating to customers.
In practice, who is trained in medical confidentiality at BNP Paribas Cardif?
Employees whose duties include underwriting and compensation writing have partial delegation of medical analyses. They are specifically trained and authorised for that. They work within the medical confidentiality bubble at the Nanterre site, alongside the medical consultants. We also train other employees who might come into contact with confidential documents containing personal health data, whether these documents are paper-based or digital. This type of data enters a medical EDM² system, is marked as “confidential”, and is accessible only to authorised persons. Also, as part of my role, I take part in the process of securing medical documents communicated to us by clients.
And so, going back to your role: what are the main roles of a medical consultant?
In addition to the role of guarantor of securely held and confidentially processed medical information, the roles of the medical consultant are varied and cross-departmental.
We are in charge of medical risk analysis. We have a lot of discussions with actuaries and lawyers about the evolution of rules, constraints, and the limits of this risk analysis. We seek to adapt to scientific progress and societal changes, in order to improve the way the insurer deals with pathologies. In addition, we take part in committees and professional federations aiming to expand the rules for the processing insurance medical files.
Your roles are very customer-oriented.
We even have an almost direct link with customers, as one of our roles is writing letters explaining decisions with medical content to customers (or their heirs). So I would answer yes, as a medical consultant, we have a duty to protect and support customers. But also that of helping the insurer to establish fairness between the medical information transmitted, and the application of contracts (verifying that requests for compensation correspond to what was initially provided for in the contract). In practice, we recruit and assign independent medical experts to examine and assess the incapacities/degrees of incapacity of customers. This network is a pillar of analysis and medical decision-making.
A topical question: has the Lemoine law³ altered your approach, or even your role as a medical advisor?
We adapt our practices and tools to successive legislative developments, but our technical analysis remains the same. The Lemoine law³ provides for easier access to insurance for certain people who have aggravated health risks. We continue to study medical dossiers following coverage claims, that being the main role of the medical consultant and expert. Another of our roles is to respond to customers who request explanations about the application of this principle to their particular case.
In conclusion, what makes you passionate about your job as a medical consultant?
The intellectual approach to investigation, that pushes us to do research on infrequent or unknown pathologies that we come across. This objective medico-technical-legal analysis of cases allows us to work in two worlds: the world of medicine and the world of business. And the human aspect: experience on the ground allows me to project myself further than just a dossier, and put myself in the place of a customer suffering from a pathology which is impacting their daily life, on a personal and professional level, and helping them in their coverage plan. And not forgetting the sharing of experience and expertise within the teams interested in this rich and varied medical subject.
¹ University Diploma RJDC - Legal Compensation for Bodily Injury - insurance specialty at the University of Paris V René Descartes
² EDM: Electronic Document Management
³ Lemoine Law: voted on February 28th, 2022, this law aims to simplify consumers’ access to Borrower Insurance for their real estate loans. It brings some major changes: removal of medical formalities according to certain criteria, facilitating termination/substitution, strengthening of the right to be forgotten.