Hypothetical - Basic Med & Insurance

B

Basic Med

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I have a friend that needs some info...

He has a Basic Med certification in hand. He takes a drug that is on the DNI list however it is admissible with a SI. His GP doctor signed his Basic Med form. His GP doctor obviously knows the drug he is on and knows he is fully functional on the drug. His doctor knows the drug is on the DNI list.

Given that background...

Would he have any possible insurance issues (renters or owners) if he were to ever get into an incident? Could the insurance company deny a claim if he takes the drug even with a doctor's approval but WITHOUT the SI?

Thoughts?
 
Interesting. Is there a particular policy type or carrier that would be more conducive to his situation?

Thanks
 
Do not issue is not the same as do not fly.

What is your real question?
 
bflynn said:
Do not issue is not the same as do not fly.

What is your real question?
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The only person who would nave the issue is the doctor who signed off, counter to Federal Advise on the DNI list. Thank "your friend" for creating the "test liability case" (when the dependents sue) which mercifully doesn't involve me. :O
 
Could he have issues? Of course, insurance is a game of how can I avoid paying enough that I make money. But that is more about a poorly written policy. It is not grounded in any reality of medical deficiency. An insurance company should have no cause to deny a claim based on which medical certification issued. By that same logic, they could deny a claim for a sport pilot or even for someone with a third class if a first class medical would have been better.

The medical was properly issued under the law. There are no SIs in basicmed. Do not issue merely says that an AME is required to defer the decision to the FAA. What that decision is depends on the drug and the underlying condition...there are some things the FAA wants to be fully informed about, so when they see a drug, they trigger a process to learn. DNI is the FAA forcing a pilot to tell them about a condition, not necessarily about a problem.

The GP has no need. They know the drug, they know the condition, that is part of the advantage of basicmed. They are not making an inferior decision by not deferring to the FAA, there is no process for them to do that.

The drum that Dr Chien keeps beating is the belief that a GP is not qualified to know how medical conditions are affected by flying, because they are not using the FAA procedures that AMEs are forced to use. Entirely different topic.
 
bflynn said:
The GP has no need. They know the drug, they know the condition, that is part of the advantage of basicmed. They are not making an inferior decision by not deferring to the FAA, there is no process for them to do that.
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Plus, they know the patient as an individual and are not placing them in what are ultimately stereotyped boxes.

The drum that Dr Chien keeps beating is the belief that a GP is not qualified to know how medical conditions are affected by flying, because they are not using the FAA procedures that AMEs are forced to use. Entirely different topic.
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I think part of the problem is that we think of flying a light aircraft as something so unique even in areas where it is not. Our regulations are the most restrictive and confusing. The FAA is the most obtuse and evil of any administrative agency. How can a plain ordinary physician who clears patients to return to work using machinery which can cut off their arms and legs possibly understand the superhuman skills required to land light piston airplane?

Now, arguably, there are some aspects to flying that might lead a GP to say, "I'm not really sure I understand what special abilities are involved," and I would expect that to be a good reason for the GP to decline to do a BasicMed exam.

I doubt stats we look at 10-20-30 years from now will find a statistically relevant difference in aviation accidents being caused by medical conditions among pilots with Part 67 medical, BasicMed, and (legal) no medicals at all. And that's going to be from a pool of accidents which is pretty small to begin with compared to perfectly healthy pilots who fly into weather they can't handle, run out of fuel, or do those many non-medical things which form the bulk of our GA accident rate.
 
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Thanks for the responses. All had a very interesting take on the subject.

I called my av insurance agent on his behalf since I was curious on the situation. They agreed with the reply above about how the policy is written. They went on to say that not every underwriter would see it the same but in their eyes a 3rd class with SIs was the same as Basic Med alone.

As all seem to agree, time will tell.

Thanks again. I appreciate these forums where people can discuss and disagree at times on interpretation but keep things civil.
 
bflynn said:
Could
The drum that Dr Chien keeps beating is the belief that a GP is not qualified to know how medical conditions are affected by flying, because they are not using the FAA procedures that AMEs are forced to use. Entirely different topic.
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I just love how nonphysicians keep saying "no worries doctor"...and then you get the summons. Sigh
 
bbchien said:
I just love how nonphysicians keep saying "no worries doctor"...and then you get the summons. Sigh
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No comment on it one way or another. Anyone's doctor could get sued for not finding a condition whether we're flying under Basicmed or not. If I'm under a 3rd class and have a MI while flying, does that prevent someone from suing my cardiologist for not knowing that it was going to happen? Successful or not, you have to deal with the lawsuit.

My comment here is that it's a different topic than the thread.
 
It certainly seems prudent for any doctor who is thinking of doing BasicMed exams to check with their insurer to see if they're covered for it.
 
bflynn said:
No comment on it one way or another. Anyone's doctor could get sued for not finding a condition whether we're flying under Basicmed or not. If I'm under a 3rd class and have a MI while flying, does that prevent someone from suing my cardiologist for not knowing that it was going to happen? Successful or not, you have to deal with the lawsuit.

My comment here is that it's a different topic than the thread.
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Under 3rd class, if the standard of inspection had been met, there would be no question or remaining liability. Not so under basic med, Brian.

Suit youself and ignore the difference but I can't ignore that.
 
bbchien said:
Under 3rd class, if the standard of inspection had been met, there would be no question or remaining liability. Not so under basic med, Brian..
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I understand your statement, why wouldn't the same apply to GP's liability as concerned with driving cars, boats, etc.? Then why not planes.
 
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bbchien said:
Under 3rd class, if the standard of inspection had been met, there would be no question or remaining liability. Not so under basic med, Brian.

Suit youself and ignore the difference but I can't ignore that.
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With Basic Med, the doctor is only supposed to review the information supplied, do a basic exam and sign that everything was discussed and nothing surprising found. Certification of "fit to fly," as always, rests with the PIC, and this is emphasized in the information package I printed off from AOPA.

I've never had an AME do anything to my heart more complicated or investigative than listen briefly with a stethoscope and look at the blood pressure numbers writte down by the nurse. How is this supposed to "certify" that I'm healthy and won't have a heart attack next week?
 
But if the dr was just ignorant/didn’t know that he’s on a med that’s a problem and signed it the dr will be liable for anything bad that could come of that. While PCP do know the patients best I the basic med process seems less complicated then a commercial drivers medical. As a PA I can’t fill these out but I have seen local docs doing them and not sure they really know what they are getting into!
IMO more training should be provided/required.

I may get hung out for this, but the beauty of going to an AME is that they don’t know you all that well and I think look more objectively. Whereas someone you see all the time allows that familiarity to fog things at times.
 
benyflyguy said:
But if the dr was just ignorant/didn’t know that he’s on a med that’s a problem and signed it the dr will be liable for anything bad that could come of that. While PCP do know the patients best I the basic med process seems less complicated then a commercial drivers medical. As a PA I can’t fill these out but I have seen local docs doing them and not sure they really know what they are getting into!
IMO more training should be provided/required.

I may get hung out for this, but the beauty of going to an AME is that they don’t know you all that well and I think look more objectively. Whereas someone you see all the time allows that familiarity to fog things at times.
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I never have had as thorough of going over at any AME as I have with my PCP.
The only reason I went basic med was the fact that my insurance covers my office visits and my doctor doesn't charge me any copays as a professional courtesy....
As mentioned before, I believe any AME is released of liability if the patient is not truthful on the FAA forms. If there is any problems/SI's he just punts it to the FAA relieving him further. Where as a PCP "might" be liable if he signs off on a basic med with known problems that will cause impairments.
 
1RTK1 said:
I never have had as thorough of going over at any AME as I have with my PCP.
The only reason I went basic med was the fact that my insurance covers my office visits and my doctor doesn't charge me any copays as a professional courtesy....
As mentioned before, I believe any AME is released of liability if the patient is not truthful on the FAA forms. If there is any problems/SI's he just punts it to the FAA relieving him further. Where as a PCP "might" be liable if he signs off on a basic med with known problems that will cause impairments.
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I’m not saying exam will be better. But there stands the chance for some more laxity with the rules and paperwork review. Think of the average AME. How many Aviation exams a week or a day do they do. Think of the average pcp, how many basicmed physicals do they do a week or a month. Some might see one or two a year.
While there are always exceptions...AME’s are geared towards the strict requirements because they do it all the time. Pcp’s have a lot going on outside of your basic med physical. That’s all.
 
1RTK1 said:
I understand your statement, why wouldn't the same apply to GP's liability as concerned with driving cars, boats, etc.? Then why not planes.
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cars, as in DOT comm: doc takes a course+ test annually so he has a CREDENTIAL.

Not so for basic med.
Am. Bd. of Fam Practice competency staternt doesn’t have the word “airplane” in it.....
 
1RTK1 said:
I never have had as thorough of going over at any AME as I have with my PCP.
The only reason I went basic med was the fact that my insurance covers my office visits and my doctor doesn't charge me any copays as a professional courtesy....
As mentioned before, I believe any AME is released of liability if the patient is not truthful on the FAA forms. If there is any problems/SI's he just punts it to the FAA relieving him further. Where as a PCP "might" be liable if he signs off on a basic med with known problems that will cause impairments.
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bbchien said:
cars, as in DOT comm: doc takes a course+ test annually so he has a CREDENTIAL.

Not so for basic med.
Am. Bd. of Fam Practice competency staternt doesn’t have the word “airplane” in it.....
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This and this. Not a lawyer but I was struck by the wording of Texas law regarding conceal carry if a medical exam is required, specifically shielding the physician from liability, and I have seen no such wording in BasicMed. In my opinion such wording should have been included because without it you are holding the doctor responsible for judging whether a condition makes one unfit to fly without having had any specific training on the matter.
 
Rushie said:
This and this. Not a lawyer but I was struck by the wording of Texas law regarding conceal carry if a medical exam is required, specifically shielding the physician from liability, and I have seen no such wording in BasicMed. In my opinion such wording should have been included because without it you are holding the doctor responsible for judging whether a condition makes one unfit to fly without having had any specific training on the matter.
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The FAA holds the PIC responsible for determining that he / she is fit to fly before every flight . . . .
 
Kenny Phillips said:
Whilst true, it won't stop a grieving widow from suing anyone and everyone for her loss.
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Anyone with the cash to pay to file can sue anyone they want, for any reason they want. In WV (where I used to live), the filing fee for a lawsuit was $35; I don't know what it is here in AL

And since BasicMed was created by Federal Regulations in compliance with laws passed by Congress, both the laws and the appropriate FARs can be introduced as evidence for the defense.

But there is no way to prevent anyone, much less everyone, from ever suing you . . . .
 
Hank S said:
Anyone with the cash to pay to file can sue anyone they want, for any reason they want. In WV (where I used to live), the filing fee for a lawsuit was $35; I don't know what it is here in AL

And since BasicMed was created by Federal Regulations in compliance with laws passed by Congress, both the laws and the appropriate FARs can be introduced as evidence for the defense.

But there is no way to prevent anyone, much less everyone, from ever suing you . . . .
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This is true but if there is liability protection in the verbiage I would hope that would carry weight in the court. It's above my pay grade to know whether this is true but I would hope it's something.
 
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One reason that insurance coverage is important is that it covers your legal costs.
 
Palmpilot said:
One reason that insurance coverage is important is that it covers your legal costs.
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I think in the context of the original question, the issue was about your owners/renters policy hanging you out to dry under basic med because you did not follow a stricter standard. In that context, your insurance would not pay for legal costs.

Then the thread drifted, as basicmed threads tend to do, into liability because of the standard of medical judgement. One thing to keep in mind is that the FAA does not consider basicmed to be a medical certification. It is an alternative procedure, but is not a medical certification. Whether or not insurance would cover legal bills would depend on the individual policy and terms.
 
bflynn said:
Then the thread drifted, as basicmed threads tend to do, into liability because of the standard of medical judgement. One thing to keep in mind is that the FAA does not consider basicmed to be a medical certification. It is an alternative procedure, but is not a medical certification. Whether or not insurance would cover legal bills would depend on the individual policy and terms.
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I was talking about liability coverage. A local attorney said that insurance companies have a "duty to defend" if their insured gets sued. I'm in California and don't know whether the same would be true in other states.
 
Hank S said:
Anyone with the cash to pay to file can sue anyone they want, for any reason they want. In WV (where I used to live), the filing fee for a lawsuit was $35; I don't know what it is here in AL

And since BasicMed was created by Federal Regulations in compliance with laws passed by Congress, both the laws and the appropriate FARs can be introduced as evidence for the defense.

But there is no way to prevent anyone, much less everyone, from ever suing you . . . .
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Couldn't disagree more. Most state court by the way have filing fees more likely in $100"S except for small claims, ( and any claim involving FAA regs would likely be in Federal court anyway) but that is irrelevant.

The issue is the pilot is "knowingly" circumventing the FAA reg regarding a disqualifying condition that requires an SI first before Basic Med. In addition he's asking primary care doctor to sign off on it knowing that it's not in compliance with the regulations. This is just the type of stuff that forces more regulations designed to stop this end around maneuver and the everyone screams and yells about new regulations. Do what is required and don't put your primary doc in this position. The legal aspects of a claim following an accident where a pilot wrongly had his basic med issued outside of the SI protocol would require a separate class in law school. My '02


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There are only 3 SI conditions for Basicmed - cardiac, neurological or mental.

Trying to apply any other standard or process to it becomes outlandish. Past those three, there are no regulations or standard that must be applied. Because a doctor does not go to the lengths the FAA will go to is not deficiency. Or if you want to call it so, then you must argue that every doctor in the country is deficient if they are not following FAA 1st class protocols.

If an airman lies about their condition, then insurance is probably equally unlikely to support them regardless of their medical process.
 
In terms of the original question on insurance coverage: I think the insurer may have an argument that the pilot committed fraud in his application as to the status of his medical in that the pilot would know that he had a condition that required an SI prior to a basic med which essentially means his basic med was invalid. as usual it will depend on the plane, the injuries and ultimately how much money is at stake.


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Tommar98 said:
In terms of the original question on insurance coverage: I think the insurer may have an argument that the pilot committed fraud in his application as to the status of his medical in that the pilot would know that he had a condition that required an SI prior to a basic med which essentially means his basic med was invalid. as usual it will depend on the plane, the injuries and ultimately how much money is at stake
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Wow, we cannot get even pilots to understand basicmed.

If you would require a SI under the third class protocol, that is meaningless under basicmed. It does not mean a condition is being hidden, it means your doctor is treating it instead of the OM doctors in Kansas City dictating research into the status of the condition. Your health is probably better served by engaging with your doctor instead of being the FAA’s research dummy. That is the major difference - the FAA just wants to understand the condition, you and your doctor want it made better.

If a pilot hides a medical condition from their doctor, then it really doesn’t matter which protocol they work under.
 
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bflynn said:
Wow, we cannot get even pilots to understand basicmed.

If you would require a SI under the third class protocol, that is meaningless under basicmed. It does not mean a condition is being hidden, it means your doctor is treating it instead of the OM doctors in Kansas City dictating research into the status of the condition. Your health is probably better served by engaging with your doctor instead of being the FAA’s research dummy. That is the major difference - the FAA just wants to understand the condition, you and your doctor want it made better.

If a pilot hides a medical condition from their doctor, then it really doesn’t matter which protocol they work under.
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I can see where if even pilots cannot understand BasicMed, insurance companies and lawyers definitely won't and might hassle you with lawsuits anyway.

Nevertheless you are right. But OP didn't state what the drug was for. If the underlying condition is one of those three you list, I could see where he might have an issue. But even if it is in one of these three broad categories it would have to be one of the listed conditions below, if the FAA.gov website is correct and I'm not assuming it is.

Medical Conditions Requiring One Special Issuance Before Operating under BasicMed
  • A mental health disorder, limited to an established medical history or clinical diagnosis of—
    • A personality disorder that is severe enough to have repeatedly manifested itself by overt acts;
    • A psychosis, defined as a case in which an individual —
      • Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or
      • May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;
    • A bipolar disorder; or
    • A substance dependence within the previous 2 years, as defined in §67.307(a)(4) of 14 Code of Federal Regulations
  • A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following:
    • Epilepsy;
    • Disturbance of consciousness without satisfactory medical explanation of the cause; or
    • A transient loss of control of nervous system functions without satisfactory medical explanation of the cause.
  • A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following:
    • Myocardial infarction;
    • Coronary heart disease that has required treatment;
    • Cardiac valve replacement; or
    • Heart replacement
 
Self-grounding requirements are the same for 3rd Class and BasicMed. BasicMed pilots are required to take a course that explains the self-grounding requirement and how medications contribute to that. 3rd Class pilots are not. From the personal responsibility perspective the insurance companies should favor BasicMed.

The internet perpetuates the idea that insurance companies will deny coverage over small details that aren't cause for an accident. I know accident pilots and lost pilot's survivors and haven't seen any hostile denials by insurers. If insurance denial is part of the discussion perhaps denial statistics should be established. Without it any implication of potential denial is unsupported rhetoric.
 
Stewartb said:
Self-grounding requirements are the same for 3rd Class and BasicMed.
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Yes, pilots operating under Basicmed are required to self ground if they know of a condition that would impair their ability to safely fly. No, they are not required to use the 1st, 2nd or 3rd class medical standards to do it. Yes, they should consider aeromedical knowledge as well as their doctor's opinions in making their decisions. Yes, if the pilot has any condition, they are required to be under a doctor's care for that condition.

Basicmed is not a medical certification. It is an alternative procedure to getting a medical and as such it does not require adherence to other medical standards beyond the ability to be safe.
 
bflynn said:
Yes, pilots operating under Basicmed are required to self ground if they know of a condition that would impair their ability to safely fly. No, they are not required to use the 1st, 2nd or 3rd class medical standards to do it. Yes, they should consider aeromedical knowledge as well as their doctor's opinions in making their decisions. Yes, if the pilot has any condition, they are required to be under a doctor's care for that condition.

Basicmed is not a medical certification. It is an alternative procedure to getting a medical and as such it does not require adherence to other medical standards beyond the ability to be safe.
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Correct. Alternative TO getting a medical, not FOR getting a medical. It is not a medical.

From https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/
On July 15, 2016, Congress passed legislation to extend the FAA's funding. This legislation, FAA Extension, Safety, Security Act of 2016 (FESSA) includes relief from holding an FAA medical certificate for certain pilots. This relief is called BasicMed.

When can I fly under BasicMed?
If you meet the BasicMed requirements, you can operate under BasicMed (without an FAA medical certificate) right now!
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It can't be any more plain: "relief from holding an FAA medical certificate" and "without an FAA medical certificate".

They should have called it something other than BasicMed, that seems to be confusing everybody.
 
Semantics. BasicMed is a medical certification, just not issued by the FAA. A BasicMed approval certifies that you complied with the requirements if the BasicMed exam checklist on the date of the exam, no different than a 3rd Class certifies you met the 3rd Class requirements on the date of the exam.
 
I have one of the three conditions listed in the BM rule, consulted with and retained Dr Bruce, got my tests, got my sh|t into one sock, and got the 3rd class SI done. I've since renewed using BM, and I can't be an happier. BM is a godsend for those with medical issues.
 
Stewartb said:
Semantics. BasicMed is a medical certification, just not issued by the FAA. A BasicMed approval certifies that you complied with the requirements if the BasicMed exam checklist on the date of the exam, no different than a 3rd Class certifies you met the 3rd Class requirements on the date of the exam.
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No Stewart, the doctor finds "I certity that I am not aware of any medical condition that, as presently treated would interfere with the indivdual's ability to safely operate an aircraft." Anything he overlooks is NEGLIGENT. It is in his judgement.

Try certifying when your board certification expertise statement doesn't have the word "aircraft" in it. NOT semantics. TORTS.
 
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