PBOR2 passes Senate Committee

[jbarrass]

Just where in the hell do you come up with this crap? Sorry to say my friend you are clueless!

Step up to the plate and show me the info to support what your spewing!

Well, this is a source. Agree?

Here is Dr. Mark Eidson from CAMA's letter to Congress/Senate

Dear Congressman/Senator,
The Civil Aviation Medical Association (CAMA) is composed of aviation medical examiners (AME’s) who are interested in aviation and who provide medical certification services for our nation’s pilots. AME’s, half of whom are pilots, fully support general aviation and the safe medical certification of pilots. We wish to state our strong opposition to H.R. 3708 and S.2103, which we believe will seriously threaten the safety of affected pilots, their passengers, and the public below. These bills propose complete elimination of the FAA third class medical certificate for private pilots flying in clear weather with up to five passengers at altitudes up to 14,000 feet and speeds up to 287 miles per hour.

The third class medical certificate for private pilots is neither costly nor burdensome, being required every five years below age 40 and every two years thereafter. Its very existence deters individuals with clearly unsafe medical conditions from applying. In others, safe certification follows identification and treatment of potentially serious conditions. The House and Senate bills would allow lifelong flying without medical oversight by any physician, much less an AME. Individuals with serious and even life-threatening heart, lung, brain, psychiatric and alcohol/substance abuse conditions could declare themselves fit to fly. Self-declaration would free these individuals to carry five passengers at high altitudes at speeds approaching 300 miles per hour. Complete elimination of medical oversight for these pilots would constitute a clear and present danger to aviation safety.

Being mindful of challenges to general aviation, a CAMA task force for medical certification has proposed expanded recreational pilot privileges that would allow operation of larger aircraft at greater speeds with relaxed, simplified medical requirements. The key difference would be the preservation of medical oversight by AME’s. This model exists today safely and successfully in Canada, Australia, and the United Kingdom—all insist upon medical oversight. CAMA strongly recommends preservation of medical oversight for pilots and urges you to vote against its elimination as proposed in these bills.
Sincerely,
Mark Eidson, M.D.
President, CAMA

 

[GLMS_NC]

When will the house vote on this?

 

[bbchien]

I just can't bear Jthamilton getting abused here.

Skyhog, as I have commented to you privately, your need is, and has been, to see a particular sort of specialist. I will say no more, but public abuse demands a rebuttal. Grinding the axe is unbecoming.

Jbarass, your abuse of physicans is only matched by your 2012 prediction that we would get relief in spring of 2012.

Would anyone else like to step forward?

******
Fact of the matter is that Sen Feinstein's change of wording and process essentially makes PBOR2 a FOURTH class medical, something I have feared. No family doc is going to sign a "comprehensive" (her addition) medical exam and the 8500-8 exam side, because-

"Dr X, please tell the court your training and qualificiations for aviation medicine. Do you have any specific training? Any specific time in Occupational medicine? Or in it's subspecialty, Aviation Medicine? Tell us about your residency rotations!"

"oh, NONE? Please tell the court if you have ever been to FAA training on the subject?"

"Oh, never?"

"Your honor, I move to have the defendant struck from the status of 'expert'"
YHGBKM.

Now we await the assault from the House side. You all need to look a the GAO report dated September 2015 about the state of insurance in the GA fleet. The map on page 2 tells the story. Seems a lot of congress critters think that if the regulatory part is going away, the insurance part will do the regulation. Oh, but wait! only a bare minority of states require ANY sort of insurance.....

JtHamilton, I apologize for the behavior of this board. it is why user #5 (me) rarely comes around anymore. The usual players are grinding their usual axes.

 

[SkyHog]

I just can't bear Jthamilton getting abused here.

Skyhog, as I have commented to you privately, your need is, and has been, to see a particular sort of specialist. I will say no more, but public abuse demands a rebuttal. Grinding the axe is unbecoming.

Jbarass, your abuse of physicans is only matched by your 2012 prediction that we would get relief in spring of 2012.

Would anyone else like to step forward?

******
Fact of the matter is that Sen Feinstein's change of wording and process essentially makes PBOR2 a FOURTH class medical, something I have feared. No family doc is going to sign a "comprehensive" (her addition) medical exam and the 8500-8 exam side, because-

"Dr X, please tell the court your training and qualificiations for aviation medicine. Do you have any specific training? Any specific time in Occupational medicine? Or in it's subspecialty, Aviation Medicine? Tell us about your residency rotations!"

"oh, NONE? Please tell the court if you have ever been to FAA training on the subject?"

"Oh, never?"

"Your honor, I move to have the defendant struck from the status of 'expert'"
YHGBKM.

Now we await the assault from the House side. You all need to look a the GAO report dated September 2015 about the state of insurance in the GA fleet. The map on page 2 tells the story. Seems a lot of congress critters think that if the regulatory part is going away, the insurance part will do the regulation. Oh, but wait! only a bare minority of states require ANY sort of insurance.....

JtHamilton, I apologize for the behavior of this board. it is why user #5 (me) rarely comes around anymore. The usual players are grinding their usual axes.

I'm not grinding an axe against you, Bruce. My point was simply that the only ones who banded together against PBOR2 were AMEs. I would hope that you weren't one of the opposers, but if you were, then I guess you have reasons also (as I alluded to).

I really don't mind the public discussion on my case...I know HIPAA ties your hands, but I don't mind. I took your advice. I tried everything I could, including finding a nephrologist and paying out of pocket since my doctor said (and I quote) "nephrology is quackery for kidney stones." But I disagreed and did it...

Still couldn't get the damned stones to stop appearing long enough to get a clean CT. My doctor told me outright to stop getting CT scans done because I was endangering my health getting so many done.

I don't call that a "Bruce didn't do what I needed" case, I call that a bunch of manufactured hoops put in place by the FAA unnecessarily for what amounts to a very rare, and non-dangerous event (since I can feel a stone passing a few days ahead of time, it's easy to avoid flying, and moreover I seem to create and destroy stones regularly and rarely ever pass them).

I have no personal axe to grind against anyone but the idiots in OKC that have no business making medical decisions when I have a doctor that does that for me.

 

[SkyHog]

Just where in the hell do you come up with this crap? Sorry to say my friend you are clueless!

Step up to the plate and show me the info to support what your spewing!

Chew on this, i collect $125 an exam no matter what class. I could easily double my monies or prob. triple it by seeing regular patients in place of these. Instead i do these at the end of the day so they don't interfere with my regular schedule. This places me getting home 30-45 minutes later to spend with my family just to help a pilot. The cost comes nowhere close to compensate your for your time to review documents on certain physicals.

Then clearly, you must be a supporter of the elimination of the 3rd class medical, right?

 

[bbchien]

I'm not grinding an axe against you, Bruce. My point was simply that the only ones who banded together against PBOR2 were AMEs. I would hope that you weren't one of the opposers, but if you were, then I guess you have reasons also (as I alluded to).

I really don't mind the public discussion on my case...I know HIPAA ties your hands, but I don't mind. I took your advice. I tried everything I could, including finding a nephrologist and paying out of pocket since my doctor said (and I quote) "nephrology is quackery for kidney stones." But I disagreed and did it...

Still couldn't get the damned stones to stop appearing long enough to get a clean CT. My doctor told me outright to stop getting CT scans done because I was endangering my health getting so many done.

I don't call that a "Bruce didn't do what I needed" case, I call that a bunch of manufactured hoops put in place by the FAA unnecessarily for what amounts to a very rare, and non-dangerous event (since I can feel a stone passing a few days ahead of time, it's easy to avoid flying, and moreover I seem to create and destroy stones regularly and rarely ever pass them).

I have no personal axe to grind against anyone but the idiots in OKC that have no business making medical decisions when I have a doctor that does that for me.

Sigh. Not quackery. I have about a dozen airmen who just don't get stones anymore. You have to alter the river so that you don't have stuff appearing like crystalline sugar in the pot at Christmastime. What ignorance a physician has...Look up a company called Litholink if you wish, they are one of several that do the analyses. This sounds like "TMI" but it's really, "urine composition engineering".

 

[MichiPilot]

Dr. Edison's misuse of possessive punctuation makes me judge the entire content of his letter.

Well, this is a source. Agree?

Here is Dr. Mark Eidson from CAMA's letter to Congress/Senate

Dear Congressman/Senator,
The Civil Aviation Medical Association (CAMA) is composed of aviation medical examiners (AME’s) who are interested in aviation and who provide medical certification services for our nation’s pilots. AME’s, half of whom are pilots, fully support general aviation and the safe medical certification of pilots. We wish to state our strong opposition to H.R. 3708 and S.2103, which we believe will seriously threaten the safety of affected pilots, their passengers, and the public below. These bills propose complete elimination of the FAA third class medical certificate for private pilots flying in clear weather with up to five passengers at altitudes up to 14,000 feet and speeds up to 287 miles per hour.

The third class medical certificate for private pilots is neither costly nor burdensome, being required every five years below age 40 and every two years thereafter. Its very existence deters individuals with clearly unsafe medical conditions from applying. In others, safe certification follows identification and treatment of potentially serious conditions. The House and Senate bills would allow lifelong flying without medical oversight by any physician, much less an AME. Individuals with serious and even life-threatening heart, lung, brain, psychiatric and alcohol/substance abuse conditions could declare themselves fit to fly. Self-declaration would free these individuals to carry five passengers at high altitudes at speeds approaching 300 miles per hour. Complete elimination of medical oversight for these pilots would constitute a clear and present danger to aviation safety.

Being mindful of challenges to general aviation, a CAMA task force for medical certification has proposed expanded recreational pilot privileges that would allow operation of larger aircraft at greater speeds with relaxed, simplified medical requirements. The key difference would be the preservation of medical oversight by AME’s. This model exists today safely and successfully in Canada, Australia, and the United Kingdom—all insist upon medical oversight. CAMA strongly recommends preservation of medical oversight for pilots and urges you to vote against its elimination as proposed in these bills.
Sincerely,
Mark Eidson, M.D.
President, CAMA

 

[Palmpilot]

Dr. Edison's misuse of possessive punctuation makes me judge the entire content of his letter.

Compared to the level of apostrophe abuse we normally see on the Internet, his is a pretty mild case, IMO.

 

[SkyHog]

Sigh. Not quackery. I have about a dozen airmen who just don't get stones anymore. You have to alter the river so that you don't have stuff appearing like crystalline sugar in the pot at Christmastime. What ignorance a physician has...Look up a company called Litholink if you wish, they are one of several that do the analyses. This sounds like "TMI" but it's really, "urine composition engineering".

Agreed. And I told my doctor that his opinion mattered not and that I had an expert (namely, you) that recommended it and I trust you over him.

His response: "have him refer you, I care about my reputation."

Sigh.

 

[bbchien]

..and of course, from afar, not a member of your insurance network, he knows I can't do that. He's participating in a plan that penalizes him for referrals. LOVE IT....not.

 

[denverpilot]

I'm not advocating this at all, but there's absolutely no shortage of broke/not good Docs who happily sign anything for a buck. They don't have enough to lose to care about the liability either.

Still more "medical" marijuana sold in CO than legal OTC variety. Folks realized early on that the "medical" stuff is cheaper without taxes tacked on.

Only the tourists buy the non-medical variety.

I know this because I work for a company that has a large component that is a pre-employment drug screening company and services DOT screeners with data/web services. Not that employers care if it's "medical" or not, most of the time, but the majority of positive results, come from folks who have found Docs who'll sign anything.

Nobody sues these Docs when a dope head has a car wreck anyway.

 

[mcjon77]

I'm not advocating this at all, but there's absolutely no shortage of broke/not good Docs who happily sign anything for a buck. They don't have enough to lose to care about the liability either...

I was thinking the EXACT SAME THING. You mentioned the medical marijuana prescriptions. There are also the tons of "pain clinics" in Florida whose only purpose seems to be to write and fill out scripts for oxycontin.

I can imagine many docs looking to set up a simple "cookie cutter" business that uses their license to bring in steady income by serving this niche. Heck, I bet if you suggested it to the medical weed docs at least some of them would love to set this up as an additional revenue source.

 

[Old Geek]

Sigh.

I would hope that the sponsors would withdraw the bill, given that it has so little resemblance to the original.

 

[denverpilot]

Sigh.

I would hope that the sponsors would withdraw the bill, given that it has so little resemblance to the original.

Never miss an opportunity to give the appearance of doing something useful, while creating additional bureaucratic nightmares that'll keep your lawyer buddies in work forever.

 

[Jeff Oslick]

As I posted to the red board, there are tens of thousands of physicians who sign medical exams and release statements for kids to go to Boy Scout camp and play in sports leagues every year.

The notion that these docs won't sign a statement about a person's ability to fly an airplane on a specific day (the same as an IA who says a plane is "airworthy" at the moment of completion of an annual inspection) is ridiculous.

This doesn't even look like the radar return of a sparrow on the risk radar of most physicians.

The most important part of this bill is recurrent aeromedical education requirements for the pilots. That single component may have a greater risk reduction reward than anything else we could hope to do to screen pilots for medical conditions.

 

[Jeff Oslick]

Sigh. Not quackery. I have about a dozen airmen who just don't get stones anymore. You have to alter the river so that you don't have stuff appearing like crystalline sugar in the pot at Christmastime. What ignorance a physician has...Look up a company called Litholink if you wish, they are one of several that do the analyses. This sounds like "TMI" but it's really, "urine composition engineering".

And none of that has anything to do with the lack of incapacitation incidents related to kidney stones in the accident databases. Quite simply, the FAA's judgment that stone production=sudden incapacitation isn't supported by *any* evidence.

I got "lucky" based on a confluence of favorable events and a cooperative urologist that I was able to escape the FAA hell of an SI for kidney stones. It was at the cost of essentially grounding myself for over a year, and out of pocket costs of over $1,500. I hope I don't get cancer from those extra CTs and x-rays I had to put myself through. I'm sure if I'd been able to spend that extra money on more time with a flight instructor it would have had a much greater contribution to aviation safety.

 

[bbchien]

And none of that has anything to do with the lack of incapacitation incidents related to kidney stones in the accident databases. Quite simply, the FAA's judgment that stone production=sudden incapacitation isn't supported by *any* evidence.

Not true. There are about 10 such events (stone colic as a contributing factor) over the years- and those who have had a "troubled stone passage" will tell you it is downright near impossible to anything but think about said pain. YOUR experience isn't universal.

...... I'm sure if I'd been able to spend that extra money on more time with a flight instructor it would have had a much greater contribution to aviation safety.

I do agree with this, in the case of stones, however. Just be "smarter" about your assertions. Once you say something false, the rest is "blah blah blah blah"


Have you even read the final bill?

The questionnaire is the frontside of the 8500-8.
The signature to include medical license # is after the backside of the 8500-8. It is clearly designed to lay the unmistakable TORT trail back to the doctor, and it'll only take one suit to make this a problem.
But now, it's too late, I fear, to go back to the Aussie model.....

Good luck with your doc.
I'm outta here.

 

[Fearless Tower]

I'm not grinding an axe against you, Bruce. My point was simply that the only ones who banded together against PBOR2 were AMEs.

Not true. Did you forget the big stink that ALPA threw up in opposition?

 

[wsuffa]

Remember that there are three ways to kill a bill: 1) vote against it and/or oppose it and/or withdraw it, 2) drag it out until it dies, and 3) add enough stuff to it in the name of "public interest" that adopting it will be worse than not adopting it (frequently used). Number 3) lets the person opposed say they're for the bill, but are just adding things to make it "safer" or "better".

It appears to me that Option 3) was used in this case.

 

[Fearless Tower]

It appears to me that Option 3) was used in this case.

Yes it does. I'm going to barf if I hear AOPA calling this a win.

 

[Palmpilot]

Remember that there are three ways to kill a bill: 1) vote against it and/or oppose it and/or withdraw it, 2) drag it out until it dies, and 3) add enough stuff to it in the name of "public interest" that adopting it will be worse than not adopting it (frequently used). Number 3) lets the person opposed say they're for the bill, but are just adding things to make it "safer" or "better".

It appears to me that Option 3) was used in this case.

If AME's will be willing to do the exam and sign the statement, then it's still a worthwhile improvement, because in most cases, it avoids getting the federal bureaucracy involved, thus avoiding the potential for delays, unnecessary expenses, or outright denial. There also appears to be less risk (or no risk?) of losing the sport pilot option.

 

[Jeff Oslick]

Not true. There are about 10 such events (stone colic as a contributing factor) over the years- and those who have had a "troubled stone passage" will tell you it is downright near impossible to anything but think about said pain. YOUR experience isn't universal.

"over the years" - many, many years, and I believe all or most of the ones you're referring to involved airline flights, where there was someone else there to take over. A medical incident, not an accident, and we don't know what the outcome would have been in a single-pilot situation. The body has the means to suppress pain when it is advantageous for maintaining "life".

Of these incidents, how many involved 1st-time stone occurrences that the FAA medical would have done absolutely nothing to address?

Have you even read the final bill?

The questionnaire is the frontside of the 8500-8.
The signature to include medical license # is after the backside of the 8500-8. It is clearly designed to lay the unmistakable TORT trail back to the doctor, and it'll only take one suit to make this a problem.
But now, it's too late, I fear, to go back to the Aussie model.....

Good luck with your doc.
I'm outta here.

Yes, I have read the bill. I have also read several Boy Scout and sports-medical release forms and statements that physicians sign literally millions of times each year. The FAA form does not differ in any significant manner.
Here is the statement for Boy Scouts:
"I certify that I have reviewed the health history and examined this person and find no contraindications for participation in a Scouting experience."

I call BS on the notion that regular GPs won't complete and sign the form. Sure, maybe a few won't, but it will be rare.

If we're smart about how we conductor ourselves as pilots under this new system, just like Sport Pilot opened the door to this change, this change can be the starting point for the next "loosening of the noose".

 

[bbchien]

"over the years" - many, many years, and I believe all or most of the ones you're referring to involved airline flights, where there was someone else there to take over. A medical incident, not an accident, and we don't know what the outcome would have been in a single-pilot situation. The body has the means to suppress pain when it is advantageous for maintaining "life".

Of these incidents, how many involved 1st-time stone occurrences that the FAA medical would have done absolutely nothing to address?




Yes, I have read the bill. I have also read several Boy Scout and sports-medical release forms and statements that physicians sign literally millions of times each year. The FAA form does not differ in any significant manner.
Here is the statement for Boy Scouts:
"I certify that I have reviewed the health history and examined this person and find no contraindications for participation in a Scouting experience."

I call BS on the notion that regular GPs won't complete and sign the form. Sure, maybe a few won't, but it will be rare.

If we're smart about how we conductor ourselves as pilots under this new system, just like Sport Pilot opened the door to this change, this change can be the starting point for the next "loosening of the noose".

Anything you say, Dr. Oslick, (so qualified to say). PS the latest version of the bill removed the original article 7. So, I won't be doing these.

But you should know. you're an _____ by profession.

 

[Jeff Oslick]

Anything you say, Dr. Oslick, (so qualified to say). PS the latest version of the bill removed the original article 7. So, I won't be doing these.

But you should know. you're an _____ by profession.

I deal with high risk, high liability work frequently in my work. You're not the only doc in the country, and not even the only "highly experienced difficult case AME". You're just the most vocal on the internet.

I thought you were "done" here.

 

[Lindberg]

Can't speak to that, I only know what I'd do. I guarantee Docs without AME training are going to pass on this.

Some certainly will pass. I once had a doctor say he wouldn't sign a form that said I was fit to take SCUBA lessons because, "It's dangerous and you shouldn't do it." But there will certainly be some who will sign. I think my current PCP would likely sign off after carefully reading everything. He's a good doc and has been my family doc since I was in high school. My prior family doc was also my first AME.

Worse case, there will still be AMEs and you can go to one of them for your non-flight-physical flight physical.

 

[Bill]

I have also read several Boy Scout and sports-medical release forms and statements that physicians sign literally millions of times each year. The FAA form does not differ in any significant manner.
Here is the statement for Boy Scouts:
"I certify that I have reviewed the health history and examined this person and find no contraindications for participation in a Scouting experience."

I call BS on the notion that regular GPs won't complete and sign the form.

A boy scout with a medical issue won't have the potential to kill an apartment house full of people, or drop into a mall, or.....

 

[SkyHog]

A boy scout with a medical issue won't have the potential to kill an apartment house full of people, or drop into a mall, or.....

Statistically, neither does an airplane.

 

[Bill]

Statistically, neither does an airplane.

True, but as Bruce said, all it will take is one Dr being taken to the cleaners and it's game over.

 

[jbarrass]

There's a DO in my bldg that does DOT physicals for $45. Saw him yesterday and asked him if he'd be doing them for the FAA.

He said no. Smiled, and said $55.....

I'm not worried about finding a doc for a simple 4 year government exam.

 

[Jeff Oslick]

A boy scout with a medical issue won't have the potential to kill an apartment house full of people, or drop into a mall, or.....

The medicals are for the Boy Scout adult leaders too. A serious medical problem in the back country can endanger the whole group when they attempt a rescue.

We keep hearing the "cry wolf" of what if ....

Well, the "what if's" have happened, and they make the news cycle for a day and are then promptly forgotten about.

 

[JoseCuervo]

The medicals are for the Boy Scout adult leaders too. A serious medical problem in the back country can endanger the whole group when they attempt a rescue.



We keep hearing the "cry wolf" of what if ....



Well, the "what if's" have happened, and they make the news cycle for a day and are then promptly forgotten about.

Comparing Boy Scout leaders, unless they are molesting the little kids, does not have anywhere near the liability that a pilot could have.

 

[Everskyward]

Doctors (and pilots) have different perceptions of risk, whether it be liability or otherwise, which they are willing to accept. The mistake is thinking everyone is the same. I'm sure there are doctors who won't sign off and also some who will. I once tried out a new PCP who thought flying was dangerous. That was the last time I went to her.

 

[Jeff Oslick]

Comparing Boy Scout leaders, unless they are molesting the little kids, does not have anywhere near the liability that a pilot could have.

First, the slam on BSA wasn't relevant or warranted. If you had any knowledge on the subject you'd know the strict rules BSA operates under now to prevent that cr@p from happening again. You'd also know that an incapacitated leader has the potential to put the boys at significant risk, particularly in the "high adventure" hiking areas.

The vast majority of pilots are only exposing themselves to the risks of their health issues. The data show that medical risk for pilots is rare to begin with, and events involving passengers third parties are even more rare.

Fortunately, there are still many in this country that don't run from their own shadows and understand that life isn't worth living if you're always afraid of getting sued for every remotely possible scenario.

 

[Jeff Oslick]

Doctors (and pilots) have different perceptions of risk, whether it be liability or otherwise, which they are willing to accept. The mistake is thinking everyone is the same. I'm sure there are doctors who won't sign off and also some who will. I once tried out a new PCP who thought flying was dangerous. That was the last time I went to her.

There are also a lot of pilots who are non-AME physicians, including my GP. I haven't asked him yet, but I suspect he won't have any issues signing this form.

 

[nddons]

Statistically, neither does an airplane.

True, but Boy Scout camp doesn't cost $50,000 per week. New Cessna 172s - built with the finest technology that the 1950s have to offer - cost over $350,000. I suspect liability has something to do with such an outrageous cost.

 

[Jeff Oslick]

True, but Boy Scout camp doesn't cost $50,000 per week. New Cessna 172s - built with the finest technology that the 1950s have to offer - cost over $350,000. I suspect liability has something to do with such an outrageous cost.

The aircraft costs has little to nothing to do with the liability. That is baked in to insurance cost. Short of absolute gross negligence, I very much doubt any insurance company would sue a physician over the medical issues. The concern is really only about personal injury/death liability.

 

[nddons]

The aircraft costs has little to nothing to do with the liability. That is baked in to insurance cost. Short of absolute gross negligence, I very much doubt any insurance company would sue a physician over the medical issues. The concern is really only about personal injury/death liability.

How does Cessna pay for their liability insurance cost?

 

[steingar]

My MD has yet to blink about signing (and writing) letters far more specific than what's on PBOR2. I find it hard to believe he'd blink at any of this. GPs write letters all the time.

 

[Palmpilot]

How does Cessna pay for their liability insurance cost?

By charging over $300,000 for a 172?

 

[JoseCuervo]

First, the slam on BSA wasn't relevant or warranted. If you had any knowledge on the subject you'd know the strict rules BSA operates under now to prevent that cr@p from happening again. You'd also know that an incapacitated leader has the potential to put the boys at significant risk, particularly in the "high adventure" hiking areas.

The vast majority of pilots are only exposing themselves to the risks of their health issues. The data show that medical risk for pilots is rare to begin with, and events involving passengers third parties are even more rare.

Fortunately, there are still many in this country that don't run from their own shadows and understand that life isn't worth living if you're always afraid of getting sued for every remotely possible scenario.

Which has caused more victims? Boy scout leaders molesting the young kids or an incapacitated leader on a "high adventure" hike?

Which has caused BSA (and their insurers) to pay the most money in claims?