As P&I Club Correspondents, Jiménez, Graffam & Lausell is often instructed to liaise with vessel Agents to make sure that injured or ill crewmembers receive adequate medical care and that the costs incurred are reasonable. In many instances, the need for medical care develops as an emergency where immediate action is required. It is also not unusual that Puerto Rico is not a scheduled port of call.
-Certain Aspects to Keep in Mind-
1. In those instances where Puerto Rico is not a scheduled port of call, it is important that the ship Owners appoint a local Agent as soon as possible. Not only do ship Agents clear the ship and the injured or ill crewmember with local authorities for entry, but also coordinate with resources for evacuation and transportation of the injured or ill crewmember from the ship to a medical facility. In some instances, we are approached to make these arrangements, but the local Agents are the ones that have the necessary guaranteed bonds in place and comply with requirements by local authorities to deal with clearance issues, as well as to hire local contractors who may have to participate in the evacuation/disembarkation effort.
2. Hospitals in Puerto Rico are both private and public. Medical care in private hospitals in Puerto Rico may turn out to be quite expensive. In those cases where the crewmember is admitted to a public medical facility, the ship Owners may still be billed for medical services, notwithstanding the fact that the crewmember was treated in a public facility.
3. In most instances the local hospitals will require a letter of financial responsibility identifying the person or entity ultimately responsible for the medical bills and guaranteeing payment. In some cases, the Agent or the local P&I Correspondent will receive authorization to tender such letter on behalf of the Owner or its P&I Club. It is important to obtain the letter of financial responsibility or the authorization to issue such letter early in the case. If not, treatment could be indirectly affected or delayed pending this administrative step.
4. Because of the economic element involved, not only with Hospital expenses, but also with those associated with ship’s clearance and the arrangements on disembarkation of the ill or injured crewmembers, we have seen instances where some local ship Agents are reluctant to accept assignments on short notice. There have been instances where local Agents have not received payment or reimbursement of funds to cover Hospital and other related expenses; or payment has been delayed for an inordinate amount of time. In every case involving a serious injury, where it is reasonable to expect that the crewmember will be admitted to a Hospital, the Agent will demand that the Owners advance funds for them to be able to cover expenses. If, for example, a crewmember is to undergo surgery, and it is expected that he will have to remain in Puerto Rico for a week or more, it would not be unusual to see a demand on advance funds in the range of $10,000.00 - $15,000.00.
5. In our role as P&I Correspondents, we liaise with the Agent to confirm that payments are made against invoiced medical, or other related, services and that charges are reasonable. We, as local P&I Correspondents, have also had cases where funds are transferred to our escrow account for us to disburse funds against invoiced charges and services from the local Agent or the medical facility. Under either scenario, adequate prompt payment of medical charges and expenses has an indirect effect for the benefit of ship owners in general (i.e. avoiding the adverse effect of having reluctant Agents based on lack of, or delayed, payment or reimbursement of medical and other related services).