Life assurance + unlimited access to medical records?

dunstonh

The have a justifiable need to know if there is information in the medical record that would affect their decision to offer the policy or whether a claim is payable. Where's the business need for the rest or the need to actually know the contents of the medical record rather than solely whether and what is relevant to the policy?

The insurers dont ask for the whole medical file unless it is required. They ask questions based on the health of the individual depending on the way the individual has answered the questions. So, that data is relevant. The only time they tend to go for more is on death to verify that there is no other information. Again, relevant.

Where's the legitimate business need to know about an ingrown toenail or fungal infection 20 years ago when providing a life only term insurance policy today?

There isnt and an insurance company isnt going to have any interest in that. They wouldnt write to a doctor for information about that (unless it turned bad and they had to have their leg chopped off )

Then it appears that the access requirement could at least be constrained to those times rather than at any time.

The OP (and possibly you?) seem to think they write to the doctore often or whenever they want. They dont. They write on because of certain events. Certain events that could occur at different times. Policy conditions may allow for guaranteed insurability options to be kicked in on house purchase, marriage or children being born. What dates are they going to happen? You dont know, hence why the declaration is open ended.

It's far from a non-issue when there's a past history of insurers improperly declining to pay claims based on medical details that weren't relevant.

There was a period when the media got onto this issue but in reality, it is usual for non-disclosure to be a reason in just 5% of cases. The FOS have a standard for non-disclosure and how they would expect it to be followed. So, that issue is really done and dusted.

It's also an issue for those who are reluctant to take insurance for this and other related disclosure reasons and the insurers who don't get their business as a result.

I know its often said and its not always fair but if you have something to hide then perhaps the insurers are better off not getting that sort of business.

the-chauffeur_2

I know I'm dragging this thread our for any longer than is absolutely necessary but I thought the following might be of interest . . .

At the point of application, insurance companies will only request either GP reports or medical records if any of the answers on questions on the forms are affirmative - in other words, if the applicant discloses a relevant medical condition (the key here is relevant). The application questions are almost always worded in such a way that they can be understood by anybody and often ask for details of symptoms rather than actual diagnoses.

There are a number of reasons for this approach - one is that is that some medical conditions have more than one name, which may not be immediately familiar to the applicant i.e. hypertension and high blood pressure. Another is that the individual may have experienced some of the symptoms detailed on the form, but not realised they're significance. Many life assurance applications contain at least one question asking whether the applicant has experienced any extended periods of numbness and tingling, which at face value can seem something of an odd thing to ask. But underwriters and medical specialists know that in some instances, such episodes can be an early indicator of neurological disorders like multiple sclerosis - hence the question.

When an insurer receives a claim notification, it will need to verify that the plan was established on the correct basis (insofar as the applicant provided all of the relevant information at the application stage) and to confirm that all of the claim criteria in the policy terms have been met. Until recently, insurance companies generally requested full copies of policyholder's medical records, but not for any particularly sinister reason . . . in most, if not all cases, this was done for the sake of expediency - it was felt that it was easier for doctor's surgery staff to copy an entire file rather than sort through the papers and pick out certain pages.

However, the Association of British Insurers (ABI) and the Financial Ombudsman Service (FOS) have been in lengthy discussion over the issue of non-disclosure - in part in response to some of the high profile cases in the media. Earlier this year, the ABI changed its guidance to insurers with regard to what information they should obtain on submission of claims and how they should treat non-disclosure. The changes and findings are too broad to detail here (and should be available on the ABI website), but briefly, insurers should now only request information they can show is material to their consideration of a claim. Naturally, the records they will need to request will differ from claimant to claimant, but the guidelines should make the industry position clearer.

That said, insurers have no control over what a doctor's surgery will send in return, so some may continue to copy entire files regardless. And there are other logistical hurdles in the way of access to patient medical history that neither the insurer nor the individual can have any influence over. For a start, there is no central database in the UK for patient records, and so all original papers are held by each individual's GP.

Secondly, there is no networked computer system between surgeries. Although we'd like to think that doctor's surgeries can pass bits of patient records to each other electronically (particularly when we switch GP's or in case of emergency), at present they simply do not have the infrastructure and so each surgery is left to manage its own records - both Lloyd-George notes (the paper records) and any they may have added to their own computers.

Consequently, if an insurer asks for copies of medical records, GP surgeries can only respond with paper copies. These are sent to specific departments within the insurer where they are closely guarded and can only be accessed by authorised individuals such as underwriters and their administrators - and regulation prevents the sensitive information they contain from being accessible or available to any other staff within the organisation. This labour-intensive record keeping system is in stark contrast to the recent types of data losses by government departments, almost all of which were electronic. Until such time as the NHS co-ordinates GP surgeries IT infrastructure (it's in the pipeline, but is still a long way off), the sheer impracticality of the patient records system mean that the chances of an individual's medical information being 'lost' in the public domain by an insurance company are absolutely minimal.

Details of the FOS' position on the issue of non-disclosure are available on its website. Given that its position is in line with that of the ABI, it expects insurers to apply the same standards when considering claims. If a claim is rejected, the policyholder can always submit a complaint to the FOS.

If you intend to apply for insurance (and this applies to all types of insurance or assurance), make sure you read and re-read all of the questions carefully. Think about what is being asked - and not what you think is being asked. As I said, the application questions are almost always worded in such a way that they can be understood by anybody. And if you are in any doubt whatsoever about whether you should disclose past medical conditions, put them down and let the insurer decide if they are important.

Hope that helps . . .

Wutang_2

chaffeur - I only read the end of all that but I don't think this chap is too bothered about the ABI and non-disclosure...but rather letting an insurance company contact his doctor!!

...by doing this, it ensures that you have insurance in case you die. I would accept that exchange. he seemingly would not.

grogdog

i think a point to note is that if they had any reason to contact your doctor after the policy started(which i have never heard happen), the policy would would only ever be changed if anything was brought to their attention that wasnt disclosed when the application was made. if something appears after policy was put in force then it would not alter original policy.

so basically if you disclosed everything up front then there should not be an issue.

the-chauffeur_2

Wu - I fear you may be right, but I won't be losing any sleep over it. Like I said, I just thought my comments might help.

Grog - you're right about up front disclosure, but I guess some folks prefer not let anyone other than their doctor have access to their medical records rather than get life cover.

Hey - each to his own, eh? There's room for everyone, right? :rolleyes:

jamesd

Dunstonh, if the insurance comapany wants access only in reasonable situations it shouldn't be seeking consent for access outside of those situations. If they ask for consent for it all at arbitrary times, then consumers reading the contract have to act on that basis, even if they would be willing to accept reasonable and relevant access.

Companies that act in that overbroad manner have to be presumed to lack due regard for privacy of personal and medical information.

dunstonh wrote: »

The OP (and possibly you?) seem to think they write to the doctore often or whenever they want.

I think that if I'm asked to sign a contract to give permission for access to any information at any time, I'd better be assuming that that access will be used or seeking a more reasonable contract. If their access is constrained, let the contract reflect those constraints.

dunstonh wrote: »

Policy conditions may allow for guaranteed insurability options to be kicked in on house purchase, marriage or children being born. What dates are they going to happen? You dont know, hence why the declaration is open ended.

Presumably the contract identifies those events in some way already, so those clauses could be used to constrain the access to records based on those events, among other possible triggers.

dunstonh wrote: »

it is usual for non-disclosure to be a reason in just 5% of cases

It's been a reason for me declining to proceed with more than 5% of the insurance applications that I've been offered.

Both at work and personally I take security, privacy and confidentially very seriously. Arbitrary access at arbitrary times just isn't normally required. Not even in insurance, where it's apparently been traditional to seek it, regardless of actual need.

the-chauffeur, that presence of medical information in many different systems is probably the greatest single safeguard there is for the privacy of medical information. It's excellent privacy practice to make the information inherently hard to access and require a human intermediary to get to it.

I'll have a look at the ABI site but I wasn't greatly impressed by the result of their consultations on HIV, which merely resulted in a question that everyone sexually active with a partner has to answer yes to. If I recall correctly it's "have you been exposed to any risk of HIV infection in the last five years" or similar. Any body fluid exchange carries that risk so it'd be interesting to know how many people who are sexually active with a partner answer no. Maybe the ABI just wasn't paying attention to all of the "safer sex" (as opposed to safe) campaigns that present that message.

The issue, at least for me, isn't access, but seeking unreasonably broad access instead of constraining it to only what is legitimately required for the cover involved.

dunstonh

I hear what you are saying but you have to find a balance between a declaration that is relatively short and easy to understand (simple) and one that is comprehensive, specific and pages long and unlikely to be read.

Insurers have a lot of things where we can be critical but I just don't see this as being an issue. However, the thread contains a lot of ways of looking at it so thats good.

All that said, I would not put my family's financial security at risk by refusing something that for the majority of people is never going to be activated.

OshayAway

True, the wording could be more specific but perhaps could just prove confusing.

As far as I am aware, the only time the insurer will request information from the GP is at point of application and/or claim.

The guaranteed insurability option would not be cause as the whole point to is to be able to increase the sum assured (within certain limits and as a result of certain events) without the need for further medical evidence.

The fact is that insurers are trying to get away from writing out for GP reports as far as possible due to the expense involved and delays in underwriting the policy in the first place.

In fact, what would be the point to request information once the policy had started? There is no advantage to the insurer. The contract is formed and based on material facts at point of application, or more accurately from the date the policy starts.

If the individual’s health declines after the policy commences, there is no implication on the ability for the policy to pay out. It does not present any non-disclosure issues and has no bearing on such. In the same way as if the individual took up bungee-jumping, took a job working on an oil rig or has immediate family diagnosed with MS.

Apart from that, the provision is bound by the Access to Medical Records Act of 1988 http://www.opsi.gov.uk/acts/acts1988/ukpga_19880028_en_1 as such there is provision for the application to see any information requested by the insurer, prior to it being released. The form that the applicant signs, includes this option to select and accompanies any request for information sent to the doctor.

If that still doesn't satisfy, I would suggest putting your concerns in writing directly to the insurer or via your adviser, and request assurance that your doctor will not be written to ad-hoc.

I hope that helps... and makes some sense!

jamesd

OshayAway, thanks!

dunstonh, "At the start of the policy and at any of the events given in section 4.1 we may ask your doctor to tell us about any conditions that may affect your life expectancy" would seem to be at least a reasonable start at a simple and constrained consent clause for a life cover policy with guaranteed renewability clauses.

What else would an insurer have a legitimate need to have disclosed?

dunstonh

dunstonh, "At the start of the policy and at any of the events given in section 4.1 we may ask your doctor to tell us about any conditions that may affect your life expectancy" would seem to be at least a reasonable start at a simple and constrained consent clause for a life cover policy with guaranteed renewability clauses.

Remember that the declaration has to be read by the GP staff. So, making reference to a section wouldn't tell them what those conditions are. Its just making it harder work all round.

Some doctors do ignore the insurance company medical request form and send out their own version to the customer/patient to sign. Maybe what is needed most is a standardisation in the declaration.