Life assurance + unlimited access to medical records?

the-chauffeur_2

Unfortunately, clauses of that nature simply won't capture all of the information that the underwriters are likely to need.

As well as the fact that most of the administration in relation to patient notes is carried out by surgery staff (whom in the main are not medically qualified), the suggested clause essentially asks a general practitioner (the clue is in the name) to make a value judgement about what he/she feels is important and/or material to insurance risk. A general practitioner is just that - a qualified individual with a general understanding of medical ailments and experience in treating such conditions - and although GPs knowledge base is broad, the depth of knowledge varies widely.

Moreover, GPs and underwriters are very different creatures - and just as you wouldn't ask an underwriter to diagnose a medical condition, GPs have little or no concept or experience of the consideration and calculation of factors affecting insurance underwriting. As a result, contacts of insurance (in this country at least) are constructed on the basis of disclosure and supply of information 'a prudent underwriter' would deem material - and not what the man in the street or his GP think is relevant. That's not to say this is an ideal situation - far from it - but it's the way the law has evolved in the UK.

Another issue that would arise is the suggestion of negligence or accidental non-disclosure on the part of the GP. As an example, say an insurer asked a GP surgery only to send what they felt was relevant to an individual's history. The surgery returns a bunch of selected papers, but something crucial (again, I'll use my example of numbness and tingling here) is not sent, because there's been no diagnosis, and the surgery staff don't feel that two or three episodes over two years is particularly interesting. I'm not suggesting for one moment that any GP would intentionally withhold something he or she knew about when asked by an insurer. But again, it's the surgery staff who do almost of the administration work. GPs themselves just don't have either the time or the spare resources.

The policy is then underwritten on the basis of the information provided, but within the space of a year, the policyholder is diagnosed with MS (happens more often than you'd think). As part of the claim notification process, the policyholder sends in letters from his or her specialist detailing the development of the condition over time, and makes specific reference to the medical records that were not sent in by the GP surgery.

As the law stands, on discovery of the previous episodes, the insurer would be within its rights to say that it did not receive all of the material information it required at the outset and either reject the claim, or only make partial payment - leaving the policyholder either short or with nothing. The only recourse the policyholder would have at that stage is legal action against the GP - which is not a situation any of us would want to find ourselves in. And I doubt any GP would want to accept that kind of responsibility, either. So the wordings are drafted in the way they are to remove any/all subjectivity on the part of the GP.

Either way, the resources that would be required to find our 'perfect' medium are just too costly to be practical - both from the insurers perspective and the additional burden it would place on the NHS. When setting insurance premium levels, insurers have to factor in all of the costs of administration, as well as what basically amounts to the odds of whatever it is they are being asked to cover happening (crude way of putting it, I know). It's simple economics - the more complicated the process (particularly processes that are not mechanised and require human involvement), the more costly the process becomes, and those costs have to be reflected in the final product price.

There's also the danger of becoming a little to conspiratorial about what goes on inside big companies. Don't forget that - sweeping generalisation alert - commercial companies want to make as much money as easily as they can. Reviewing medical records is a labour-intensive exercise as it can only be done by qualified individuals (and not machines or cheap labour). Again, it would be neither cost effective nor practical to review every application or policy at any time other than application or claim - insurers just don't have those sort of resources at their disposal and if they did, their premium costs would be so high, their products would be unaffordable.

I always maintain a healthy level of skepticism about what any company is doing with my personal data or information, but at the same time, I accept there are cost-benefit trade-off's that I might not like, but mean that I can afford the products I want. If you've got a credit card, storecard or any form of clubcard, your data is being gathered. Registration on internet forums requires you to share personal data. I chose to accept the terms of those facilities so that I can benefit from their services, but I realise that some won't want to - that's fine, their prerogative.

As far as abuse of access to medical records is concerned, ask yourself this - when was the last time you heard of the regulator fining or censuring an insurer for misuse of access to records rights? No, I've never heard of such a case, either. And believe me, you would've done if it happened - or happened regularly for that matter. Leaving aside the cost issue, insurers are very conscious of regulatory and legislative powers and know that when it comes to medical records, they have to be very careful. Large insurers are subject to FSA monitoring visits regularly, at which they need to demonstrate compliance with relevant regulation/legislation and explain their processes and procedures. It's widely acknowledged that medical records data is so sensitive that the regulators would take any breach or abuse very seriously. Just ask the FSA and see what they say.

It goes without saying that insurance companies are not perfect - not by any stretch of the imagination. After all, they're commercial entities and they certainly have their flaws. That said, don't get too wrapped up in media hype (which is generated to sell papers or make you visit websites or watch particular television programs) - and that goes for any subject. Whenever you can, base your choices on your personal knowledge and first-hand experience, and not on what others (including well meaning folks like me) have told you or what you've read. If you're in a situation where you can't do that, make informed, educated decisions based on what you are prepared to exchange (money and/or personal data) in return for goods or services. If you don't like what you're offered, vote with your feet and go somewhere else.

Wutang_2

the-chauffeur wrote: »

Unfortunately, clauses of that nature simply won't capture all of the information that the underwriters are likely to need.

As well as the fact that most of the administration in relation to patient notes is carried out by surgery staff (whom in the main are not medically qualified), the suggested clause essentially asks a general practitioner (the clue is in the name) to make a value judgement about what he/she feels is important and/or material to insurance risk. A general practitioner is just that - a qualified individual with a general understanding of medical ailments and experience in treating such conditions - and although GPs knowledge base is broad, the depth of knowledge varies widely.

Moreover, GPs and underwriters are very different creatures - and just as you wouldn't ask an underwriter to diagnose a medical condition, GPs have little or no concept or experience of the consideration and calculation of factors affecting insurance underwriting. As a result, contacts of insurance (in this country at least) are constructed on the basis of disclosure and supply of information 'a prudent underwriter' would deem material - and not what the man in the street or his GP think is relevant. That's not to say this is an ideal situation - far from it - but it's the way the law has evolved in the UK.

Another issue that would arise is the suggestion of negligence or accidental non-disclosure on the part of the GP. As an example, say an insurer asked a GP surgery only to send what they felt was relevant to an individual's history. The surgery returns a bunch of selected papers, but something crucial (again, I'll use my example of numbness and tingling here) is not sent, because there's been no diagnosis, and the surgery staff don't feel that two or three episodes over two years is particularly interesting. I'm not suggesting for one moment that any GP would intentionally withhold something he or she knew about when asked by an insurer. But again, it's the surgery staff who do almost of the administration work. GPs themselves just don't have either the time or the spare resources.

The policy is then underwritten on the basis of the information provided, but within the space of a year, the policyholder is diagnosed with MS (happens more often than you'd think). As part of the claim notification process, the policyholder sends in letters from his or her specialist detailing the development of the condition over time, and makes specific reference to the medical records that were not sent in by the GP surgery.

As the law stands, on discovery of the previous episodes, the insurer would be within its rights to say that it did not receive all of the material information it required at the outset and either reject the claim, or only make partial payment - leaving the policyholder either short or with nothing. The only recourse the policyholder would have at that stage is legal action against the GP - which is not a situation any of us would want to find ourselves in. And I doubt any GP would want to accept that kind of responsibility, either. So the wordings are drafted in the way they are to remove any/all subjectivity on the part of the GP.

Either way, the resources that would be required to find our 'perfect' medium are just too costly to be practical - both from the insurers perspective and the additional burden it would place on the NHS. When setting insurance premium levels, insurers have to factor in all of the costs of administration, as well as what basically amounts to the odds of whatever it is they are being asked to cover happening (crude way of putting it, I know). It's simple economics - the more complicated the process (particularly processes that are not mechanised and require human involvement), the more costly the process becomes, and those costs have to be reflected in the final product price.

There's also the danger of becoming a little to conspiratorial about what goes on inside big companies. Don't forget that - sweeping generalisation alert - commercial companies want to make as much money as easily as they can. Reviewing medical records is a labour-intensive exercise as it can only be done by qualified individuals (and not machines or cheap labour). Again, it would be neither cost effective nor practical to review every application or policy at any time other than application or claim - insurers just don't have those sort of resources at their disposal and if they did, their premium costs would be so high, their products would be unaffordable.

I always maintain a healthy level of skepticism about what any company is doing with my personal data or information, but at the same time, I accept there are cost-benefit trade-off's that I might not like, but mean that I can afford the products I want. If you've got a credit card, storecard or any form of clubcard, your data is being gathered. Registration on internet forums requires you to share personal data. I chose to accept the terms of those facilities so that I can benefit from their services, but I realise that some won't want to - that's fine, their prerogative.

As far as abuse of access to medical records is concerned, ask yourself this - when was the last time you heard of the regulator fining or censuring an insurer for misuse of access to records rights? No, I've never heard of such a case, either. And believe me, you would've done if it happened - or happened regularly for that matter. Leaving aside the cost issue, insurers are very conscious of regulatory and legislative powers and know that when it comes to medical records, they have to be very careful. Large insurers are subject to FSA monitoring visits regularly, at which they need to demonstrate compliance with relevant regulation/legislation and explain their processes and procedures. It's widely acknowledged that medical records data is so sensitive that the regulators would take any breach or abuse very seriously. Just ask the FSA and see what they say.

It goes without saying that insurance companies are not perfect - not by any stretch of the imagination. After all, they're commercial entities and they certainly have their flaws. That said, don't get too wrapped up in media hype (which is generated to sell papers or make you visit websites or watch particular television programs) - and that goes for any subject. Whenever you can, base your choices on your personal knowledge and first-hand experience, and not on what others (including well meaning folks like me) have told you or what you've read. If you're in a situation where you can't do that, make informed, educated decisions based on what you are prepared to exchange (money and/or personal data) in return for goods or services. If you don't like what you're offered, vote with your feet and go somewhere else.

I was just about to say that