Insurance companies and non disclosure.

pedro123456

Is a Insurance Company legally allowed to ask for your full medical records after you have made a claim?
Has this ever been challenged in a court of law?

Once you make a medical claim the first thing they ask you to do is give permission for your GP to send Full medical records are they within the law to do this?

Is the GP allowed to forward your Full medical records as opposed to relevant medical records, is he breaking patient confidentiality?

Is the GP breaking some form of code of conduct by sending full medical history just because the IC has asked for them and you have signed to agree to this?.

Before answers/opinions please read this taken from joint BMA?ABI guidelines


The industry has developed a standard GPR (I understand this to be a GP Response form)form, which is available on the ABI
website and is widely used by insurance companies.

The BMA met with the ABI to discuss the development of the form, but the BMA has
Concerns about a number of aspects of the form, including the validity of consent
for its completion and questions about lifestyle and family history.

The BMA has not approved the form, which is currently under review. It is hoped that the
Revised form will be agreed by both organisations.

Only relevant information should be provided and it is ethically unacceptable to
Provide extraneous information. Doctors must not send originals, photocopies or
printouts of full medical records in lieu of medical reports and ABI members should
not accept them.

The full records are not necessary and will very probably include
information that is not relevant to the insurance being applied for. Insurance
companies are entitled only to information which is relevant to the policy, and
disclosure or other processing of irrelevant information is likely to breach the Data
Protection Act 1998.

I would be interested to find out in particular about the legality of their actions and also any moral thoughts.

I would think both Medical and Legal members frequent this board, what your oppinion?

Thanks Pete

dunstonh

Is a Insurance Company legally allowed to ask for your full medical records after you have made a claim?

Cant see why not. After all, you sign to say they are allowed information.

Once you make a medical claim the first thing they ask you to do is give permission for your GP to send Full medical records are they within the law to do this?

Why wouldnt they be? You are signing to say its ok.

Is the GP allowed to forward your Full medical records as opposed to relevant medical records, is he breaking patient confidentiality?

Not if he is supplying what has been asked for and agreed to be issued by you.

Is the GP breaking some form of code of conduct by sending full medical history just because the IC has asked for them and you have signed to agree to this?.

I cant see logically how it would be if he is doing what he is asked to do by the individual.

Its only a breach of data protection if info not requested is supplied.

There has been some discussion going on with consent forms and some GPs will get their own forms signed and not rely on the insurance comapany forms. So, there does appear to be a lack of standardisation there which probably does need tidying up.

pedro123456

Thanks dunstonh....so the man makes a claim, the IC asks for your consent for the GP to send your full medical records and if you dont agree I guess the claim goes no further, so in effect you have to agree in order to progress your claim.

So......there are guidlines as already pointed out saying in effect "only relevent information should be asked for by the IC and only relevent information should be supplied by the GP".

I respect your opinion, you obviously know what you are talking about, but at the end of the day........its your opinion and as grateful as I am, I was looking at it from a Legal view point.

I fail to see how they can legally obtain all your PMH as opposed to relevent medical History as jointly agreed by the Insurance/Medical profession.

or am I missing something?

Pete

LinasPilibaitisisbatman

The only reason they would do it though is if they had concerns you had lied or been unfit to drive contrary to the terms and conditions.

I bet very few accidents have records claimed unless there is suspicions of non disclosure or that it was a medically induced incident.

mattymoo

LinasPilibaitisisbatman wrote: »

The only reason they would do it though is if they had concerns you had lied or been unfit to drive contrary to the terms and conditions.

I bet very few accidents have records claimed unless there is suspicions of non disclosure or that it was a medically induced incident.

I suspect we are talking about critical illness or ASU cover here, not motor.

I don't deal with these claims myself but on forms I have seen in the past (relating to my own affairs), there was an option to have a copy of the records sent to you as well so that you could add further comment if needed.

pedro123456

ok. sorry folks I don’t know how to do the "quote" things you all seem to do....anyway.

Lina, thanks for your input -you say "The only reason they would do it though is if they had concerns you had lied or been unfit to drive contrary to the terms and conditions" and I understand what you are saying.........but the IC and GP and not adhering to guidelines that both respective bodies went to the trouble to agree on........……….
As an add-on….its CI and the IC as far as I’m aware will ALWAYS REQUEST Full Medical Records for a CI claim….I may be wrong



Matty cheers ......yes it's a CI claim question, and although you may be forgiven if you were to think from my initial questions that for some reason I had non disclose issues I haven't,

I’m concerned that IC's (in my opinion) are not answerable to anyone, and although the Ombudsman may have a say at a later stage, the Insurance industry appears to me to be ungoverned ……and yes the FSA have some say………so……

The example of If they are entitled to have FMH is just one area, both BMI and BMA agree they are not entitled to Full medical History…….but………..
The IC make you sign to say they can have your Full Medical History or you willn’t be able to continue the claim…….they then ask the GP to provide it and just because you have HAD to sign it………the GP sends if off.

There are many other issues/examples too, and they wonder why there is no consumer confidence!!!!!

Pete

SueMaggie

Just to play devil's advocate here for a moment, insurance companies are commercial businesses and exist to make money so they need to make sure that their policies have conditions to protect them against paying out when they shouldn't.

The aim of the terms and conditions (T&Cs) of a policy are to (as much as possible) level the playing field between the policyholder and the insurer. If the T&Cs didn't exist customers wouldn't know what they were covered for and insurers wouldn't be able to check that customers were being truthful about their current situation.

A condition of taking out a critical illness, income protection, ASU or PMI policy is that the customer has to allow the insurer access to full medical history should this be required. If a customer is unwilling to do this when asked they're in breach of the contract terms and so the claim can't go ahead. If they're happy to drop the claim at this stage this would generally be interpreted by the insurer as an indication that the customer has something to hide.

Although it's easy to say that insurers should only ask for medical information relevant to the claim, how can anyone know what is and what isn't directly relevant until they've seen the full history? The types of illness that you can claim for on CI policies are major and complex so may have many different types of symptoms - generally the only way is to check the full history.

I would also say that, having worked in the past for an insurer requesting medical information from GPs, even though you would ask very direct questions about a particular medical condition a lot of GPs would just send you a copy of the full file rather than give you the limited information you asked for. (And then charge you (and often the patient too) an arm and a leg for all their work in answering your query when in fact all that happened was that their secretary photocopied the full file and put it in an envelope.)

Also, some GPs I dealt with were in the habit of changing their answers if it looked like a claim wouldn't go through - so, for example, asking how long a patient had a history of a particular condition would get the answer "6 months". If you then rejected the claim as the policy had only been taken out 3 months ago, the GP would come back with a letter saying "Terribly sorry, silly me, when I said 6 months I meant 6 weeks." This happened quite a lot when I was doing this, and may well go on nowadays too.

So again, often getting the full history is the only way to ensure that the insurer is getting the truth, the whole truth and nothing but the truth.

Figures that came out this week show record-levels of insurance fraud, so it's no wonder that insurers are trying to protect themselves against non-disclosure.

pedro123456

Thanks Sue....Devil’s Advocate……………I used to watch that on TV..twas good

"A condition of taking out a critical illness, income protection, ASU or PMI policy is that the customer has to allow the insurer access to full medical history should this be required"............

So in effect the IC can disregard guidelines set out by their respective bodies and impose their own by imposing it’s own Terms and conditions, am I correct?

"Although it's easy to say that insurers should only ask for medical information relevant to the claim”

Sue its not easy to say...they are the agreed guidelines...they are not open to an individual IC's interpretations.

"how can anyone know what is and what isn't directly relevant until they've seen the full history"

The GP knows surely being a qualified practitioner, qualified and trained to be able to decide relevance or PMH.

“ a lot of GPs would just send you a copy of the full file rather than give you the limited information you asked for. (And then charge you (and often the patient too) an arm and a leg for all their work in answering your query when in fact all that happened was that their secretary photocopied the full file and put it in an envelope.”…

So again GP not following the guidelines……is it legal?
The full records are not necessary and will very probably include information that is not relevant

“So again, often getting the full history is the only way to ensure that the insurer is getting the truth, the whole truth and nothing but the truth”…………well that sounds a bit like a legal statement……….except this bit “getting the full history”……guidelines state Only relevant information should be provided and it is ethically unacceptable to
Provide extraneous information


“Figures that came out this week show record-levels of insurance fraud, so it's no wonder that insurers are trying to protect themselves against non-disclosure…..
who’s figures are these……..let my guess……………….ABI………anyway that’s a different subject one that I will gladly discuss on another thread.

Ta Pete

pedro123456

So...........that's it in a nut shell, the Insurance bodies and Medical bodies have an agrrement neither of them stick to it, I bet 99% of GP/Medical proffesion dont know of its existance. and insurance companies dont go out their way to inform them.............I say that insurance companies are a law unto them selves.....1-0 to me....

Now.................Policy defintions of illness......for example "heart Attack".......who actually sets out these definitions...............I say the IC.........because as i've already stated IMO.......the IC are a law unto themselves.

Thanks for any imput in advance.please feel free to inform me I am wrong if you opose my opinions.


Some may be of the opinion this site is all about saving money.......if it is, it shouldn't be.................we hear times many about fraudulant claims and we are aware of colosal profits the IC are making.........so lets look at the power IC's appear to have, and how that power dominates claims (IMO of course), and how of course this power......well..................makes money. This power should be chalenged and Martins site should be a place to challenge that power.


Ta Pete

pedro123456

Quent.................why dont you critically analyse this post........it shouldn't be too difficult for a lad of your expertise and knowledge.

Pete

FH_Brit

Legal if agreed, and if you look at your FULL POLICY WORDING not just the schedule, you will see that you agreed to this situation. And as you agreed upon purchase then if it was challenged in court you would loose.

The reason they ask is rule out any pre-existing medical condition (PEMC) - for example (and most policies are pretty much the same here) when you buy the policy you should disclose ANY PEMC, if you (for example) say no, and you have had a heart attack say 6 month previous, and while away you suffer another heart related problem, look at it from the insurers point of view, it had absolutely nothing to do with your travel. You travelled knowing you had a heart problem that may re-appear and therefore what has it to do with travelling? - Also some less honest people will travel just to get a better medical service for surgery/treatment and then try to get travel insurance companies to pay for it - they won't.

Just another point (again generally speaking in most policies) the GP is entitled to charge you for supplying your Medical Recs or for a certificate and YOU pay for that, not the insurers.

However another of your points your GP cannot supply your records to any 3rd party (IC included) without your written permission. Take care though you could have already signed this permission when you took out the policy.

Every policy is different and you should check up first with your policy - I could not be certain without reading your policy conditions.

See my other thread that has some useful Travel Insurance info:

Click Here for must-read information: Medical & Travel Insurance