Requests for information by insurance companies
We receive many enquiries from members concerning their obligations to provide information to insurers.
Advice is sought on the validity and purpose of requests made by an insurer for either a medical report or a summary/copy of patient records.
Nature of the request
Often the request is extremely onerous; for example
"Please provide…. a full history of all consultations at the surgery including details of dates, diagnosis, treatment and results."
This is particularly so if the patient suffers from long-term chronic conditions which have required extensive consultations and medical treatment.
Obligation to release
Provided the patient has authorised release, a doctor has an ethical obligation to provide the requested medical information, in report form, to the insurer. Furthermore, where the medical records have been created or used after 21 December 2001, the patient may authorise (and require) the doctor to provide a copy of their records to the insurer.
Priority
Generally the request for information follows an application by the patient for some form of insurance (e.g. income protection, sickness and accident, death and disability), or to allow the insurer to assess a claim made under a policy.
Until the insurer receives the information, the patient's application for insurance will not be processed and they may be left uninsured. The occurrence of a serious disabling injury for example, whilst uninsured, could have disastrous consequences for the patient. If there has been a delay on the part of the doctor in providing the requested information, it is possible that the patient may bring a claim for damages against the doctor.
We recommend that doctors give first priority to responding to requests by insurers for information to be used in assessing an application for insurance.
How to respond
The first step in answering a request is to ensure that the patient has validly authorised the release of the information.
Ideally, once the request is received an appointment should be made to see the patient. The preparation of the report should be done either in the patient's presence, or the report discussed with the patient to ensure that they agree with its content. The patient's acknowledgement of the accuracy of the report should be noted in their medical record.
If it is not possible to make an appointment with the patient, the patient should be contacted to ensure that they agree to the release of the information. The report should then be prepared from the records.
If answering the request for information is going to be unduly onerous, we suggest members seek the patient's consent to provide a copy of the relevant records. Alternatively, a summary of the relevant period might be appropriate.
Payment
The letter of request from the insurer will generally indicate the fee that the insurer is prepared to pay for the report. This fee may not properly reflect the time and effort that will go into the compilation of a report. Where a doctor believes the fee is inadequate, they should advise the insurer in writing of what they consider to be a reasonable fee and seek agreement to pay that amount. If the insurer will not agree to pay that fee then the doctor must bring that issue to the attention of the patient. As it is for the benefit of the patient and not the insurer that the report is to be written, the patient should be prepared to meet the reasonable costs of the report being prepared.
If the patient is not prepared to pay this, then as an alternative the patient may choose to authorise the doctor to provide the insurer with a copy of the medical records which would be at a lower cost (i.e. the reasonable administrative/copying charge).
What to include
Some doctors may form the view that aspects of a patient's medical history are not relevant to the insurer and thus omit them from the report. Alternatively, a patient might request that the doctor not include a certain aspect of their medical history. Doctors should not engage in this practise. Doctors are not in a position to decide what information might be of significance to the insurer in assessing an application for insurance. If information which was not disclosed subsequently comes to the attention of the insurer in the course of investigating a claim under the policy, it is possible that the claim may be rejected on the basis of that failure to disclose information.
If the insurer seeks medical information covering a particular period, it is not appropriate for the doctor to provide information outside that period unless specifically permitted by the patient to do so.
Where a member has any doubt about responding to requests for patient information, please contact one of our solicitors in our Medico legal Department for advice.
By Libby Bishop
Claims and Legal Advisor
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