FSC says medical data framework needed

11-Dec-2017

By Sarah Kendell

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Life insurers and doctors must work together to come up with a standard framework around the use of a policyholder’s medical information, as discrepancies between the ways general practitioners and insurance companies were requesting and providing this information were creating confusion and insecurity among consumers, according to the Financial Services Council.

Addressing the recent Parliamentary Joint Committee for Corporations and Financial Services hearing into the life insurance industry, FSC chief executive Sally Loane said such a framework was needed given sensitivities around the use of medical information that may breach ethical and privacy expectations.

“Creating a report [around a specific medical condition] is a time-consuming process for doctors, so insurers often receive full medical records that they did not ask for,” Loane said.

“We would welcome a recommendation from GPs that would allow insurers to get the information they need without intruding on people’s privacy.”

Loane maintained the FSC had been trying to get representatives from the medical sector around the negotiating table to agree on universal standards around medical information disclosure, as insurers were often unwittingly ending up with medical records and facing public criticism for doing so.

“What we hear back from the insurers is that they are given over the full files when they actually don’t want [them], or there may be times where they don’t need full files and times where they do, so that is where we need to get together with the doctors,” she said.

FSC life insurance policy manager Nick Kirwan said doctors and insurers needed to establish processes of engagement during policy application and claim time, and could consider going down the same route as the UK, which mandated full disclosure of a consumer’s medical history when applying for a policy.

“The point of application is sometimes where firms would ask about a specific condition a customer has disclosed in the form, and if the customer has a complex medical history the doctor might not have time to go through that so that is where the insurer might get the full record,” he said.

“In the UK the decision from the [financial] ombudsman was to provide insurers with the full record at application time because then there could be no risk of non-disclosure and non-payment at claim time. But there are competing arguments so we will need to talk with the GPs.”

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