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A Claims Story Covering Every Current Claim Issue - UPDATED

This story is fascinating - and I wish we knew more, but we will probably never find out. My sympathy for those involved in the case.

As usual I shall make no comment on the case directly, apart from adding what I hope is a little clarity. Please note that the claim is under the terminal illness benefit of the life policy. I am guessing but I assume that the amount of the claim has been reduced (there is reference to 50% in the article) to the sum insured that would have been purchased by a higher, probably loaded, premium.

Of course, what one can glean from such a small article cannot properly do justice to what is likely to be a complex situation. Much more complex than we can read from this piece.

However, as an illustration of the current issues affecting claims as a whole this is a very useful discussion study, because it brings together so many of the current and developing claims issues.

  • The first is a constant one: non-disclosure. This is demonstrated in a number of dimensions. The difference between what consumers and insurers understand as non-disclosure, and how memory can fade and yet when compared to indelible notes made by a doctor can suddenly look contradictory to record.
  • The second is more recent: doctors' notes. Brave Day gave a good example. Doctors don't think about your insurance application when they scribble 'depressed' in your file. I have no idea whether the doctor was making a diagnosis or an observation. This leads us into the emerging conflicts over privacy - whether insurers should have access to all notes, or simply an edited summary, or perhaps none of the notes: only 'hard' outcomes such as prescriptions, tests, and measurements. Some Doctors are expressing some pretty hard views around this issue, and consumers listen to them. Expect to hear more of it.
  • The third is the process of application: seemingly you can't make an application from memory. If your memory isn't good then you may need to obtain access to your medical records first in order to refresh it. That might well be prudent, but it is also very time-consuming, placing another barrier in the way of applying. Yet that is exactly the recommendation made by Karen Stevens according to the report in this article.
  • Finally there is the question of tests: as a market we place unusual reliance on disclosure and doctors notes in our underwriting process - and do everything possible to avoid making the client undergo examinations or provide test results. In the US, in contrast, most applications will result in tests. While irrelevant in cases of mental health these provide a much more objective and reliable approach to assessing other health issues.

 

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