Thursday, 14 September 2017

Are banks and insurance companies misusing personal health information and medical files?

“After an insured has made a claim against their policy, the insurer obtains access to and reviews the insured’s medical records. PIAC has seen instances of insurers obtaining an insured’s complete medical history, including from doctors that treated the insured during childhood, before deciding a claim.

PIAC has found that insurers often rely on matters ‘discovered’ during the review of the insured’s medical records to allege that the insured has breached their duty of disclosure.

Often the conclusions drawn by the insurer from the insured’s medical record about their experiences of mental health are inconsistent with the insured’s medical record and the opinions of their treating medical practitioners.

PIAC has represented individuals who have had a policy avoided because the insurer has relied on medical records to impute a medical condition that either did not exist or that the insured did not know existed at the time of applying for insurance.

In PIAC’s experience, it appears that consumers are being disadvantaged by the reforms to the remedies available to insurers (as set out above), or at the very least, are not seeing any benefits flowing from the increased flexibility.” [Public Interest Advocacy Centre, 18 November 2016]

Parliament of Australia, Inquiry into the life insurance industry:

On 14 September 2016, the Senate referred an inquiry into the life insurance industry to the Joint Parliamentary Committee on Corporations and Financial Services for report by 30 June 2017.
The committee welcomes individual stories that may identify widespread issues and recommendations for reform. The committee is not able to investigate or resolve individual disputes.
If you make adverse comment about people in your submission, the committee may reject such evidence or offer a right of reply.
Submissions close on 18 November 2016.
On 29 March 2017, the Senate extended the reporting date from 30 June 2017 to 31 October 2017.

Submissions received by the Committee can be found here.

ABC News, 8 September 2017:

Doctors are pushing back against insurance companies asking them to send them their patients' entire health records as they make decisions about life insurance.

"I am very alarmed that there might be tens of thousands of people's entire health record across the country now stored with insurance companies," Labor Senator Deborah O'Neil told Parliament's joint committee on corporations and financial services.

Edwin Kruys from the Royal Australian College of General Practitioners told the committee doctors do not believe it is appropriate to send entire files to insurance companies.

"It contains information that is often not relevant to the claim, it is all sorts of information that patients have shared with their doctor over the years and they may not even remember what they have shared," Dr Kruys said.

Anne Trimmer from the Australian Medical Association (AMA) told the committee it is challenging for a doctor to determine which parts of a file are relevant.

"And you overlay that with doctors who are time poor with busy practices, it is really hard to make the determination of what is really relevant," she said.

Helen Troup who is managing director of the Commonwealth Bank's Life Insurance arm, CommInsure, told their insurance customers agreed to let doctors provide the files.

"We do get a full authority," Ms Troup said.

She said the company keeps the files but could not say how many it had.

"Our claims principle is to ask for information that is relevant to the claim assessment," she said.

But she said it sometimes meant the company received the full file.

"We of course take due care with that information," Ms Troup said.

But Dr Kruys said he did not take a tick in a box on a form as true consent from his patients to hand over their records, so he contacted them and checked.

He told the committee that they often then withdrew that consent and he would instead send a much more specific report.

Associate Professor Stephen Bradshaw of the Medical Board of Australia told the committee that the request for medical records could come months or years after the doctor had seen the patient.

No comments: