Insurance companies requesting full medical records
This guidance is to assist GPs who are asked to provide information to insurance companies. These fees are for guidance only. It is up to the individual doctor and relevant insurance company to negotiate and agree an acceptable fee.
It reflects the advice from the Information Commissioner’s Office that use of the subject access request (SAR) provisions of the Data Protection Act 1998 (DPA) is not an appropriate mechanism by which medical information should be provided to the insurance industry.
Download our guidance on SARs for insurance purposes
|GP report for insurance applicants
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Guidance for doctors completing insurance reports
Where reports are still being requested by insurance companies, the process of applying for life assurance should run smoothly with the minimum of disruption to doctors and their patients.
We would expect doctors to abide by the following principles:
- The information should be provided in the manner requested and be as complete as possible. This should prevent needless issuing of additional questionnaires or requests for clarification, or further information on the original report, which do not command a further fee.
- The report should be returned within 20 working days of receipt of the request. We acknowledge that insurance companies may ask for a more speedy response in exceptional circumstances, for example in connection with the completion of a loan.
- When an insurance applicant is declined or postponed as a result of a medical disclosure that they have made on the application form, the insurance company will give the reason for declination to the applicant.
- However, if a new or poorly controlled medical condition is revealed on the GPR or following a medical examination, and not disclosed on the application form, the insurance company will inform the GP.
- Under this Act, if a patient indicates that they wish to see the report before it is despatched, the GP should refrain from sending it for 21 days from the receipt of the request for the report.
- It may be advisable to inform the insurance company if a request to see the report has been made. Once the patient has seen the report they may decide to withdraw their consent for it to be sent.
Fees and private medical insurance companies
Fees are offered to GPs by some private medical insurance companies for medical reports on prospective subscribers for private medical insurance (PMI) policies.
We do not recommend fees for this work and would advise doctors to charge at their private rate.
A number of insurance companies have introduced targeted reports for life assurance and income protection. These reports are shorter than a GP reports and require information on a single condition.
The Professional Fees Committee has not supported the introduction of these targeted reports, and therefore there is no recommended fee.
We would advise that doctors' charge at their own rate for undertaking targeted reports. It should also be noted however, that there is no obligation on the doctor to undertake this work, but where the work is declined the doctor-patient relationship should be considered.
Reports for patients taken ill abroad
Doctors are not bound by their Terms of Service to provide these reports, and are entitled to a charge at their own rate for providing the report.
Consent is needed before information is disclosed to insurance companies for the purpose of verifying claims, for example before a company organises repatriation of a policy holder taken ill abroad. In such cases, the company must approach the policy holder for permission to release sufficient information to verify the claim.
Evidence of consent must be provided to the policy holder's doctors in the usual way. If the policy holder is not competent to give consent, doctors may release information necessary to satisfy the claim provided that doing so is in the person's best interests and not contrary to his or her previously stated wishes.
Sometimes insurance companies need information about people other than the holder of the policy. This is most often the case with travel insurance, for example where a close relative of the policy holder becomes ill, and the policy holder has to curtail a holiday and return home.
In such cases insurance companies will want to confirm that the illness of the relative was sudden and unexpected and occurred at the time the policy holder claimed.
Depending on the nature of the policy, the company may also want to confirm that the condition was such that the policy holder was urgently required to attend the relative. If competent to give it, the relative's consent is needed before doctors can release information to verify the claim. If the relative is not competent, doctors may disclose relevant information to the company, provided this is not contrary to their patient's wishes or interests.
The insurance company will explain what information is required in each case.
The view of the Professional Fees Committee is that if the above conditions are met then GPs should aim to co-operate with any reasonable requests. GPs should not however be blackmailed with any threats that certain action will compromise the validity of the patient's insurance and the repatriation process.
We would also advise that the doctor checks that the person requesting the report is who they claim to be and to ensure that they will respect the patient's confidence.
In addition, if the report is to be faxed, we would advise that the report is first anonymised and the patient's identity sent separately. The recipient should be informed when the fax is being sent and asked to acknowledge receipt of the report.