Doctors Call for Tightening on Provision of Medical Records

The Royal Australian College of General Practitioners has called for a tightening of the patient records its GP members provide to life insurers.

RACGP President, Dr Bastian Seidel

RACGP President, Dr Bastian Seidel

This call for a tightening of information was made in a four-point submission by the RACGP to the Parliamentary Joint Committee Inquiry into the Life Insurance Industry, in which it addressed life company processes involved in accessing health information about applicants.

In a submission under the name of RACGP President, Dr Bastian Seidel, Dr Seidel noted what he referred to as “…widespread concern within the general practice sector that inadequate information is provided to consumers when their consent is sought for access to medical records.”

Dr Seidel said many GPs have related the extent of the effort required to ensure that their patients are fully aware of what they have consented to. He said this often involves contacting a patient and explaining the possible repercussions that may stem from the release of their full health record to life insurers. “In many instances, this results in a patient withdrawing consent for release of their health record,” said Dr Seidel, who added that other GPs reported refusing applications from insurers for full medical records and instead, with patient consent, providing a more targeted report to the insurer to assist the insurance application process.

…insurers should not request a full patient record as part of the usual application process

In documenting what the RACGP sees as the need for greater patient education on consent and the release of health information to insurers, Dr Seidel said “We also believe that there should be a tightening of the requirements around requests for full medical records and that insurers should not request a full patient record as part of the usual application process.”

In other points raised in the submission to the PJC Inquiry, Dr Seidel cautioned that “…the therapeutic relationship between a GP and a patient could be affected
by the GP providing a life insurer with a medical record if the patient does not understand that they consented to the release.” He said doctors’ consultation notes act more as an ‘aide memoir’ and are not made for the assessment of risk for insurance purposes: “Our members are concerned about the risks to both them and their patients of misinterpretation by insurers when reviewing a patient’s consultation notes,” said Dr Seidel.

He also warned, “Understanding that medical records can be requested by an insurer may lead GPs to under-document or under-identify patients at risk in efforts to ensure the patient’s access to insurance is not affected.” He continued, “GPs have advised the RACGP that they feel they are placed in a difficult situation where they need to ensure adequate documentation of their consultation with patients while also considering the broader impact this may have on their patient. This in turn may have medico legal ramifications for GPs.”

…patient knowledge of the issues they may face after disclosing symptoms …is likely to discourage disclosure

Dr Seidel added that, similarly, “…patient knowledge of the issues they may face after disclosing symptoms or seeking treatment, particularly for mental health issues, is likely to discourage disclosure and help-seeking, which adversely affects patient wellbeing.

In his concluding remarks, Dr Seideil noted the RACGP has recently had discussions with the Financial Services Council about a roundtable they are establishing with mental health groups. “We will support efforts to provide clarity to patients, GPs and other health service providers about the issues raised in this Inquiry regarding access to and use of patient health information.”

  • paulkate72

    Hmm. Call me cynical, but a GP criticising the system when so many of them take forever and a day to release any patient details in respect of life apps, leaves me wondering whether there may be agenda here.

    Is it really patient concern or are they gathering the clans in support of higher fees?

    • BKY

      Paul I too am very cynical of people’s agendas…also could it be a coverup or a “backside protecting” submission because Dr’s might be hauled under the microscope regarding their client filenotes??? Sounds to me like they don’t want to be holding the can when a Life Insured is declined at application time or even worse…Claim time. When are Dr’s going to understand that Life Insurance contracts are “guaranteed renewable”…Life companies don’t have the luxury that Dr’s do to monitor someone’s condition…for these Dr’s to even suggest limiting a clients medical history to a Life company means that they don’t understand anything about the Duty of Disclosure…I wonder if the Duty of Disclosure and how non-disclosure works was explained to them when they applied and implemented for their own personal risk protection policies??? HMMMM!

  • emkay

    so GP’s are underwriters as well. Okay, so don’t provide the information, application gets declined, potential insured dies, GP sued for not releasing any information?

  • John Galt

    Howard Gordon once wrote a phrase that I think is apt here: Deceive, inveigle and obfuscate.

    So essentially the RACGP are proposing that GP’s and patients should downplay, hide and deny Insurers knowledge of an applicant’s medical history because it may affect their ability to get insurance. Do they understand what they are publicly saying?

    Of course it will impact an applicant’s insurance application! Insurers are in the business of assessing and insuring risk. Without the fundamental right to underwrite and understand an applicant’s medical history, exactly how are they proposing that Insurers assess the risk they’re being asked to insure?

    Is the proposal that all customers should just be “given” insurance regardless of their health history? Are they proposing that Mr Smith who smokes and drinks and has heart disease should pay the same premium for his cover as Mr Blogs who leads a healthy lifestyle and has a clean medical history? Are they proposing that all insured lives (healthy or not) should pay enormous premiums to cover the unknown risks Insurers will have to cover without underwriting? Are they aware that this will make insurance so unaffordable that the only people taking it out will be those with increased health risks who are selecting against the Insurer?

    The answer is no – they’re not aware and therein lies the issue. This submission demonstrates the absence of knowledge and understanding of insurance fundamentals. Insurance is not a new fad that sprang up overnight, Insurers have been collecting health and claims data and insuring lives since the 18th century. They are experienced and absolutely qualified in assessing the insurable risk that an applicant’s medical history presents. Life Insurers have vast amounts of insurance and medical data available to them. They employ Consultant Medical Officers; specialists experienced in medicine and insurable risk who review and provide guidance on claims and underwriting decisions based on the medical information provided.

    On the other hand, GP’s working in general practice have no insurance knowledge and in fact are NOT qualified to be making these comments, submissions, or decisions as to what is or isn’t relevant to assessing the insurable risk of a medical history. It is plain arrogant and insulting to say otherwise.

    The exception is the obvious and demonstrated knowledge (and apparent advocacy) of non-disclosure and misrepresentation for the purposes of obtaining insurance. Demonstrated by this submission.

    I find it incredible that a body of medical professionals can stand behind a submission that advocates calculated deceit by doctors and patients in order to obtain insurance cover that may not ordinarily be available to them or for which they should pay a higher premium than other healthier insured lives.

    In reality, full medical histories are rarely requested at underwriting and make up only a minority of applications assessed. For those applications where a medical history is requested, patients have every right to withhold their medical history from the Insurer and in the vast majority of those cases, the Insurer will make alternative arrangements and seek a detailed report from the GP. Where patients and GP’s make a decision not to provide medical information, they are making a choice as to whether they want to be insured or not, if the Insurer cannot assess the risk, then how can they offer cover?

    Notwithstanding the above, it is important to recognise that the “targeted reports” referenced by Dr Seidel as “assisting the application process”, amount to the GP deciding to withhold other medical history, which may be subject to contractual and legislative disclosure obligations. The GP is placing themselves in the position of the Insurer and determining on behalf of both applicant and Insurer, what is “relevant to the decision of the Insurer whether to accept the risk and if so, on what terms.” The issue being that whilst there are no repercussions on the GP for non-disclosure and misrepresentation, the insured may be prejudiced in their ability to make a claim as the duty to disclose their medical history lies with them.

    Where a GP is providing misguided advice to an applicant to not disclose or to misrepresent their full medical history, it potentially creates an environment for fraudulent behaviour and exposes the GP to risk of litigation from those people who have had claims declined due to non-disclosure or misrepresentation (having acted on their doctors advice to withhold medical information).

    The suggestion that some GP’s are under-diagnosing and limiting their clinical notes is extremely concerning and absolutely should have medico-legal or just plain legal ramifications. Reference to these notes being an “aide memoir” is unacceptable and is shirking accountability for the accuracy and detail for what should be and are, highly important contemporaneous notes of an individual’s symptoms, investigations and medical history. The importance of these notes goes far beyond insurability, but to the heart of a person’s life long medical care. Clinical histories are utilised by many different people over the course of a lifetime. Other and new doctors the patient decides to see, specialists, courts, Insurers and coroners to name a few.

    In any other industry, information of such importance requires accurate file noting and record keeping; so given the implications highlighted in this submission, a reasonable suggestion might be that the clinical notes of medical practitioners be subject to regulation and meet specific standards in detail, accuracy and legibility. This could also allay the RACGP’s concerns as to the therapeutic relationship with patients following disclosure of an individual’s medical history. A medical practitioner should have complete confidence in the clinical histories they have notated as being an accurate and contemporaneous account of an individual’s medical history as known to them.

    There is no doubt that Insurers and GPs could work on providing further clarity to applicants around the repercussions of a decision to disclose or not disclose their medical history. This would reinforce that the responsibility of disclosure remains that of the applicant and that impacts on their insurability are an accurate reflection of the medical history they disclose.

  • Maybe a good idea for GP’s to to provide personal signed statements that their clients are insurable and then personally financially guarantee in the event of a rejected claim.

    • BKY

      Good One

  • BKY

    John…awesome account…the RACGP submission is inconceivable &
    ridiculous based on all the points you make…good on you for taking the
    time to articulate this in the manner you have…now for the AFA and
    FPA and all industry bodies to go and tell the Educated GP to shove it
    where the sun don’t sun.

    By-the-way, where you mention
    affordability in your article sounded a lot like what the Insurers do
    now under group policies and Industry Funds…then when they have a bad
    claims experience the insurers cry poor and uses this inevitable
    increased claims experience as an excuse to raise rates across the
    board…including underwritten risk.

    My more cynical view about
    insurers is they use the same flawed methodology within a closed product
    series…they close the booked using lame excuses and then incentivise
    advisers to move the good risk while leaving behind those that can’t
    move due to current health and medical history. Then when the
    inevitable happens…(which is more claims when the “RISK POOL” in not a
    cross-section), they set about increasing the rates for that old
    book/series, which leaves people that can’t move with no choice at
    all…either to drop amounts or benefits…OR drop cover altogether,
    which is exactly what the insurer wants… When is this strategy going
    to be addressed?

    • John Galt

      Spot on BKY.

      As much as I’d like it not to be the case, I fear your views are not unfounded.

      Unfortunately a lot of this can be attributable to the guarantee of renew-ability which you rightly pointed out as reason for underwriting thoroughly up front. This same guarantee of renew-ability prevents Insurers from making tweaks and changes to a product to make it more sustainable.

      Over the years Insurers add additional benefits and improvements to the product and the reality is that the claims outcome for many of these changes is not known or realised until several years later and even then, it is not always so clear cut in the experience to be able to relate it back to a particular change. Ultimately, this means that certain features and definitions are under-priced from the outset.

      The inability to change those product terms means that the losses can only be rectified with rate increases to offset the poorly performing products/features and by closing the unsustainable products.

      So instead of maintaining a comprehensive, affordable and sustainable product, the industry is left with shrinking books of legacy that are complex and expensive to maintain and administer. The customer loses out as well because they are left in an out dated product that is becoming more expensive; and as you say, changes in their health likely mean that they will be unable to transition to a new and more affordable product. There are no winners (except perhaps for the product ‘boffins’ who introduced the rubbish benefits in the first place, hit their sales targets and were out of there before long before the fall out).

      And in case this isn’t gloomy enough – given the market’s current product offerings are arguably unsustainable also, the irony is that today’s products are destined for the same end. Another expensive closed group of legacy products. Another failure.

      • BKY

        Yes, and I tend to think they are letting us advisers do their dirty work only to then turn around and blame us for this mystical thing called “Churning”…until there is legislation that allows a consumer to understand the costs over the term of the contract regardless of the books claims history, then it will not improve (isn’t that why actuaries are paid their $500,000 plus pa and isn’t it all based on the risk pool??? of course these philosophies will be challenged when they strip the good risks out of the pool and leave the bad…I don’t need an actuarial degree to make that observation or calculation…it’s called common sense)…I’m finding is harder and harder to justify level premiums when there is so much uncertainty with rates and series closures…

  • disqus_sxdzTFJ28Y

    What about the increasing trend of lazy GPs who just sent the entire medical history to an insurer, because they can’t be bothered sparing 10 minutes to do a proper report. I’ve had a recent application go pear shaped because a 29 page report was sent off without the key issues being addressed. We are still trying to sort out the mess. I have let the client know that her GP (part time female) is the cause.

    • Chester

      What ahs the gender of the doctor got to do with anything??

      • disqus_sxdzTFJ28Y

        Many female doctors work short hours and don’t give priority to medical reports. This has been a consistent observation over 30 years.

  • John Galt

    ***RE-POSTING AS THIS CONTENT DOES NOT CONTRAVENE THE DISQUS TERMS OF SERVICE***

    Howard Gordon once wrote a phrase that I think is apt here: Deceive, inveigle and obfuscate.

    So essentially the RACGP are proposing that GP’s and patients should downplay, hide and deny Insurers knowledge of an applicant’s medical history because it may affect their ability to get insurance. Do they understand what they are publicly saying?

    Of course it will impact an applicant’s insurance application! Insurers are in the business of assessing and insuring risk. Without the fundamental right to underwrite and understand an applicant’s medical history, exactly how are they proposing that Insurers assess the risk they’re being asked to insure?

    Is the proposal that all customers should just be “given” insurance regardless of their health history? Are they proposing that Mr Smith who smokes and drinks and has heart disease should pay the same premium for his cover as Mr Blogs who leads a healthy lifestyle and has a clean medical history? Are they proposing that all insured lives (healthy or not) should pay enormous premiums to cover the unknown risks Insurers will have to cover without underwriting? Are they aware that this will make insurance so unaffordable that the only people taking it out will be those with increased health risks who are selecting against the Insurer?

    The answer is no – they’re not aware and therein lies the issue. This submission demonstrates the absence of knowledge and understanding of insurance fundamentals. Insurance is not a new fad that sprang up overnight, Insurers have been collecting health and claims data and insuring lives since the 18th century. They are experienced and absolutely qualified in assessing the insurable risk that an applicant’s medical history presents. Life Insurers have vast amounts of insurance and medical data available to them. They employ Consultant Medical Officers; specialists experienced in medicine and insurable risk who review and provide guidance on claims and underwriting decisions based on the medical information provided.

    On the other hand, GP’s working in general practice have no insurance knowledge and in fact are NOT qualified to be making these comments, submissions, or decisions as to what is or isn’t relevant to assessing the insurable risk of a medical history. It is plain arrogant and insulting to say otherwise.

    The exception is the obvious and demonstrated knowledge (and apparent advocacy) of non-disclosure and misrepresentation for the purposes of obtaining insurance. Demonstrated by this submission.

    I find it incredible that a body of medical professionals can stand behind a submission that advocates calculated deceit by doctors and patients in order to obtain insurance cover that may not ordinarily be available to them or for which they should pay a higher premium than other healthier insured lives.

    In reality, full medical histories are rarely requested at underwriting and make up only a minority of applications assessed. For those applications where a medical history is requested, patients have every right to withhold their medical history from the Insurer and in the vast majority of those cases, the Insurer will make alternative arrangements and seek a detailed report from the GP. Where patients and GP’s make a decision not to provide medical information, they are making a choice as to whether they want to be insured or not, if the Insurer cannot assess the risk, then how can they offer cover?

    Notwithstanding the above, it is important to recognise that the “targeted reports” referenced by Dr Seidel as “assisting the application process”, amount to the GP deciding to withhold other medical history, which may be subject to contractual and legislative disclosure obligations. The GP is placing themselves in the position of the Insurer and determining on behalf of both applicant and Insurer, what is “relevant to the decision of the Insurer whether to accept the risk and if so, on what terms.” The issue being that whilst there are no repercussions on the GP for non-disclosure and misrepresentation, the insured may be prejudiced in their ability to make a claim as the duty to disclose their medical history lies with them.

    Where a GP is providing misguided advice to an applicant to not disclose or to misrepresent their full medical history, it potentially creates an environment for fraudulent behaviour and exposes the GP to risk of litigation from those people who have had claims declined due to non-disclosure or misrepresentation (having acted on their doctors advice to withhold medical information).

    The suggestion that some GP’s are under-diagnosing and limiting their clinical notes is extremely concerning and absolutely should have medico-legal or just plain legal ramifications. Reference to these notes being an “aide memoir” is unacceptable and is shirking accountability for the accuracy and detail for what should be and are, highly important contemporaneous notes of an individual’s symptoms, investigations and medical history. The importance of these notes goes far beyond insurability, but to the heart of a person’s life long medical care. Clinical histories are utilised by many different people over the course of a lifetime. Other and new doctors the patient decides to see, specialists, courts, Insurers and coroners to name a few.

    In any other industry, information of such importance requires accurate file noting and record keeping; so given the implications highlighted in this submission, a reasonable suggestion might be that the clinical notes of medical practitioners be subject to regulation and meet specific standards in detail, accuracy and legibility. This could also allay the RACGP’s concerns as to the therapeutic relationship with patients following disclosure of an individual’s medical history. A medical practitioner should have complete confidence in the clinical histories they have notated as being an accurate and contemporaneous account of an individual’s medical history as known to them.

    There is no doubt that Insurers and GPs could work on providing further clarity to applicants around the repercussions of a decision to disclose or not disclose their medical history. This would reinforce that the responsibility of disclosure remains that of the applicant and that impacts on their insurability are an accurate reflection of the medical history they disclose.

  • John Galt

    ***RE-POSTING A SECOND TIME AS THIS CONTENT DOES NOT CONTRAVENE THE DISQUS TERMS OF SERVICE***

    ***#Freedomofspeech #Truth***

    Howard Gordon once wrote a phrase that I think is apt here: Deceive, inveigle and obfuscate.

    So essentially the RACGP are proposing that GP’s and patients should downplay, hide and deny Insurers knowledge of an applicant’s medical history because it may affect their ability to get insurance.

    Of course it will impact an applicant’s insurance application! Insurers are in the business of assessing and insuring risk. Without the fundamental right to underwrite and understand an applicant’s medical history, exactly how are GP’s proposing that Insurers assess the risk they’re being asked to insure?

    Is the proposal that all customers should just be “given” insurance regardless of their health history? Are they proposing that Mr Smith who smokes and drinks and has heart disease should pay the same premium for his cover as Mr Blogs who leads a healthy lifestyle and has a clean medical history? Are they proposing that all insured lives (healthy or not) should pay enormous premiums to cover the unknown risks Insurers will have to cover without underwriting? Are they aware that this will make insurance so unaffordable that the only people taking it out will be those with increased health risks who are selecting against the Insurer?

    The answer is no – they’re not aware and therein lies the issue. This submission demonstrates the absence of knowledge and understanding of insurance fundamentals. Insurance is not a new fad that sprang up overnight, Insurers have been collecting health and claims data and insuring lives since the 18th century. They are experienced and absolutely qualified in assessing the insurable risk that an applicant’s medical history presents. Life Insurers have vast amounts of insurance and medical data available to them. They employ Consultant Medical Officers; specialists experienced in medicine and insurable risk who review and provide guidance on claims and underwriting decisions based on the medical information provided.

    On the other hand, GP’s working in general practice have no insurance knowledge and in fact are NOT qualified to be making these comments, submissions, or decisions as to what is or isn’t relevant to assessing the insurable risk of a medical history. It is plain arrogant and insulting to say otherwise.

    The exception to their lack of insurance knowledge is the obvious and demonstrated knowledge (and apparent advocacy) of non-disclosure and misrepresentation for the purposes of obtaining insurance. Demonstrated by the RACGP PJC submission.

    I find it incredible that a body of medical professionals can stand behind a submission that advocates calculated deceit by doctors and patients in order to obtain insurance cover that may not ordinarily be available to them or for which they should pay a higher premium than other healthier insured lives.

    In reality, full medical histories are rarely requested at underwriting and make up only a minority of applications assessed. For those applications where a medical history is requested, patients have every right to withhold their medical history from the Insurer and in the vast majority of those cases, the Insurer will make alternative arrangements and seek a detailed report from the GP. Where patients and GP’s make a decision not to provide medical information, they are making a choice as to whether they want to be insured or not, if the Insurer cannot assess the risk, then how can they offer cover?

    Notwithstanding the above, it is important to recognise that the “targeted reports” referenced by the RACGP as “assisting the application process”, amount essentially to the GP deciding to withhold other medical history, which may be subject to contractual and legislative disclosure obligations. The GP is placing themselves in the position of the Insurer and determining on behalf of both applicant and Insurer, what is “relevant to the decision of the Insurer whether to accept the risk and if so, on what terms.” The issue being that whilst there are no repercussions on the GP for non-disclosure and misrepresentation, the insured may be prejudiced in their ability to make a claim as the duty to disclose their medical history lies with them.

    Where a GP is providing misguided advice to an applicant to not disclose or to misrepresent their full medical history, it potentially creates an environment for fraudulent behaviour and exposes the GP to risk of litigation from those people who have had claims declined due to non-disclosure or misrepresentation (having acted on their doctor’s advice to withhold medical information).

    The suggestion that some GP’s are under-diagnosing and limiting their clinical notes is extremely concerning and absolutely should have medico-legal or just plain legal ramifications. Reference to these notes being an “aide memoir” is unacceptable and is shirking accountability for the accuracy and detail for what should be and are, highly important contemporaneous notes of an individual’s symptoms, investigations and medical history. The importance of these notes goes far beyond insurability, but to the heart of a person’s life long medical care. Clinical histories are utilised by many different people over the course of a lifetime; other and new doctors the patient decides to see, specialists, courts, Insurers and coroners to name a few.

    In any other industry, information of such importance requires accurate file noting and record keeping; so given the implications highlighted in this submission, a reasonable suggestion might be that the clinical notes of medical practitioners be subject to regulation and meet specific standards in detail, accuracy and legibility. This could also allay the RACGP’s concerns as to the therapeutic relationship with patients following disclosure of an individual’s medical history. A medical practitioner should have complete confidence in the clinical histories they have notated as being an accurate and contemporaneous account of an individual’s medical history as known to them.

    There is no doubt that Insurers and GPs could work on providing further clarity to applicants around the repercussions of a decision to disclose or not disclose their medical history. This would reinforce that the responsibility of disclosure remains that of the applicant and that impacts on their insurability are an accurate reflection of the medical history they disclose.