In Focus: Vulnerability  

How tech can help your clients to claim

  • To understand the constraints on medical claims processing
  • To ascertain how technology is being developed to help the process
  • To be able to explain how best to approach making a claim
CPD
Approx.30min
How tech can help your clients to claim
 Photo: Julia Cameron via Pexels

Getting patient medical data and reports to insurers via GPs is currently time-intensive and onerous for all parties.

There are approximately 2.8m requests for patient medical reports each year from third parties, such as insurers and government agencies that pay for the report.

All the reports need to be supplied accurately, swiftly and compliantly under the general data protection regulation. 

If this isn’t the case, then it can cause lots of issues. It can mean delays in underwriting decisions, delays in cover and delays in payments. 

It can also mean that insurers don’t get to see all the information they need.

The more information they get, the better they’re able to develop products that are relevant and actually meet the needs of people, so it’s vital for the future development within the industry too. Technology is at the heart of making this happen. 

What happens in practice

It’s important to understand how GP practices work. It’s not uncommon for one person within a practice to be responsible for dealing with third-party requests for medical reports.

That person might work just one day per week, and it’s only possible to deal with so many requests in that time. 

Also, with fewer GP partners – who have additional demands for running the practice; and an increasing number of locums – who have fewer practice demands and more patient responsibility, the accountability for ensuring requests for medical reports are dealt with is falling on fewer shoulders, at the same time as increasing in number.

GP practices are incredibly busy, and particularly so at key times throughout the year. Planning for the annual flu vaccination programme starts in the summer, and it’s implemented in the autumn and winter.

Quarter one is year-end, when data needs to be supplied to the NHS on what conditions have been treated. So fulfilling third-party medical report requests is a challenge.

The current pandemic has put even greater pressures onto GPs, and there are likely to be more to come. Patients haven’t been attending surgeries, so serious illnesses aren’t being diagnosed.

The insurance industry has seen the effect of decreased attendance, with reportedly fewer-than-expected critical illness claims*, and an increase in income protection claims and a concern of the effects of Long Covid and mental health issues. 

This all increases the challenge of fulfilling requests for medical reports. Delays in supplying reports, means delays to claims being processed and delays to payments being made.

So the current manual process of dealing with requests for medical reports doesn’t benefit anyone.

It puts pressure on GP practices, it increases the admin burden for insurers in chasing reports, advisers are unable to expedite the process, and the insured is left waiting for a resolution.