ProtectionFeb 14 2023

GP delays over insurance cause 'real suffering'

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GP delays over insurance cause 'real suffering'
Many GP surgeries are inundated and cannot process time-sensitive claims, meaning a better tech solution is needed. (Alex Green/Pexels)

GP surgeries' failure to process insurance claims on time have led to "suffering" for claimants and could even be tantamount to "gross negligence", a senior protection specialist has claimed.

Ian McKenna, founder of F&TRC, said he had become increasingly aware of issues where families have been left facing huge debts, simply because GP surgeries have taken weeks - even months - to return forms to insurers.

He told FTAdviser it could even be classed as "gross negligence" because patients and their families are left facing enormous financial stress at a critical time.

McKenna said: "Can there be any worse situation than having a really serious illness, for which you are insured via either a critical illness or income protection claim, and your insurer cannot pay out because the doctor can't be bothered to return the forms?

"We are seeing multiple cases people are experiencing real and unnecessary suffering because of this medical negligence."

He claimed: "I know of someone whose cancer had been in remission for so long, that their insurers were willing to look at new proposals for new cover.

"But the doctor took so long to submit the information - we are talking about several months here, that the cancer actually returned and the person is now uninsurable."

While admitting that some doctors are "great", he said there were too many others who see insurance as unnecessary admin and have a "negative attitude".

Responding to requests from insurers is not healthcare, and is not NHS work.Dr Clare Bannon

Ian McKenna, founder of F&TRC. (McKenna)

McKenna (pictured, left) also said some GPs have been asking brokers' clients for up to £500 per insurance claim forms.  

But there is not always time in the GP's day to process forms.

Richard Freeman, founder of Medi2Data, told FTAdviser: "I pay all due respect to the protection market but they need to think about the impact of their instructions on a GP surgery. 

"From Medi2Data's research, we found there were approximately 3mn policies sold every year. Of the inbound applications, 10 per cent require GP information. 

"But on top of that, GPs need to deal with the Department for Work and Pensions, the Ministry of Defence and solicitors. All these instructions come into a GP surgery."

Dr Clare Bannon, the British Medical Association's England GP committee deputy chairperson, said: "The public will be only too aware of how overstretched practices are, battling daily to meet the needs of patients amid mounting demand and with falling numbers of staff.

"At times of such severe pressure, practices are understandably prioritising the immediate healthcare needs of patients.

"While important for individuals, responding to requests from insurers is not healthcare and is not NHS work, meaning that it must be lower priority than looking after sick patients."

Communication problems

According to McKenna, often the root cause is a lack of connectivity between insurers, GPs and brokers. But he says this is not the real challenge. 

He added: "The challenge is not the technology; it is the politics. It relies on the GP surgeries wanting to plug that data in. The tech is there. And some insurers are more forward thinking than others and embracing change."

However, even where tech does exist and surgeries have adopted it, communication between insurers, brokers and the GP can be problematic.

On an adviser forum recently, an adviser said they were working on a protection case with a large life company, and wrote to the GP for a medical report. 

Digital solutions must not only streamline processes for both patients and practice staff, but also be secure and comply with data protection legislation.Dr Clare Bannon

They claimed the GP surgery had sent an invoice to the life insurer via insuretech software provider Medi2Data, but the insurer refused to take the reports, and asked instead for the GP to send the request to them directly. 

The adviser said: "Needless to say, the GP has ignored this request for two weeks to date and we are going to chase them."

Freeman said there is often a disconnect between insurers and GPs - and it is not always the GP's fault when it comes to providing the necessary information for either applications or claims.

Quite often, it is the sheer burden of paperwork on GPs.

According to Freeman, Medi2Data provides a way of cutting down that admin time by using a series of template forms for each insurer that can automatically pull the patient's relevant data and populate the form with the right information needed for that insurer. 

Better collaboration

However, only some surgeries have adopted this technology, as have only a few insurers. 

He says there needs to be a nationwide collaboration between the NHS, insuretech providers and insurers, so processing applications and claims can be made much quicker for all parties concerned, regardless of which insuretech solution is plugged into the back end.

Freeman added: "The current customer journey for buying protection products is not fit for purpose, so anything that can fast-track that service would be fantastic. We are all service providers and we need to work to empower the individual. 

The current customer journey for buying protection products is not fit for purpose.Richard Freeman, Medi2Data

"Our technology should be future-proof, with automatic underwriting. Large insurers should be versatile enough to use more than one tech provider that can perform this sort of data processing.

"GPs should be able to plug in the tech so the necessary data of the medical record can be sent to the insurers."

Dr Bannon echoed this. She said: “When it comes to digital solutions, these must not only streamline processes for both patients and practice staff, but crucially they must also be secure and comply with data protection legislation.

"And no system will be perfect. Given the huge amount of data in a patient’s medical record, consisting of coded entries, free text, and imported documents from elsewhere in the NHS, with the need to redact any third-party information, there will always be a demand for staff involvement and time to satisfy insurers’ requirements.”

But McKenna added that these questions will need to be answered, and soon: "It has significant consumer duty consequences because there are specific elements within consumer duty that requires insurers to act in a timely fashion to enact premiums as soon as possible."

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