By: Boonswang Law Firm

Life Insurance Companies & Your Medical Records

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You would think that because you pay life insurance premiums, your beneficiaries will automatically get their payout if you die within the policy term. It is rarely that simple.

Life insurance companies only make money when they collect premiums and don’t pay death benefits, so they look for ways to deny your beneficiaries’ claims. They may investigate your medical history to find out if you had any undisclosed illnesses, conditions, medications, or surgeries they can use to rescind your policy due to alleged misrepresentation. If the policy is rescinded, the life insurance company won’t pay.

Noted national life insurance lawyer Chad Boonswang explains how this happens and what to do about it in this comprehensive article. If your life insurance claim was denied due to misrepresentation, call the life insurance lawyers at Boonswang Law for help with your life insurance claim denial appeal. We have helped life insurance beneficiaries across the nation get the death benefits they deserve. Call us today to discuss your case.

Do Life Insurance Companies Check Medical Records Following a Policyholder’s Death?

The short answer is yes, they can. As part of most life insurance contracts, the policyholder agrees that their representative provides the life insurance company with medical records if requested. The clause may also state the circumstances under which the life insurance company will request medical records, such as:

  • The incontestability period applies
  • The policyholder died of drug overdose
  • The policyholder died from alcohol abuse
  • The policyholder died from complications related to smoking
  • The policyholder died from self-inflicted wounds
  • The policyholder died due to an undisclosed illness
  • The policyholder died due to an undisclosed disease
  • The policyholder died due to an undisclosed condition

Life insurance companies are supposed to check medical records before issuing a policy when a policyholder’s answers on the initial application and medical questionnaire indicate there may be further medical issues, or if the life insurance company needs more information about the policyholder’s health before underwriting a policy.  In reality, they rarely do so.

Do Life Insurance Companies Need Permission to Obtain Medical Records?

Yes. Under the Access to Medical Reports Act (1988) and the Data Protection Act (2018), the policyholder’s executor or other representative must provide the life insurance company with the policyholder’s medical records. The life insurance company cannot obtain medical records on their own without a representative’s consent.

That said, there are private services which provide life insurance companies with prescription histories and lab test results for a fee, without your permission. Also, life insurance companies can obtain anything in the public record, such as a DUI or a bankruptcy filing.

Life insurance companies are motivated to collect all information possible to assess the risk a policyholder will die within the policy term and they charge premiums according to that risk. They may subscribe to a service such as the Medical Information Bureau (MIB) for this purpose.

Life insurance companies are also motivated to investigate a policyholder’s cause of death if the policyholder dies within the contestability period or of undisclosed illness, disease, lifestyle habit, or condition. Obtaining the policyholder’s medical records is part of that investigation.

How Many Years of Medical Records Can Life Insurance Companies Check?

When initially underwriting a life insurance policy, life insurance companies sometimes check up to 10 years of an applicant’s medical records. If a policyholder dies under suspicious circumstances, the life insurance company looks at the medical record they have and the record generated by the policyholder from the date that they applied for life insurance coverage to the date that they died.

Why Life Insurance Companies Want to Check Medical Records

Life insurance companies look at medical records to ascertain whether the policyholder died of an undisclosed injury, illness, disease, condition, or lifestyle habit. If the policyholder failed to disclose what eventually caused their death, the life insurance company denies their beneficiaries’ claims due to misrepresentation.

Life Insurance Companies Demanding Medical Records

Life insurance beneficiaries rarely have a choice – they must provide the life insurance companies with the medical records they demand to have their claim for death benefits processed and paid.

If the life insurance company is asking for consent to view medical records, they are probably looking for something to give them cause to allege the policyholder lied on their application and rescind the policy and deny your claim due to misrepresentation.

Life Insurance Company Asking for Health Care Providers of Policyholders

Most policyholders must provide life insurance companies with the name and contact information of their primary care physician as well as any medical provider they regularly see, or they’ve seen in recent years. This facilitates gathering medical information on the policyholder before issuing the policy as well as after death.

Talk with a Life Insurance Lawyer for Help

If your life insurance claim was denied due to misrepresentation and policy rescission, call us for help. We discuss your case with you free of charge.

Know that many claims which get denied due to misrepresentation are paid after we look into it and show the policyholder did disclose everything they knew or the policyholder made an innocent mistake. Don’t take no for an answer. Call us to get your life insurance claim paid.