Lack of general practitioners’ reports should not stall protection policies

However, the lack of a general practitioner report need not be a hard barrier to anyone seeking to take out a policy. General practitioner reports are requested for two reasons. Firstly, when information is missing from the application or when contradictory information has been provided and, secondly, when there are medical limits to the policy. Such limits are naturally imposed when people are older – where both policy values and the risk is considered high. To obtain independent medical information, which helps insurers better evaluate risk, the standard practice has been to obtain a general practitioner report.

The general practitioner report has generally been perceived as the best source of data, since it is both independent and usually comprehensive. However, the reality is that the quality of the data is actually hugely variable. On top of this, even though digital services have made some progress, it still frequently takes many weeks – or even months – to obtain the reports. And that’s when things were normal, before the lockdown.

While it’s true that traditionally a phlebotomist can be sent to take blood and a few measurements, this is far less attractive during lockdown – for both the consumer and the phlebotomist.

There is a statistically proven alternative to the general practitioner report which has been shown in independent studies, by multiple insurance companies over many years, to be far more effective at uncovering material misrepresentation: the tele-interview.

Indeed, studies by multiple insurers have shown that for life and critical illness applications the percentage of cases with material missing information for a tele-interview was just 2%, while for a GPR this was 6%.  For IP which requires more information, the Tele-interview was missing material information on 7% of cases, and the GPR 13%, as can be seen on the graph below.

While at first it is hard to understand why the tele-interview is better than the GPR, the. The studies also revealed the reasons why the tele-interview provides better information than a general practitioner report:

1. Any recent symptoms are disclosed during the tele-interview which may not yet have found their way to the general practitioner’s attention or medical records.
2. It may well be that some private medical procedures, which are increasingly common (especially for skin complaints), are not on the GPR.
3. The results of any cholesterol or blood pressure tests undertaken at work or within well-person clinics are typically not passed to the general practitioner.
4. Many key health factors such as smoking, alcohol and drug use are typically not discussed with the GP and hence won’t be found in the general practitioner report.
5. Up-to-date descriptions of how conditions currently affect people may not be within the general practitioner report, particularly during the lockdown – when consumers are reluctant to attend doctors’ surgeries.
6. Tele-interviews give far more time for consumers to talk about their health, often in greater detail, so more information is obtained – especially on mental health issues or difficult personal circumstances.
7. Family history information is typically not in the person’s medical records; indeed, the BMA advises this information is not shared – since, under GDPR, they don’t have permission to share it.
8. GPR’s may not contain height information – and weight information may not be up-to-date. A tele-interview makes sure this information is current, for example, by requesting that consumers weigh themselves before the interview.
9. Any more recent health issues are disclosed in a tele-interview – almost always not the case for general practitioner reports.
10. Sports injuries, especially for men, are typically not disclosed to the doctor and are not included within general practitioner reports.

Tele-interviewing provides a statistically proven alternative to general practitioner reports. However, taking a cautious approach, many companies have simply reduced the number of general practitioners reports they request. 

If there is a worry about misrepresentation during the tele-interview, then this also can be dispelled. The fact is there is still a lot of misrepresentation across the industry, but this is almost always at the application stage. Tele-interviewing specialist MorganAsh has been providing tele-interviews for well over a decade – and all interviews are undertaken by qualified nurses. During all of that time, the number of cases which have shown misrepresentation at the claim stage – and then resulted in claims being paid – number just one. And this was over fourteen years ago. While there have been many cases of misrepresentation being uncovered during the claim stage, once the recording of the tele-interview is provided as evidence, no other claims have been progressed. Some claims have been pursued to the Financial Ombudsman Service – but to date no known cases have been found against a MorganAsh tele-interview.

It’s safe to say, that after fifteen years of claims experience, the MorganAsh tele-interview has effectively eliminated the risk of misrepresentation.  Indeed, those companies which have used the MorganAsh ‘Big T’ interview for all their cases have reported reductions in their reserves and the freeing up of capital. This impressive result may not be the same for other tele-interview providers, or where non-medical call agents are used, rather than qualified nurses.

With the increase in use of systems and the promotion of the Adviser interviewing the consumer, insurers have been reluctant to undertake a second interview over the phone, and systems are generally not flexible enough to triage cases of high risk to a full Tele-Interview instead, all cases have an Adviser interview in the hope they will go straight through. When information is missing or the case considered high risk, then the standard practice has been to go for a paramedic or nurse visit, a general practitioner report or an interview just focused collecting on any missing information. There is the opportunity to undertake a full interview to check for misrepresentation, instead of the general practitioner report or paramedic – and not delay these sales.

Setting misrepresentation aside, the other reason for collecting a GPR is when the application is misleading or incomplete in some way. The great characteristic of the tele-interview is ‘you know when you don’t know’ – by definition, the tele-interview is an interview, so there is no room for missing information. If the consumer does not know something, then even this unknown state is itself recorded.

Studies by multiple insurers, over many years, show that tele-interviews deliver sufficient results for 95% of all applications – the other 5% resulting from the consumers’ lack of knowledge or specific test results not being available. Still impressive, though.

Additional to the interview, it’s now perfectly acceptable to collect copies or photographs of medical letters and test results – and use these as evidence to supplement the tele-interview. These records can be used to corroborate the information provided by the consumer.

Proven tele-interviews ensure that there is no valid reason to delay – or not issue – policies, on the basis that a general practitioner report can’t be obtained. A good nurse-led tele-interview measurably provides the same level of protection against misrepresentation as a general practitioner report.