When anybody wants to purchase any health-related policy from an insurance company, the insurance company needs to know how healthy the person is at the time he/she signs the policy. The insurance companies figure this out through a process called underwriting, during which the customer has to take a medical exam and submit a medical statement about the current health and medical history.
The higher risk pose, the higher the premiums are being compared to a healthier person receiving the same amount of coverage. In some cases, the health may indicate too high of risk that the individual may not be eligible for insurance coverage.
What is a Medical Statement?
A medical statement is defined as a document containing a series of questions about the overall health and medical history of any individual. Depending on the plan and the coverage a person wants, a medical statement is necessary to meet underwriting rules and to complete the application.
There are lots of situations in the life of a person where a medical statement is required. For example;
- Requesting an amount of coverage that exceeds the maximum guaranteed issue amount in an insurance plan.
- Enrolling after an enrollment period closes.
- Reconsidering the choices after waiving all or part of employer-paid insurance.
- Insurance companies may ask for the medical statement of the insured after his/her car accident.
Understanding a Medical Statement in auto-insurance
If a person is involved in a car accident, he/she receives a series of authorization forms from the various auto insurance companies implicated in the accident. Standard authorization forms consist of a Medical Statement, Employment Records Authorization, and Accident Statement Form.
These forms help the insurers to collect information about the accident, as well as the medical records, bills, wage information, and other information about the insured victim. When these forms are received, anyone might think he/she is required to execute these forms and send them back to the insurance company.
Often times, the insurance companies want to collect prior medical records and review those records for prior injuries. This allows the insurance company to dig into the medical history of the insured who makes a claim. An insurance company can’t access the information about the medical history of the insured without his/her permission. It’s important to understand that an insured person can control what health care information the insurance company has access to by simply gathering the relevant bills and records.
Why do the Insurance Companies need Medical Records?
In order to recover compensation when a person is hurt in a personal injury accident of any type, he/she must prove that the other party is at fault for the accident and he/she is suffering from damages. Therefore, it seems logical for the adjuster to request copies of medical records. The insurance adjuster may tell the individual that the insurance company simply needs copies of medical records to “verify” his/her injuries before paying for the accident claim.
(Insurance adjuster is a person who investigates claims and recommends settlement options based on estimates of damage and insurance policies held.)
However, the insurance company for the other party hopes to find information in the medical records regarding a pre-existing medical condition or a prior accident. The insurance company may use this information to argue that the current injuries of the insured victim are not related to the accident in question.