Clean the doctor’s file in the case of biometric risks

10/11/2022 – Many denials of benefit cases are due to a pre-contractual violation of the duty of notification. This can be avoided when biometric risks are secured if health questions are answered completely and correctly. For those interested with previous illnesses, it is advisable to research and prepare the health history. Broker Oliver Mest now cleans every second medical file before the application is submitted.

Anyone looking for professional invalidity insurance (UB), private health or accident insurance for young and healthy clients usually has few problems. The situation is different for those interested with previous illnesses or an extensive medical history. There is a threat of surcharges, exclusions or other risk reduction measures by the insurer.

Failure to investigate has dire consequences in 20 percent of claims

Oliver Mest (Image: Blue Direct)
Oliver Mest (Image: Blue Direct)

At Oliver Mest, CEO of Optimal versicherungn GmbH, one in five BU benefit case rejections is due to a pre-contractual breach of the duty of notification. In such a case, there is a risk of termination, rejection or challenge by the insurer.

“This can only be avoided if the health history is properly prepared. Anyone who does not do this as a broker and relies on the client’s statements is acting negligently and not in the client’s interest. In many cases, the lack of investigation leads to a breach of the pre-contractual disclosure obligation and falls on the fingers of the client”, the broker knows.

This also applies to all other insurance where the risk of getting sick plays an important role. Basically, there is a health check in the area of ​​private health insurance and biometric risks such as term life insurance, BU insurance or disability insurance.

Prepare documents for the insurance company professionally

Insurers decide if a risk is insurable based on the documents presented. Therefore, it is not recommended to send a file of a blind doctor, a statement from the health insurance company or thick unclassified documents.

“But if I prepare a preliminary consultation well, have certificates created specifically for the application, attach imaging material, and the client describes his health problem exactly in his own words, then we create a reasonable examination situation for the insurance company with reasonable results.” “. is convinced Mest, expert from BU.

Every second client has to be cleaned

Oliver Mest now clears the doctor’s file for every second client. This means that it convinces the doctor or doctors to correct diagnoses and other facts. “We always have clients whose health history seems catastrophic at first glance, in the sense of uninsurable.”

If you take a closer look, you are often positively surprised: “It often turns out that many diagnoses do not stand up to scrutiny.” His examples: a dyslipidemia ended up being just nausea. Asthma turned out to be a simple cold. A long-term spinal problem boiled down to ten days of back pain from lifting boxes that were too heavy.

It is particularly important to present clients with suspected mental health problems well. This can be considered a current statement from the attending physician or a “self-assessment” from the person seeking insurance. You could describe the circumstances that led to the depression, for example, or that your medication has been optimally adjusted for years.

Biometrics expert Philip Wenzel recently reported on the problem of complacent diagnoses in medical records (VersicherungsJournal September 26, 2022).

Blue-eyed customers and brokerage-oriented brokers be warned

After many years of consulting, Oliver Mest is no longer bothered by anything, he is just surprised. On the one hand, there are clients who are so well informed that they know exactly which illnesses do not need to be declared.

On the other hand, he is surprised by colleagues who do the same for the good of the commission and turn a blind eye to health issues or do not review customer information. “This is a fraud against the interests of the client and this is at the expense of the client. In the case of a performance, it will stay in the rain and get very wet.”


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