To take out a health or life insurance policy, a medical questionnaire must be completed. In each company, these questions are different, since they are asked by the legal department of each company. The question often arises: “Shall I put this in? Let’s talk about it.
What do insurance companies look for when filling out a medical questionnaire?
Insurance companies have become very serious about medical questionnaires. Where in the past there was a lot of latitude on many issues, due to numerous problems with insurance fraud and improved internal and external audits, these requirements have been tightened up:
- Medical questionnaires are more extensive.
- The budget for the medical personnel who evaluate the questionnaires has been increased.
The logical answer to the question in the title of this article is that we should not lie to the health insurer. However, it should be clear that it is not a matter of reflecting irrelevant issues, or answering questions that are not expressly asked. Most questionnaires ask about “diagnosed” diseases.
This means, for example, that if we have a slight discomfort in the ankle and we do not have any tests arranged in the near future, except for explicit questions that question that very thing, it would not have to be declared.
Different is the person who has diabetes problems, or immunodeficiency issues, in general, diagnosed diseases or recent surgeries. All of these should appear on the questionnaire, whenever asked about.
Why NOT to lie in the medical questionnaire?
We have discussed this with the medical directors of many insurance companies. In health policies, in order to perform certain diagnostic tests, surgeries and other issues, we need to have authorization from the company.
If we have just issued our policy and, in less than a year or two years, we have to undergo surgery, the company will talk to the specialist who has advised the operation, to ask about the patient’s history.
If a lack of truthfulness is detected in the statements of the medical questionnaire, the company will not assume that operation and it could have two consequences for us:
- Impose an insurance exclusion for that condition.
- Void the policy directly based on the severity of the under-declaration.
It is even more serious if we refer to life insurance. If we are covering a capital sum in case of death or disability and, suddenly, one of these contingencies occurs:
The company will only pay if, after knowing the reason for what happened and checking the questionnaire, it detects that everything was truthful and without concealment of any medical history.
If not, the problems can be very serious, reaching not only to pay late, but not to pay at all. We have decided to write this article, as we read about such issues in the press and see them on a daily basis, and they are very serious issues.
Our recommendation for the questionnaire
It is best to be honest in the answers to the questionnaire. Afterwards, we leave it to the brokerage to negotiate with the company to avoid exclusions, since it has more leverage over them.
If you want a brokerage with a close relationship with the insurance companies, to avoid future problems, contact us. If you want to know more about life insurance or health insurance, we will help you with whatever you need.
