Reasonable delays for filling out insurance forms
Of interest to all physicians
Some physicians may believe filling out insurance forms is an imposition on their time— time that might be better spent directly looking after their patients. In the following case, the Court had a very definite message for physicians regarding the importance of this duty.
A 53-year-old woman applied for a life insurance policy naming her two children as beneficiaries. She was given a 60-day interim policy by the insurance company. Two weeks later, the company faxed a request for a medical report to her family physician’s office. A second request was sent by phone and by fax to the physician’s office another two weeks later. Six weeks after the original application was sent, a third written request was sent to the physician.
Shortly after this third request, the patient visited her physician and mentioned that she had applied for the insurance policy. The physician brought to her attention the possibility of getting insurance at a cheaper rate through her husband’s professional association. The patient told the physician she would think about this, and would get back to him about sending the information to her insurance company.
Five days before the expiration of the interim policy, the insurance company telephoned the clinic, and was told the physician would take care of the report. A fourth written reminder was sent to the physician from the insurance company, mailed that same day. Three weeks later, the patient called the physician and asked him to send the report. A week later, the insurance company left a message at the clinic and the secretary responded that she would transmit the request to the physician. Finally, the insurance company spoke to the physician and was assured the report was in the mail. The insurance company received the report four weeks after the expiration of the interim policy, but three days after the patient was killed in a motor vehicle collision. The insurance company refused to pay out on the policy.
Legal action and outcome
The patient’s children sued the family physician for the amount of the insurance policy alleging he was negligent in not having filled out the medical report within a reasonable time period. The Court ruled in their favour. In his decision, the judge quoted the regulatory authority (College) guidelines in that jurisdiction stating that a physician must provide, at the patient’s request, pertinent information to an insurer within 30 days. The judge was also critical of the physician offering advice about insurance matters to his patient. The children were awarded compensation in the amount of the policy, which was paid by the CMPA on behalf of the member physician.
Most Colleges have guidelines for the provision of medical information upon the request of their patient to third parties, such as insurers. Some Colleges do state a specific time limit, while others merely state “within a reasonable time.” Physicians have a professional responsibility to fill out patient forms in a timely manner and should consult their College to determine the recommendations for their province or territory.
More information on the pitfalls of medical certificates, forms, notes, and legal reports can be found in the CMPA eLearning activity of the same name.