How Do Insurers Know Your Medical History?

A sneak peek into where insurers get your health information as they decide whether to approve your application for individual disability insurance.

Before you apply for individual disability insurance, you may be curious what background checks will be performed as part of the process. Insurance companies have many tools at their disposal to paint a more complete picture of an applicant's risk profile.

Background Checks That Insurers Conduct

This applies to individual coverage only.

If you apply as an individual, the underwriting path will very likely be designated as "full underwriting" in which case the insurer will conduct background checks. This section summarizes where insurers get their information.

Quest Diagnostics (LabPiQture)

This report provides physician-ordered blood testing results related to preventative care, disease monitoring and diagnostic purposes, as well as labs completed for insurance purposes for the past 7 years. It serves as an alternative to a fresh blood draw.

Generally, insurers use this report if the available blood test results are expected to be less than 12 months old and if the insurer is willing to make decisions based on less information. LabPiQture test results can be less complete than what the insurer would normally get from it's own exam and labs, particularly regarding nicotine and narcotics.

10101 Renner Boulevard, Lenexa, KS 66219
Email: Scriptcheckcompliance@ExamOne.com
FCRA Voice Mail: (844) 225-8047

Exam with Labs and Measurements

If the insurer is asked to take on a lot of risk, they may call for a blood draw and urine specimen which has the advantage of being comprehensive and fresh.

If called for, it would be taken from a local examiner at the insurer's expense who would come to you to take height, weight, blood pressure, and gather urine and blood specimens which are sent to a lab. The most commonly used lab is CRL: Clinical Reference Laboratory.

At the time of the exam, you can specify whether you want to fetch your blood test results online. If so, you will receive a text message when the results are available.

CRL's portal is accessmyhealth.com.

LexisNexis Consumer Center

This is a report that draws on public records, driving history
and credit. Matching the correct record is aided by a few extra questions on the application including any prior names, address history, driver's license number, and state of birth.

Attn: Life Reports
P.O. Box 105108, Atlanta, GA 30348-5108
Phone: 888-497-9215 | Fax: 770-291-3140
https://consumer.risk.lexisnexis.com/request

Medical Information Bureau (MIB)

This is a report of individual insurance history among all member insurance companies for life, disability and long term care insurance. The main purpose of the MIB report is to mitigate concealment. Codes are reported for the last 7 years by insurance companies for medical and nonmedical conditions.

If an applicant has concurrent applications pending with multiple carriers for same line of coverage, the process will usually stop with all insurers until the situation can be cleared up, which is typically coordinated by the agent.

When you apply, the insurer will both search the MIB and report into the MIB. Preliminary inquiries do not get reported to MIB.

50 Braintree Hill Park, Suite 400,
Braintree, MA 02184-8734
Phone: 866-692-6901
Email: infoline@mib.com

Milliman IntelliScript

This report has two parts: a "script check" and medical insurance claims.

The script check shows prescriptions you have had filled in the last five (5) years. The report is cross-checked against your representations on the medical questionnaire to see what it's for. This report can be useful to uncover medical history and validate prescription drug usage patterns.

The medical insurance claims portion of the report relates to how you utilize your medical insurance. For example, if you had an MRI, and the claim was run through medical insurance, it would likely show up on the "medical claims" portion of the report. The insurer would then cross check your representations on the application in hopes of finding an explanation.

Significant medical history that comes to light in this fashion can work against you due to the appearance of concealment. Therefore, it is important to get ahead of this by thinking through how you have used your medical insurance in recent years and then make sure your disclosure of medical history on the application (see below) accounts for it.

P.O. Box 2223, Brookfield, WI 53008
Phone: 877-211-4816
Email: FCRAReport@milliman.com
https://www.rxhistories.com/for-consumers

Medical Records

Medical records may be requested if there is good reason to do so. The insurer decides this on a case-by-case basis depending on such factors as:

your age
the amount you are applying for
what shows up on the Milliman Intelliscript report
the medical history you disclose on the medical questionnaire
insurance application history (if you have previously applied to another insurer or have another application pending, records requests are more likely)
the particular method by which the medical questionnaire was filled out (online reduces the liklihood)

How the Milliman Intelliscript report lines up with your disclosures on the medical questionnaire makes a huge difference. If potentially significant medical history shows up on the Milliman Intelliscript report but that is undisclosed on the medical questionnaire, medical records are much more likely to be requested due to the appearance of concealment.

In the application kit, there is an authorization for release of medical information. This form covers all sources, with medical records being just one of them. The authorization grants blanket access and there is no way to limit it to specifically named sources.

Insurers identify medical providers primarily by how you answer the medical questionnaire, but they may discover other providers from the script check and any previously received records.

Insurers request medical records directly from providers at no charge to you.

What are the Medical Questions?

When you apply for disability insurance, there will be a questionnaire to fill out regarding your medical history. It is not possible to preview every question; however it is possible to view an example of the first line of questions.

All carriers have a catch-all question buried somewhere in their questionnaires. The catch-all question effectively puts the burden of disclosure on you, prompted or not. Because medical records may be requested anyway, it is in your best interests to get ahead of anything they will find.

If you mark yes to something, a second line of questions will be posed that are specific to that condition. Due to the huge number of possible second line questions, medical questionnaires have traditionally been conducted by telephone with someone who knows what questions to ask. These days, most insurers offer an option to complete it by online form - using their own special user interface - which works well if you don't have much to confess to.

Typically, medical questions are not answered at the time of application. Instead, they are answered after the basic application has been submitted on what is called the Part 2 or Part B because the manner in which the medical information is collected plays an important role.

Tip: Go over your medical history ahead of time, informally, with Rip Curtis who will be your agent for whatever carrier is eventually selected. An informal discussion will offer insight as to whether an application should be submitted, provide a heads-up on what the second line questions will be, and help to identify insurers receptive to your particular situation.

Your medical history is absolutely crucial in making placement decisions.

Informally Discuss Your Situation with Rip Curtis

Ask to discuss your situation in the form below. It is best not to be specific about medical history here and just introduce yourself.