“Head to toe”: How the medical underwriting process works

We peer behind the curtain to find out what really goes on at an insurance medical assessment.

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Dr Deepak Gaur

Dr Deepak Gaur is the founder of Pop Up GP and has diverse experience in acute medical care, executive medical screening, indigenous health, correctional health and insurance assessments including life insurance, travel insurance, workers' compensation and motor vehicle accidents.

When I do a medical for insurance purposes, either for a new insurance policy or a re-assessment of an existing policy, it's a head-to-toe examination through the patient's vital systems. Essentially, I am looking for anything that's abnormal.

I start by reviewing the history the patient has provided. Generally, the person being assessed will have had to answer a series of preparatory questions from the insurer.

What an insurance medical form looks like

Medical underwriting form 1
Medical underwriting form 2

The questions I ask are based on the applicant's current medical history, their health history and their family history. Questions may be open-ended about new symptoms a person has experienced during a set time, such as the last 12 months. I may also inquire about whether the issue has been resolved.

Details of the treating medical practitioners as well as health practitioners such as physiotherapists, psychologists and social workers may also be requested.

General questions about the consumption of alcohol, nicotine products and substance use are common.

How I do my assessment

The medical is a very detailed, systematic examination of the patient. I'll go through all of the body's systems, such as cardiovascular, respiratory, gastrointestinal, genitourinary, dermatological, musculoskeletal and neurological.

Questions about appearance, behaviour and communication during the examination may also be included. These may be relevant to underlying medical conditions, such as mental health diagnoses and treatment.

FLI chart

I then come to a conclusion

Is this person, on the basis of the history they're providing me and the examination I've completed, fit for a policy or do they require further assessment?

It may be that further investigation is needed, or there may need to be a review of their current management of a certain condition.

I've performed insurance assessments over a 20-year period and the principles remain the same. As the doctor completing the examination, my findings usually conclude the final sections of the insurer's assessment.

This part of the assessment usually asks if we recommend that a patient requires any further investigation, procedure or operation based on the history the patient has provided and the examination I've completed.

This is typically a "yes" or "no" answer. When you do find something specific, further assessment may be required and the process can take longer.

What could happen following my examination

The insurer may decide to defer the commencement of the policy, or the assessment of the policy, until the issue is clarified. Or, if I've specifically requested an investigation, they may wait for this result, which has the potential for the process to become more protracted.

For instance, I might see someone with high blood pressure. If the patient's blood pressure isn't well controlled after multiple measurements and they've advised me about the medicine they have been prescribed for this medical condition, I would recommend a review of their blood pressure management including their medication.

It may be as simple as a patient going to see their GP to have their blood pressure reviewed. If the patient's blood pressure readings are within the normal range or they normalise after a revision to the dose of their medication, the insurer may proceed with the policy.

An insurer may ask for more details

But if a person has a history of a diagnosis such as cancer, that's where the insurer may request very specific details.

If the patient has had extensive therapy – such as a biopsy, surgery, chemotherapy or radiotherapy – the insurer may want a copy of a pathology report from any surgical procedure and associated investigations that provide information about the patient's prognosis. It is possible a review by a third-party expert, such as an oncologist, will be requested.

A patient with a multi-system disease, such as an auto-immune disease, may also require more complex assessments due to an insurance company assessing the likelihood of future medical treatment.

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