TID claim problem. Help needed.

[sinophile888]

In June 2013, I bought an annual travel insurance policy with TID. In February this year, I had to cancel a March cruise, two April flights and hotel accommodation for myself and my husband due to my ill health. The total claim is around $12000.

I have submitted a claim with TID but I am having difficulty with the requirements they have as the claim is over $10000.

This is part of an email I received:
To assist us in the assessment of your claim we request you provide us with the following information:

1. Medical History for the last 24 months from your usual treating doctor. This must include complete clinical notes, medical summary, hospital admission reports, specialist’s referrals, list of all medications and treatments.

The 24 months referred to are from June 2011 up to June 2013 which was the start date of the policy. I have spoken to my GP and he is unwilling to provide complete clinical notes as he says this would breach the WA Privacy Act. My GP did a quick scan of my notes and they show only one referral on a matter with which EmilyHoward may be familiar .

He said that the insurance company should contact him and ask him a series of questions. That, rather than him spending his precious Sunday morning forwarding the information that he thinks they want, only to be told that he didn’t forward exactly what they wanted.
During those 24 months, I had two conditions, both of which are covered in the 43 Automatically Covered Medical Conditions. One condition is ongoing.

Has anyone had a similar claim and how did you approach it?

 

[MarcB]

In June 2013, I bought an annual travel insurance policy with TID. In February this year, I had to cancel a March cruise, two April flights and hotel accommodation for myself and my husband due to my ill health. The total claim is around $12000.

I have submitted a claim with TID but I am having difficulty with the requirements they have as the claim is over $10000.

This is part of an email I received:
To assist us in the assessment of your claim we request you provide us with the following information:

1. Medical History for the last 24 months from your usual treating doctor. This must include complete clinical notes, medical summary, hospital admission reports, specialist’s referrals, list of all medications and treatments.

The 24 months referred to are from June 2011 up to June 2013 which was the start date of the policy. I have spoken to my GP and he is unwilling to provide complete clinical notes as he says this would breach the WA Privacy Act. My GP did a quick scan of my notes and they show only one referral on a matter with which EmilyHoward may be familiar .

He said that the insurance company should contact him and ask him a series of questions. That, rather than him spending his precious Sunday morning forwarding the information that he thinks they want, only to be told that he didn’t forward exactly what they wanted.
During those 24 months, I had two conditions, both of which are covered in the 43 Automatically Covered Medical Conditions. One condition is ongoing.

Has anyone had a similar claim and how did you approach it?

A recent claim through TID only required that I complete a TID Medical Certificate (available on their website). That asked relevant questions about medical history. Surely this would be enough.

 

[sinophile888]

MarcB, was your claim over $10000?

 

[MarcB]

No - but on what basis are TID applying an arbitary claim $10,000 value to require the information. It's certainly not in their PDS that such a condition applies. This is the form I filled in. http://www.travelinsurancedirect.com.au/Content/pdfs/tidau-gp-dentist-medical-certificate.pdf

 

[Cynicor]

No - but on what basis are TID applying an arbitary claim $10,000 value to require the information. It's certainly not in their PDS that such a condition applies. This is the form I filled in. http://www.travelinsurancedirect.com.au/Content/pdfs/tidau-gp-dentist-medical-certificate.pdf

I'll put this out as a load of bunk, in my opinion. As a doctor, I am regularly asked for the complete patient file for various things. As long as patient consent is there, it doesn't breach any privacy act and is a regular request from insurance companies. I wonder if he would rather a medical report request for which he could bill a larger amount of money?
My last request for this sort of thing was Monday, so I'm fairly sure it's still commonplace...

Edit- And I work in WA. PM me if you want to chat about this issue.

 

[Pushka]

I think your GP is being lazy. If you provide your written consent there is no breach of privacy.

We had to claim through TID for the same cruise - the plane flight that was cancelled by CX. It took a few weeks to convince them to pay the Hotel night and it was to and fro a little.

So between them and the GP who "has better things to do" apparently, you just have to keep on with your claim. Good luck.

 

[Cynicor]

I feel it's more greedy than lazy, as it would take all of about 5 min to print the last 2 yrs consults. And it would be at most 10% of the time required to do a medical report and address specific questions.

The difference is in the billing. Without a medical request coming through he can't bill the company.

 

[Mark3000]

I feel it's more greedy than lazy, as it would take all of about 5 min to print the last 2 yrs consults. And it would be at most 10% of the time required to do a medical report and address specific questions.

The difference is in the billing. Without a medical request coming through he can't bill the company.

Cynicor is right, this doesn't breach any privacy regulations if you, the patient, agree to it.
He wouldn't even need to do it, his secretary would just photocopy the file for you and that's that.
They may charge a photocopy fee per page which is reasonable, as long as the fee is not excessive. Try asking the doctor's secretary, not the doctor

 

[sinophile888]

This is the form I filled in. http://www.travelinsurancedirect.com.au/Content/pdfs/tidau-gp-dentist-medical-certificate.pdf

I had not seen the form you suggested. It looks exactly like what my GP wanted and I think he may be happy to fill that in. I will print it off and ask him if he's happy to fill it in.

I am sure the difficulty is not money related.

Thank you to everyone who has replied to my questions.

 

[eosphoros]

Just adding my 2 cents here:

This is quite a strange request from TID. A medical history is one thing. But the request for (among other things) "complete clinical notes" is quite another. A medical history can be attested to in an appropriate certificate. Complete clinical notes are your doctor's property and, quite apart from any privacy legislation, your doctor can deny handing those over. And this is why I find TID's request strange as this is surely a fact that they should have been advised of.

 

[Pushka]

They are just tying to establish whether the symptoms were apparent but not diagnosed prior to taking out the insurance.

It's an interesting issue about property rights. Given the patient has paid for those notes (through Medicare and gaps) surely they belong to the patient but are kept as an historical record by the Dr.

 

[Mark3000]

It's an interesting issue about property rights. Given the patient has paid for those notes (through Medicare and gaps) surely they belong to the patient but are kept as an historical record by the Dr.

My understanding is that for a long time they have been considered the property of the doctor, or in a group practice situation, the practice itself.
The current legal situation is though, that patients and subsequent medical practitioners have a right to obtain a copy, but the original records remain the property of the doctor (if a solo doctor) or practice who created them.
If an employee doctor leaves that practice, they are able to take a copy, but the original records remain the property of the practice.

I am not a lawyer and I am sure there are a thousand technicalities, but I hope that is a fair summary of the current situation in Qld at least

 

[Pushka]

That makes sense. The patient should be able to retrieve a copy.

Not sure about the Dr being able to take a copy when they leave though.