Successful Insurance Claims

Most dentists have some form of life, critical illness or income protection insurance. One of the most important aspects of insurance is to make sure that any future potential claim is successful, and I would like to point out a couple of areas you may want to consider to ensure that any insurance contract you have is set up correctly and will pay out when you need it. The following areas are perhaps some of the most important considerations, although the following points focus on non-disclosure:





  • setting the correct levels of cover;


  • ensuring deferred periods are appropriate;


  • “own occupation” – ensuring they pay out in the event of being unable to work as a dentist;


  • money back - being able to repurchase life cover in the event of a critical illness claim;


  • ensuring there are no standard exclusions on the contract, e.g. war or civil commotion;


  • guaranteed premiums rather than renewable premiums ensuring the risk is placed on the insurer rather than you;


  • worldwide cover - being able to claim outside the UK if necessary;


  • HIV needle stick cover - you are not over-insured in terms of your current income and financial situation; equally you are not under-insured and that you review your insurance recently in light of your current circumstances and current earnings;


  • Innocent non-disclosure.




So, although there are many areas to consider, some of which you may already be familiar with, it is the last point of innocent non-disclosure which I would like to cover in detail here. This is the largest single reason for failure of claims in insurance. Innocent non-disclosure is exactly that. It is where an applicant for insurance innocently “forgets” to disclose some medical information which the underwriters may find relevant to the application. As not all insurers will request a medical or a doctor’s report, the underwriter is often entirely dependent on the applicant correctly completing and answering the questions on the application form. There are a variety of reasons why someone may forget information:





  • memory – they may simply have forgotten about a visit to the GP they may have had within the last five years;


  • they may be completing the application form in a rush and simply tick ‘no’ to all the questions to complete the form quickly;


  • they may simply not realise the importance of disclosing all medical facts;


  • the applicant does not complete the form themselves but is asked the questions over the phone and some details of the questions are inadvertently omitted;


  • the applicant might be embarrassed to disclose some information to the financial adviser.




I would like to take each of these areas in turn and explain how we ensure that their clients disclose all relevant medical information, so that in the event of a claim the money will be there when it is needed. It is important to remember that insurers rely on “utmost good name,” so, for example, even if you can legitimately answer negatively to a question on the application form or answer negatively to all the medical questions, if there is a medical fact which you are aware of that may affect the underwriter’s decision then it is imperative that this information is disclosed. Remember, there is no point paying hundreds of pounds a year in insurance premiums if you are never going to be able to make a successful claim.

Memory – they may simply have forgotten about a visit to the GP they may have had in the last five years

It is very possible to genuinely forget information and a recent case that went to the ombudsman has established that application forms are not meant to be used as a memory test; the recent case where a lady who forgot to disclose that she had been to the GP about 10 years prior to the application was able to claim under a policy on the basis that the applications are not memory tests. However, typically insurers are interested in any visit to any health professional within the last five years. We keep a central record of all medical information that has been disclosed to us by clients. We can then use this to cross-reference against any new applications and ensure that clients have fully disclosed. We had a case a few years ago where upon doing the cross-referencing we established that the client had not disclosed on a previous application several years ago a family condition where his mother had had breast cancer. We therefore contacted the previous insurer, advised them of the details and fortunately, in this case, there were no changes to the contract. However we were satisfied that the client had fully disclosed and therefore in the event of a claim in the future he would not have been subject to a refusal of a claim due to non-disclosure on the original policy. Another question that insurers frequently ask is whether you have ever been declined, refused insurance or accepted on terms other than normal. Again this could be argued as a memory test as you may well have taken out insurance 10-15 years ago and had special terms imposed and not necessarily remember them. We therefore prefer not to rely on memory and we will review all the insurance contracts for which we are acting and check to see if there have been any special terms imposed in the past.

They may be completing the application form in a rush and simply tick ‘no’ to all the questions to complete the form quickly

Typically when you do disclose medical information, the underwriter will do one of three things: you will either be accepted on normal terms; you will be declined; you will be accepted but the premiums will be increased (rated); or, finally, the insurer may place an exclusion on the contract whereby you will not be able to claim in some cases (or a combination of the above). I once had a client who had been insured by a previous financial adviser and had no exclusions on his contract. However during our conversation it appeared that he had had back problems in the past. As back problems are one of the main reasons for income protection claims, it seemed extremely unusual that an insurer had not applied any exclusions to his contract. I therefore requested a copy of the application form and the previous adviser had completed the form and put ‘no’ to every question, so although on the face of it his contract seemed good in that there were no exclusions, in the event of any claim or anything related to his back it would have been a non-disclosure case and the claim would have been refused. It is possible in some cases that the premiums would not even be refunded. We therefore re-applied to another insurer and disclosed all the relevant medical facts and ensured that he was fully insured.

They may simply not realise the importance of disclosing all medical facts

The applicant does not complete the form themselves but is asked the questions over the phone and some details of the questions are inadvertently omitted We also encourage our clients to complete the medical information on the form themselves so that they are reading the questions themselves directly and are encouraged to take the time necessary to complete it correctly. Once we have processed the application, either by post or online, we print a copy of the application form and return it to the applicants requesting that they check the information, amend where necessary and return to us. They then have the advantage of being able to find a suitable time to set aside and review the questions and ensure that they have disclosed everything they need to have done. Some clients also find it useful to talk through each question with a partner or a parent, as frequently those around us have as good a memory, if not better, of our health situation.

The applicant might be embarrassed to disclose some information to the financial adviser

If there is any medical information which you are embarrassed about and do not want to disclose personally, we encourage you to write to the chief medical officer of the relevant insurer and, together with your name and date of birth or application number, write to the chief medical officer and give any further health details that you feel may be relevant to the application. This is preferably done at the beginning or during the underwriting process. However this can be done, as explained in another example, at any time during the life of the contract. We are also keen to establish a relationship with insurers that are able to organise a telling interview with a nurse, and these interviews, which typically last approximately 30 minutes, with a health professional sometimes elicit more information than can be gathered in a face-to-face meeting with your financial adviser. We do receive a copy of this information which we then use to cross-reference with any simultaneous applications and also with the previous applications to ensure that full disclosure has happened in the past, bearing in mind the importance of innocent non-disclosure and the relevance to a successful claim in the future. We feel that these cross-referencing and checks that we perform are an excellent added-value service that we provide to our clients.