Insurers' need for health information
Insurers' access to and handling of health information
New regulations
Insurers' need for health information
The need for insurance companies to obtain health information from customers arises primarily in connection with applications for new policies or renewals of existing policies. Such health information enables insurers to make appropriate risk assessments and to decide whether coverage can be granted – and, if so, at what premium and under which conditions. Health information is also frequently needed for claims-handling purposes – for example, to establish the existence of a loss and to confirm that there is a causal link between the loss and a circumstance which is covered by the relevant policy.
Insurers' access to and handling of health information
The integrity of insurers' access to and handling of patients' case records has long been questioned. Changes in the Insurance Contract Act (2005:104), which took effect on July 1 2011, limit insurance companies' ability routinely to request health information in connection with applications for insurance.
Health declarations regularly contain passages whereby the insurance company requests the customer's consent to collect health information including patient records, doctor's assessments and information from the Regional Insurance Benefit Society. Normally, such consent is general in nature and lacks a time limit.
New regulations
Under the new regulations insurance companies can ask for consent to collect health information only when it is "necessary" for the handling of a loss occurrence(1) or when it is "necessary" for assessment of policy applications.(2) Consent must be granted in a separate document drafted by the insurance company. It must be clearly stated that the consent is limited to the time it takes to handle the loss or to assess the application in question. The insurer must inform the policyholder with regard to the implications and importance of his or her consent.
Hence, under the new regulations insurance companies may request consent to collect health information only when necessary. In addition, reasons must be given in each individual case as to why the health information sought is necessary (eg, because the health declaration provided gives reason to investigate further). Consequently, where a 'clean' health declaration has been submitted on application for insurance, only in very rare circumstances would it be deemed necessary to ask for consent to collect additional information. For claims-handling purposes it will frequently be necessary for insurers to obtain consent to collect medical records in order to establish the existence of an injury or disease, and to confirm that there is a causal link between such injury or disease and a circumstance which is covered by the relevant policy.
For further information on this topic please contact Rose-Marie Lundström at A1 Advokater by telephone (+46 8 545 811 03), fax (+46 722 36 39 03) or email ([email protected]).
Endnotes
(1) Insurance Contract Act, Chapters 7(1)(a) and 16(1)(a).