CR372
Underwriting

Life register entry – was it justified?

Complainants sometimes complain about an insurer’s underwriting process and protocols. In this matter a complainant who coincidently had been successful in a claim which had been the subject matter of a previous complaint, complained after her insurer refused her application for an increase in benefits. The complainant, who had received income benefits for a period in respect of a disability income claim due to depression, had been refused increased cover for these benefits when she applied 8 years later and after her recovery. Her complaint was not about the refusal of cover but about the fact that the insurer had, according to her, misrepresented the facts about her health. In the ASISA Life Register there was a notation which stated under the heading “Impairment:” “Depression Major” and under “Special Investigations:” “abstract from clinical records”. She regarded this as inaccurate and as having adverse consequences for her.

The insurer explained that this was the extent of the entry and that no medical records were submitted for the entry. The insurer explained that the information was recorded on the Life Register on 28 November 2013 when cover was refused. The complainant was of the view that this notation gave the wrong impression as it suggests that she was still suffering from major depression. She also questioned the accuracy of the recording as she contended that she had never been diagnosed with major depression.

We retrieved our previous complaint file from the archives and could confirm that she had in fact been diagnosed with major depression in 2004. After enquiries with ASISA and the Chief Underwriter and Chief Medical Office of the insurer we established that an insurer is obliged to make a notation on the Life Register when cover is declined, which had taken place in 2013 in this case. We also established that the public has no access to the Life Register – only the Chief Underwriter and Chief Medical Officer of any participating insurer has access. Any other insurer who was approached for cover and accessed the Life Register would have to obtain the medical information themselves and was not supposed to rely solely on the entry in the Life Register.

We advised the complainant that we could not instruct the insurer to expunge the entry as the insurer had acted in terms of the ASISA Life Register Standard and that the listing was correct.

JP
April 2016