Letters
Ethics General medicine
Volume 186 - Issue 1

Gone fishing

Author:  Bernard S Pearn-Rowe

Med J Aust 2007; 186 (1): 47. || doi: 10.5694/j.1326-5377.2007.tb00792.x
Published online: 1 January 2007
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To the Editor: No one denies the right of insurers, or law firms acting for an interested party, to obtain information relating to a claim with due authority from the patient. After all, it’s fair enough for insurers to check the details of a claim.

This system has worked well for decades and allows the insurance industry to operate reasonably and fairly.

But a recent development gives cause for great concern.

There is a trend among both insurers and lawyers to demand copies of a patient’s entire medical file. Not just details relevant to the claim, but the entire medical file, often extending for years before the relevant event. A cynic has suggested this is financially motivated, as a reasonable fee for copying and forwarding a file is likely to be less than the fee for reviewing the file and preparing a report. Another equally uncharitable explanation is that insurers are embarking on “fishing trips”, hoping to find grounds to mitigate a claim.

I’m sure the industry could produce examples in which fishing trips have identified dishonest claims that might not otherwise have been detected. But I cannot justify sacrificing the privacy of many patients to expose the occasional fraudulent claim.

In one case, one of my patients suffered a work-related injury that prevented her working as a private contractor for some months. The case was clear-cut, simple and straightforward. Yet the insurer refused to process her claim without receiving a copy of her entire file — including very personal details of a sexual assault nearly 20 years earlier, together with confirmation that she had contracted a sexually transmitted infection and details of her subsequent breakdown. For a vulnerable and very private person, it was a terrible ordeal to have this brought up and to have to sanction its disclosure to a claims officer.

My financially strapped patient was held to ransom when the insurer advised that the claim would not be processed until the disclosure was authorised.

How can the individual claimant ever stand up to a multinational insurer? And, in this case, appeals to the industry regulatory body were peremptorily dismissed. I support any stand by our profession against this unjustifiable invasion of privacy.

Author

  • Bernard S Pearn-Rowe1
  • 1. College of Medicine, The University of Notre Dame Australia, Fremantle, WA.

Correspondence: bernard@iinet.net.au

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