Unknown illnesses could scupper your insurance!

Consumers are being advised to check their medical records before buying travel, life or health insurance to make sure they give correct answers to the complex questionnaires that they are increasingly required to complete.

The Financial Ombudsman Service said one in four of the complaints it receives about travel insurance related to claims that have been turned down because holidaymakers failed to disclose pre-existing conditions. In addition, 2 out of every 100 claims for life and critical illness cover are rejected because applicants did not disclose their full medical history.

But unless you check your medical record, how can you be sure you have answered the questions correctly? And can a claim be turned down on the grounds that you failed to declare an illness you didn't know you had?

Insurers do not normally see your medical record when you apply for cover but rely on the information you give them to decide whether to offer protection and at what price. However, if you make a claim, companies frequently write to your doctor for a copy of your medical history.

This is when problems arise. If there is anything on your record that you failed to disclose, or did not understand, your claim could be rejected.

According to Eileen Dalrymple-White, a director at broker MIA, which specialises in travel insurance for holidaymakers with pre-existing medical conditions, a worrying trend is emerging where medical records do not necessarily reflect an individual's own understanding of his or her health issues.

"This causes problems when the patient discloses his health history as he understands it, but when he subsequently makes a claim and the insurer sends for his medical records and finds something he hasn't declared," she said. "But how can you disclose a condition no one has ever said that you are suffering from, and for which you are not receiving any treatment?"

In April, the new Consumer Insurance Act should help provide customers with greater protection. However, the onus remains on them to answer any health questions honestly, in an informed and considered fashion.

An Aviva spokesman said: "We hold the view that it is the customer's responsibility to ensure he or she provides a full and accurate declaration when taking out insurance."

The new law divides customers who fail to disclose pre-existing conditions into three groups.

The first is categorised as the innocents. These are policyholders who genuinely had no idea they had, or had ever suffered from, a condition, and who were not receiving any treatment for that condition. The ombudsman says such claims should be paid in full, regardless of non-disclosure.

The next and potentially largest group is those who "negligently" fail to disclose information about their health, which might have an impact on the underwriting. This can range from a tiny oversight to a material omission.

It is also the area where patient responsibility comes into it. If you should have known what you were suffering from, then ignorance is no excuse.

A spokesman from the Association of British Insurers said: "People often get in a pickle over hypertension. When asked if they are suffering from it they reply 'no', because they are taking drugs and it is under control. The correct answer is 'yes' so, technically, this is a non-disclosure. But most insurers would overlook it as an innocent mistake."

If the non-disclosure is thought to be "negligent", the claim could legitimately be turned down or customers might be asked to pay an additional premium, which they would have been charged from the outset if the condition had been declared.

Finally, where customers are found to have deliberately withheld information the claim will be turned down as a fraudulent policy. The ABI said: "If you lie about your health to get a cheaper premium, that is fraud."

So the dilemma for consumers is should they check their medical record, to make sure they are in full possession of the crucial facts? Or is it better not to know?

The ABI said this was for individuals to decide. "Some will feel happier seeing their record. But if they answer all questions on the application form to the best of their ability, they shouldn't have anything to worry about."

How can I search my medical record?

Under the Data Protection Act 1998, all patients have the right to access their medical records.

You can do this by asking your doctor informally, and he may be happy to talk you through them or show them to you in the surgery.

Alternatively, you should write to your GP practice and make what is called a "subject access request". There may be a small fee involved of around £10, although doctors are permitted to charge up to £50 for a copy of paper-based records. For more information see tinyurl.com/bl4wy9f.

Can my request be refused?

The health records manager, GP or other health care professional will decide whether your request can be approved. They can refuse if they believe that releasing the information may cause serious harm to your physical or mental health or that of another person.

Does my insurance company have automatic access to my record?

No, you have to sign an authority for it to receive a copy. However, if you refuse to sign, it could decline any claim.

Can you get your record changed?

If you discover something on your record which you did not know about, or you consider inaccurate, you can challenge it. Under the provision of the Data Protection Act, everyone has the right for inaccuracies to be removed from their record.