Writing claims and insurance reports

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Claims and insurance reports

I am sometimes asked to complete reports for patients making an insurance claim or seeking state benefits, what should I do if I feel that the claim has no merit?

When completing such reports, ensure that the information you provide is a factual and balanced account of the patient's condition, regardless of your own view of the merit or otherwise of the claim. It is important to remember that unless you are specifically instructed to do so, you are not being asked to make a decision as to the merit of the claim or application, but rather to provide information to allow others to make a decision.

In paragraph 71 of Good Medical Practice (2013) the GMC advises that 'You must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents.' It goes on 'You must make sure that any documents you write or sign are not false or misleading. You must take reasonable steps to check the information is correct, and you must not deliberately leave out relevant information.'

The GMC requires that doctors asked to provide information to a third party should be satisfied that patients have sufficient information about the scope, purpose and likely consequences of the disclosure and understand that relevant information cannot be withheld.

'You must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents.'

Additionally the doctor should have seen written consent to the disclosure from the patient or someone authorised to act on his or her behalf. Patients have a statutory right to view certain reports, such as those for insurance or employment purposes, before they are sent. Even where no statutory right exists, the GMC advises in paragraph 115 of Confidentiality: good practice in handling patient information (2017) that a doctor should offer to share a copy of any report written for employment or insurance purposes before it is sent unless the patient has 'already indicated that they do not wish to see it, disclosure would be likely to cause serious harm to the patient or anyone else, or disclosure would be likely to reveal information about another person who does not consent'.

Occasionally when patients have seen a report, they ask doctors to withhold certain information or to amend it before they submit it. You should only do this if you feel it can be done without compromising the accuracy of the report. If you cannot reach an agreement about the content of a report, a patient may add a dissenting statement detailing why he or she disagrees with the doctor's account and, he or she may of course refuse to allow the report to be disclosed.

If the patient refuses to allow a report to be disclosed once the assessment has been done, make it clear to the patient that, if the report is not disclosed, adverse inferences may be drawn. If the patient in that situation still does not consent, this must be respected and the report cannot be disclosed.

In situations where a report is being provided to fulfil a doctor's contractual obligation to a third party, the doctor must obtain the patient's consent before undertaking any examination or writing a report for that organisation. When seeking consent, explain the purpose of the examination or report and the scope of the disclosure.

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