The last touches on wrapping up a case can be some of the most difficult ones. Most everything is in, the case is ready to be paid for, but there is underwriting information that is outstanding: a test result unaccounted for; an APS that hasn’t come in; a doctor’s office that is taking its time in getting out information that is critical. There’s got to be an easier way.
Fortunately, sometimes there is. There may be more than one way to skin a cat, and what the underwriter is looking for may be available in a different way, a different format, or perhaps even the information is already contained elsewhere. No case will be held up waiting for Godot, because it’s to the company’s benefit to place it as much as it is to you and to the client. The needed information has to be pertinent to the case, necessary for the insurer to assume risk, and sometimes required by a reinsurer that is partnering in accepting part of the face amount. It all starts by asking the critical question: “What’s missing?”
You’ll want to know more than just the basic “the APS from Dr. Smith is missing.” What in the APS is it that’s essential? First, there’s a good chance that there is already information from a subsequent doctor’s notes that makes obtaining Dr. Smith’s notes less imperative. Second, there may be information in labs or testing done by a specialist that spells out what Dr. Smith was trying to ascertain. If Dr. Smith was seen for a non-essential reason (urgent care, etc.) his note may not be of much additional value.
What if Dr. Smith is the specialist? Often, his note is summarized or parroted by the primary doctor after seeing your client again in resuming care. You may already have the information you need. If Dr. Smith is the primary care physician, do you have enough information from the specialist to proceed? If yet another doctor is involved, there may be enough that you already have in the file to address an underwriter’s concern. Find out from the underwriter as closely as possible what he is looking for, as there is more than one source for obtaining that information in many cases.
Sometimes you may be waiting on a critical pathology report that may assess whether a cancer, for instance, is insurable at this stage. The doctor may have written everything you need to know in his note on a post-surgical visit, summarizing the pathology. If it’s the doctor’s report that is lacking, remember there are other places to obtain a pathology report—e.g., the hospital records. Or a third consulting specialist may have recorded in his notes everything you need to know. Find out if there’s any other place in what the underwriter already has that contains enough information for a decision to be made.
Doctors sometimes are over-cautious in their notes. In this day and age, with legal recriminations for just about anything, a doctor may advise a patient to get a benign-looking mole checked, to see a specialist if certain symptoms continue, or to obtain a certain investigation as a back-up. The client/patient hears it differently, and what the doctor has basically told him is that everything is okay and there’s no need to follow up if the problem disappears. Yet the underwriter is waiting for the follow-up test, or dermatology to look at that suspicious skin problem, etc. In that case, a short note from the doctor explaining this goes a long way. It’s a minimal inconvenience for a two or three line note explaining this to the underwriter. And the request is taken very seriously when made by the patient, because he is in effect the doctor’s client, and therein lies the good will of a physician-patient relationship.
One other difficult situation is when the request for information goes out and is met by “clinic no longer in business,” “doctor retired,” or “doctor’s office wants an ungodly sum of money for the records.” In these cases, the best answer is “be specific.” If you need one particular piece of information, ask for a short note from the doctor directly to address it. If the office is no longer in business, see if something in another doctor’s note addresses the question. When the clinic notes can’t be located, ask who got their medical records, or how old the information is that the underwriter is looking for.
An underwriter only gets one chance to ask for information, and once the policy is issued, unless there is outright fraud, there are no second chances. Be sensitive to that and ask the underwriter what it is that would put his comfort level high enough to issue the case on information that is already present. If a simple blood test or note from a current physician will suffice, it beats the frustration of waiting for notes that may never come to allow the case to go to competition. Ask if the underwriter will allow the medical director to have one more look at the case to see if he can be satisfied with existing information. Encourage that communication. And if the competition is willing to issue without that missing note, let the underwriter know that as well. It’s called “risk assessment” for a reason. Do anything you can on your end to make it as easy as possible to give the underwriter the assurance he needs to turn it into an issued case.
