Insurance and medical procedures
The procedures for medical acceptance of insured risks such as death, guaranteed income and hospitalisation, have long been a headache. Even more complex are the medical examinations in a claim where, in addition to your own physician treating you, the health insurance fund’s physician and the insurance company’s medical officer also want to examine you. These medical acceptance procedures and expert examinations do not always run as desired and often cause resentment. Nevertheless, the sector has recently adopted positive initiatives that we briefly explain here.
Since the Belgian Act of 4 April 2014 (amended in 2019), former cancer patients have ‘the right to be forgotten’ when taking out certain life insurance policies. Specifically, this means that the insurance company may no longer consider the disease if the patient was declared cured more than ten years ago and has not relapsed since.
A new Belgian Act of 30 October 2022 reinforces this right as follows:
- Besides life insurance, guaranteed income insurance (disability insurance) is also included in the Act. This covers not only standalone policies but also links to an employer’s group policy. However, the prospective insured person must not have been incapacitated for work within the periods set out below.
- The current statutory period of ten years is reduced to eight years as from 27 November 2022.
- The reduced period of eight years will be further reduced to five years as from 1 January 2025.
- The current period of ten years will be immediately reduced to five years for those who develop cancer before the age of 21.
This enhanced protection applies to all cancer disorders and certain chronic diseases included in the existing reference schedule on loan protection insurance (Royal Decree of 26 May 2019). After all, the legislator had already provided by Royal Decree that shorter terms for certain cancer disorders are possible and that any additional premiums for existing chronic diseases could be capped. This reference schedule is intended to be reviewed regularly and adjusted, where necessary.
However, the prospective insured person must still mention the disease on the medical questionnaire. This new Act forces insurers to adapt their questionnaires accordingly.
A second initiative to be welcomed are the clear rules of conduct established in the sector for conducting and following-up an expert medical examination in a claim. The expert examination is carried out by an independent insurance medical officer (or medical adviser) and aims to provide the insurance company with the necessary information to objectively assess the insured person’s medical condition and then compensate correctly under the policy.
These rules of conduct cover the entire investigation period, i.e. before, during and after the expert examination. The emphasis here is on transparency, empathy and information. The insured person also always has the right to request a copy of the medical report from the insurance company. An information brochure is available (in Dutch or French) at www.abcverzekering.be.
Let us hope that these measures lead to fewer medical disputes and improve the image of the insurance industry so that we move one step closer to an ideal world!