To see or not to see, what are the questions?

Mike Taylor

Managing Editor and Publisher

25 June 2026

Financial Newswire’s life/risk expert, Col Fullagar writes that it all began so innocently. A claims assessor advised a report was being requested from the treating doctor.

The claimant’s representative politely asked if a copy of the questions to be asked could be provided prior to the request being sent. Back came the response: “We don’t share the specific medical questions in advance, as these are designed for the treating doctor and need to be considered together with their clinical response.”

Whilst the outcome was clear the reason was not, so the matter was referred to a senior person within the insurer’s claims department for clarification. Back came the response:

“Thank you for giving me the chance to clarify our approach regarding the integrity and independence of external reports. Our consistent practice of not sharing questions in advance is founded on the principle of safeguarding against any potential undue influence on the provider’s responses. When questions are distributed beforehand, there is an increased risk that responses could be shaped by the expectations—or perspectives—of those for whom the report is being requested, rather than relying solely on the provider’s clinical expertise and judgement.

“Furthermore, this approach has been supported by AFCA in several relevant cases, confirming that our practice is both compliant and reasonable.”

Pretty heady stuff which led to various counter points being made ………

When someone infers that providing questions in advance might compromise the integrity and independence of a medical report is that saying what it appears to be saying ie that either or both of the claimant and the medical practitioner would be complicit in inappropriately influencing the content of the report?

Is it reasonable to suggest that an independent and professionally qualified medical practitioner would risk reputation or worse, by allowing themselves to be influenced to say something that was untrue? Further, would it be reasonable to suggest if they were capable of being influenced, how does not providing the questions to the claimant in advance protect the insurer from this occurring? The claimant is advised, as she/he should be, that a report is being requested. It is then an easy matter to make and attend an appointment with the medical practitioner prior to the report being written and despatched.

 What is far more likely to be the case is that medical practitioners may want to discuss their responses with their patient prior to compiling the report as they appreciate and respect the opinion and input of the patient.

In brief, if protection of the integrity and independence of the report is the primary reason for not sharing questions in advance, not only does it arguably hold little merit, but it is in fact problematic for various reasons ………….

• Adverse inference

It is not difficult to imagine that the insurer’s inference could be taken by both the practitioner and claimant as a slight on their character and integrity. This is even more so the case when it is remembered that the vast majority of claims and claimants are genuine. Why then is the insurer apparently assuming guilt rather than innocence?

• Contrary to the Life Insurance Code of Practice (“the Code”)

Insurance companies subscribing to the Code are required to commit to be honest, fair, respectful and transparent. The position taken in this case appears to be in breach of these commitments.

Then there is Section 5.12 of the Code which states in part:

“….. We may ask you to consent to requesting information from more than one source. Unless you tell us you do not want us to, we will tell you each time we use your consent ……  if you do not agree that we need some of this information, we will review our request.”

and Section 5.15 which goes on ……..

“ …. you can ask us to review whether the grounds are reasonable. We will tell you the outcome of our review and, if you are unhappy with the outcome of our review, we will treat this as a complaint.”

Commonsense dictates that, if someone is to make the necessary informed decision about whether or not they agree to certain information being requested, they must know what is being requested and how it is relevant. Commonsense also dictates that they must know this prior to the information request being made and that includes knowing the questions an insurer is looking to ask a third party bearing in mind that the purpose of questions is to obtain information.

• Claims Management – Dictatorship or Co-operative

The approach taken in this matter appears to favour the former over the latter. The author has long held a view that insurers would achieve a way better result if they respected the fact that a claimant and/or their representative might be able to add value to the process if for no other reason than you will learn far more about someone by being nice to them than by being mean.

• Consistent approach

The insurer touted the value of a consistent approach, yet this holds questionable merit. If an insurer has reason to doubt the veracity of a minority, treat them accordingly but for the majority, treat them as they deserve. If advisers and/or otherwise representatives have earned the right to be trusted, their integrity and potential for value-add should be respected.

• Quality control

Let’s be honest, the matter of letter writing is not a skill set of some today. A poorly drafted letter with inconsistencies and errors will reflect poorly on the professionalism of the insurer and the assessor. By enabling a second set of eyes to check questions being asked errors in logic, consistency and grammar are less likely to be let loose.

• Out of line with other insurers

The request made of this insurer has been made of others who are either happy or willing to respond in a positive way. Even if this were not the case, however, the sad reality in regard to claims management is that no insurer can claim the high moral ground. Insurers will form a view and do what they want to do but if this perpetuates a policy that might be seen by those already at a physical and/or psychological disadvantage aka claimants, as being disrespectful of them, those insurers will either struggle to rise above the pack or the pack will rise above them.

• AFCA

The insurer cited that its approach was supported by several AFCA decisions. When details were requested, one rather than several was provided and this turned out to be a preliminary assessment, not a determination.

The AFCA case manager stated the following:

“While I appreciate why the complainant’s representative raised these concerns …… there is no requirement under the LICOP that requires an insurer to provide the opportunity for a claimant or its representative to review its referral questions in advance of an Independent Medical Examination.”

Relevantly, this complaint concerned an Independent Medical Examination (“IME”) and the insurer’s briefing letter to the examiner undertaking the IME.

Whilst the Code would enable the claimant to challenge the need for an IME, it is acknowledged that there is no requirement under the IME section of the Code for the insurer’s referral questions to be provided to the claimant in advance of the IME. The IME examiner would usually have no prior knowledge of the claimant, and the briefing letter is instructing the examiner about the information the insurer wishes the examiner to obtain. If, during the examination, the claimant wishes to challenge the relevance of questions when they are asked by the examiner they can do so, as provided by the Code.

It is suggested that an IME briefing letter is materially different to the commissioning of a report from the treating GP or specialist. When a report is being commissioned, specific and existing information is being requested from someone who knows the claimant, but who potentially has little or no knowledge of the claim. As such, the ability of the practitioner to assess relevance may be limited. Further, if the GP or specialist does not speak with the claimant, the claimant is denied the opportunity to question the relevance of the information being requested, thus breaching 5.12 and 5.15 of the Code.

All the above was conveyed to the insurer. The response “I think this is ultimately an area where we will need to agree to disagree.”

The litmus test in this matter is simple, if you were on claim, would you be comfortable about the insurance company writing to your treating doctor and asking unknown questions about you?

Without wanting to pre-empt the answer, this scenario was put to someone outside the industry. Their response was a resounding “No way !!”, which emboldened the author to release this article.

As noted before, the Code requires insurers to commit to being honest, fair, respectful and transparent towards customers, not just when it suits but at all times. One of the many financial adviser value-adds is to ensure their clients are treated in line with this commitment.

Col Fullagar is the principal of Integrity Resolutions Pty Ltd