Clients need to see a transparent HIC report process

Insurance companies need to be more transparent in their reasons for obtaining Health Insurance Commission (HIC) reports, which can add up to 10 weeks to claim times, according to RetireInvest national manager of risk insurance Col Fullagar.

An HIC report lists every service a client has sought that qualifies for Medicare benefits and for which a claim has been processed.

Fullagar said Medicare holds these records for a five-year period and reports requested within this timeframe will take between four and six weeks to obtain.

He said if an insurance company required an HIC report dating back more than five years (maximum 1984), Medicare would need to source the report from the Department of Health — a process that could extend the claim time to 10 weeks.

Fullagar said while he understood it might be necessary to obtain an HIC report, insurers needed to stipulate this in their Product Disclosure Statements (PDS) and have a “reasonable” basis for sourcing such a report.

Fullagar believes that some insurers have “unpublished rules” on when they will automatically obtain an HIC report, including the age of a policy and when the benefit is of a certain amount.

Commenting on Fullagar’s concerns, Suncorp Life executive manager, claims management, Neil Borthwick said the company would only request an HIC report if it suspected non disclosure.

He said there were no triggers relating to size of benefit or the duration of a claim.

CommInsure executive manager, business growth services, market development and distribution, Jeffrey Scott, said while the company would always obtain authorisation from a client to gain an HIC report, the client was not informed of what information would be obtained.

He said CommInsure would request an HIC report in less than 50 per cent of claims, and while in some cases it would go back to 1984, that was very rare.

Tower Australia said it advises clients of the process of the claim and the issues they might need to explore.