Lessons learned in a virtual world: Remote Medical Examinations
Traditionally, medical evidence was only ever obtained through consultation/examination of a claimant by an expert in person. However, due to the global COVID-19 pandemic, restrictions were imposed through various means to reduce the spread of the virus. At this time, Medco relaxed its prohibition on remote examinations. Zurich mirrored this approach and provided agreement that in Motor and Casualty claims, both claimant law firms and the medical agency it uses could arrange for examinations to be performed remotely, subject to certain conditions.
As the restrictions have now been lifted, we have already seen clamour from the claimant community to continue with remote examinations, ostensibly to promote accelerated settlements and case lifecycles, as well as limiting costs and arguably improving client satisfaction. Whilst Zurich has seen real benefits to its wider sustainability objectives through the increased use of the Microsoft Teams/Zoom platforms in our business resulting from the pandemic, it is our view that this is an area where there is no substitute for a “face to face” examination.
Fraud concerns
Primarily, face to face examinations are likely to reduce the number of opportunistic insurance frauds seen by the industry. Insurance fraud is a significant problem, with the ABI reporting that £1.1 billion of insurance fraud was detected in 2021 and estimating a similar amount going undetected. Zurich has also recently reported an increase in fraud fuelled by cost-of-living pressures. Honest policyholders feel the impact of this activity, as a result of increased premiums. Insurers are impacted by having to invest considerable time, costs, and effort to detect and prevent it. It is therefore of paramount importance that we carefully consider any proposed process changes that could result in a rise in insurance fraud.
This is because remote medical examinations provide an additional layer of validation that is often lost through engagement via the sofa. Face to face examinations require the claimant to look the expert in the eyes and tell the truth. Zurich through its own experience and industry research, are of the view that one is more likely to provide a truthful account “in person” as opposed to virtually. They are more likely to feel engaged in the process and treat it with the respect it requires. And, whilst it is technically possible to conduct an examination remotely, the clear difference, is that the claimant does not have to submit to direct physical examination. This not only reduces the ability to exaggerate but will also often increase the validity of the expert’s medical assessment.
Adverse behaviours and devalued process
Secondly, from a review of a sample of cases involving remote examination, Zurich noted evidence of adverse claimant lawyer behaviour. It was not uncommon that the medical records in cases requiring their review by the instructed medical expert were not provided to the medical expert, thus preventing a full assessment and consideration of all relevant factors. It was also not uncommon that remote examinations were initially conducted by experts who were clearly not suitable to appropriately report upon the case. Moreover, examinations were held remotely and without good reason where it was clear that a physical examination was necessary in the future. Such practices only served to increase the time and cost of the claims process for all parties involved.
Way ahead
Zurich’s tolerance for remote medical examinations has ended, except in extremely limited circumstances. This will effectively reinstate our stance and the market’s approach regarding medical examination to the pre-pandemic position. The stance also reflects the guidance issued by MedCo in applicable cases. Whilst it is clear that virtual team meetings and other collaborative activity are now here to stay using modern communications technology, remote examinations are an example of where the experience lacks the quality and rigour of a face-to-face examination. The time has come to “zoom-out” of remote examinations, zooming in on insurance fraud prevention and detection, as well as retain the integrity of the claims process.
