Medical and financial evidence
Making sure your clients get the fairest price for their cover.
The full picture
We work out the cost of your client’s cover based on the information they provide during the application process and any additional information we request from them.
To secure the fairest terms for your client it’s essential this information is as complete and accurate as possible. We use a variety of ways to collect information, so we get the full picture about your client’s circumstances.
When we ask for evidence
If your client is a certain age or requests a certain level of cover, we will automatically ask for some types of medical evidence from them, even if they have no known medical conditions.
We use this evidence to make sure we apply the correct terms, based on complete and accurate information, at the application stage. Automatic evidence also protects your client if they need to claim, as any increased risk factors at the time of applying are identified and factored in to the cost of their cover.
When we need a Declaration of Health (DOH)
The DOH provides your client with the opportunity to tell us about any changes to their health or other relevant circumstances since the application was submitted.
The information given on the application is valid for 6 or 3 months depending on the amount of cover. After this period, a DOH can be used to extend the validity of the application, provided the application date is less than 12 months old. A new application will be needed if the application is more than 12 months old.
A DOH is only valid for two months from the date the client signs the form.
- Once the underwriting decision or validity date has expired (see table below).
- When the requested policy start date is beyond the validity date.
- When the direct debit is not collected within 60 days of the policy start date.
| Type of cover | Sum assured | Medical information is valid for (from date of application or medical examination) |
|---|---|---|
| Life cover | £500,000 or below | 6 months |
| Over £500,000 | 3 months | |
| Critical Illness Cover (CIC) | £350,000 or below | 6 months |
| Over £350,000 | 3 months | |
| Income Protection Benefit (IPB) | Any amount | 6 months |
| Mortgage Payment Insurance (MPI) | Any amount | 6 months |
Changing the application
A DOH will also be required if your client wants to:
- Extended the policy term by more than five years.
- Increase the sum assured by more than 10% of the original sum for Life and CIC policies. However, any increase less than £10,000 does not require a DOH even if it’s more than 10% of the original sum assured.
- Increase the sum assured by more than £30,000.
- Increase the sum assured for IPB and MPI to more than 10% of the original benefit.
- Reduce deferment periods for MPI and IPB.
- Add any optional benefits.
Types of disclosure we may use
When we ask for information to help with underwriting your client’s application, we will ask for one or more of the following documents.
| Document | Explanation | Completed by |
|---|---|---|
| Application form | The most important piece of underwriting evidence, as this forms the basis of the contract. Please make sure answers are precise and accurate so we can get your client on risk as soon as possible. | Client |
| Telemedical Interview (TMI) |
This is where a specially trained nurse or underwriter contacts your client to speak to them about a medical condition they have disclosed on the application form or about their general health for age sum assured purposes. For more information see ‘What happens during a telemedical interview (TMI)’ below. |
Client |
| Simple Financial Information (SFI) | This is a form that allows your client to provide information about existing cover, earnings, net worth and last year's profits (for Key Person cover). | Client |
| Personal Assurance Questionnaire (PAQ) |
A financial questionnaire that provides information about your client’s income, concurrent and existing cover and details relevant to their personal needs. For higher sums assured or complex applications, this form may need countersigning by an independent third party such as an accountant, solicitor or bank manager who is independent of the application. |
Client and possibly an independent third party |
| Business Assurance Questionnaire (BAQ) |
A financial questionnaire that provides information about income, concurrent and existing cover and details relevant to your client’s business needs. For higher sums assured or complex applications, this form may need countersigning by an independent third party such as an accountant, solicitor or bank manager who is independent of the application. |
Client and possibly an independent third party |
| Patient Health Report (PHR) |
This is a report is based on your client’s medical records. The report covers:
The report can be requested either as part of the age sum assured evidence or due to medical disclosures made by your client. |
GP |
| Specific Medical Reports (SMR) |
These are based on your client’s medical records. The reports cover:
|
GP |
| General Practitioner’s Report (GPR) | This is a standard industry format report, based on your client’s medical records. The report covers:
It can be requested either as part of the age sum assured evidence or due to medical disclosures made by your client. |
GP |
| Targeted Reports |
This is short questionnaire that is sent to your client’s GP instead of a General Practitioner’s Report. It asks specific questions relating to a condition that has been disclosed by your client. A maximum of two targeted reports will be issued per customer; above this a PHR will be issued. A PHR will always be requested over age sum assured limits, irrespective of the disclosed conditions. |
GP |
| Health Check Nurse –Full Screening (Also known as a Nurse Screening Examination [NSE]) |
This is a report based on a screening performed by a nurse at a convenient place for your client. For example, at their place of work or at home. It can be requested either as part of the age sum assured evidence or due to medical disclosures made by your client. Information collected during the screening includes:
To enable us to use this form of evidence, your client must supply a telephone number so that the nurse can contact them to arrange the appointment. |
Medical professional |
| Health Check Nurse –Mini Screening (Also known as a Nurse Screening Examination [NSE]) |
This is a report based on a screening performed by a nurse at a convenient place for your client. For example, at their place of work or at home. It can be requested either as part of the age sum assured evidence or due to medical disclosures made by your client. Information collected during the screening includes:
|
Medical professional |
| Health Check Doctor (Also known as a Medical Examination Report [MER]) |
This is a report based on a medical examination completed by your client’s GP or an independent doctor provided by a third party. It can be requested either as part of the age sum assured evidence or due to medical disclosures made by your client. Information collected during the examination includes:
|
Medical professional |
Other medical tests
| Human Immunodeficiency Virus (HIV) Test |
This test is always performed using a blood sample. The test is required as part of age sum assured evidence or based on your client’s answers to application questions. It can be requested in conjunction with a Health Check Nurse or Doctor. The nurse or doctor will send the sample straight to the laboratory and the results are sent directly to us. In accordance with the Statement of Best Practice on HIV, we will request an HIV test directly with your client. Whenever possible we will not tell you that your client is required to undergo an HIV test. Please read our HIV Policy below for more details. |
|---|---|
| Cotinine Test |
Cotinine is a chemical that is made by the body from nicotine and is an indicator that nicotine has been inhaled or otherwise introduced into the body. The cotinine test is performed as part of the urinalysis or as a saliva test during an examination (Health Check Nurse/Doctor). It is requested when a non-smoking client is required to undergo an examination either as part of age sum assured evidence or due to a medical disclosure that is made by your client. The test is able to distinguish between passive and active smoking. |
| Electrocardiograph (ECG) |
An ECG is a test that measures the electrical activity of the heart and is a valuable tool in detecting past and present problems relating to the heart. The test is performed during exercise using a treadmill or bicycle. An ECG is normally requested as part of larger age sum assured evidence. |
| Blood tests |
These are usually requested for larger sums assured but can also be requested to help with the underwriting of any case where the underwriter requires further clarification. Non-fasting Blood Profile (NFBP) - a blood profile that includes all the tests below. This test ensures we collect all risk data, so eliminating unnecessary delays due to omitted tests. Liver function Tests (LFT) - used to analyse the functioning of the liver. Lipids - used to calculate the cholesterol level in the blood. Renal Function Test (RFT) - used to analyse the functioning of the kidneys. Full Blood Count (FBC) - analyse the constituents of the blood. Glycosylated Haemoglobin (HbA1c) - provides a longer-term trend, similar to average, of how high the blood sugar has been over a period of time. |
Checking your details form
'Checking your details' (CYD) forms are sent out at the point we make a final underwriting decision on a life.
They include all possible amendments that have been made since the application was submitted. However, only the client will see the risk information, such as the medical answers.
It’s important that the client checks the information thoroughly and makes any amends if necessary. Amendments can potentially cause the terms to change, which may delay the application going on risk.
To reduce the chance of this happening, please double check the following before submitting the application form:
- The spelling of your client’s name.
- Their date of birth.
- Their occupation details.
- The document is signed and dated.
If there are any amends, an underwriter will review these and depending on the stage of the application there may be:
No change to the decision - a letter is issued to the client thanking them for the information and that there is no change to the decision.
New decision made - if the application has been authorised it will be reissued with the new terms.
If the application has not been authorised the new terms are applied, and a new offer letter issued.
Further information required - an underwriter reviews the information and decides if further investigation is required.
- If the case has been authorised, we will send a letter to the client to tell them that we require further information and that we will maintain cover for 60 days whilst we carry out this review. However, if we cannot obtain the information within this time period at the end of the 60 days the policy will be cancelled.
- If the case has not been authorised, we write to the customer to tell them that the original decision has been removed and the underwriting process restarted.
What happens during a telemedical interview (TMI)
If your client has disclosed a medical condition on their application form, we may need to contact them for more information. In some cases, rather than write to your client's doctor, we can speed up the underwriting process by asking your client to talk to one of our specially trained team.
TMI can also be required for age sum assured purposes.
Your client can talk freely and in confidence to a trained member of staff who has an understanding about the nature of the medical condition and knows what information is required to underwrite the policy.
We will contact your client to let them know that we need some further information over the phone. This will be by text, email and letter. You will also be sent an email, to keep you updated with progress.
The customer will then have our freephone number, so that they can call at their convenience to complete the telephone interview. We will not call them to complete the interview – we wait for when it’s convenient for your client to call us.
Lines are open Monday to Thursday 9am to 6.30pm. Friday 9am to 6pm. All calls are recorded and kept for future reference. Deaf or hard of hearing clients can also use telemedical interviews if they have access to Type Talk, or a similar service.
HIV Policy
Legal & General continue to follow the Association of British Insurers (ABI) latest Guiding Principles for HIV and Life Insurance dated July 2016.
The guiding principles are voluntary, set out industry good practice and have been developed by the ABI in consultation with its members and relevant stakeholders.
A copy of the most recent statement of guiding principles can be found here;
Key points
Acquired Immunodeficiency Syndrome (AIDS) is caused by the Human Immunodeficiency Virus (HIV). The body's immune system is damaged by the virus and results in opportunistic infections or rare types of malignancy.
Despite advances in treatment HIV and AIDS remains extremely relevant to the underwriting process.
Customers with full-blown AIDS are currently declined by Legal & General. However, we will consider offering cover to customers who tell us that they are HIV positive (on interactive applications only) due to an improvement in therapy which has led to an increase in life expectancy.
Our interactive application will request additional information which will be assessed and a point of sale decision will advise if cover is not possible or if additional medical information will be needed to assess the application further.
Customers who do not apply through our interactive application route will continue to be declined at point of sale.
To find our policy on asking a customer to take a HIV test please click here
Requirement for a HIV test
The following circumstances will result in a HIV test being requested:
- Routine evidence request for customers under age 60 applying for life cover, where their total cover is £1,500,001 or above
- Routine evidence request for customers aged 40 or older applying for an Income Protection policy where cover is £4,001 or above
- Routine evidence request for all customers of our Income Protection policies where cover is £6,251 or above
- Being resident or visiting in a non-UK country with high HIV prevalence within the last five years.
- Having been diagnosed with a sexually transmitted disease(s) with long-term health implications.
- Intravenous drug use over 5 years ago (if within 5 years the case will be declined)
Underwriting considerations
- The application form asks whether a customer has ever tested positive for HIV or whether a result is outstanding.
- The customer is not asked whether they have ever had a negative HIV test.
- If a customer refuses to undergo a HIV test we will be unable to offer cover.
