Getting your insurance records and fixing errors, questions answered

Most people never look at the records an insurer holds about them until something goes wrong: a rate that seems too high, a decline that makes no sense, or a claim that stalls. By then the questions pile up quickly. What does the insurer have? Who gave it that information? Can I see it? Can I fix it? The answers below are written for a person who has just received an adverse decision, or who wants to check before applying.

The law here is a patchwork. Federal law covers the consumer reports that insurers buy. State insurance law covers the insurer's own file, and it differs from state to state. Where a point varies, the answer says so and points you to your state insurance department.

What the insurer holds and what the law gives you

What records does a life insurer actually keep about me?

Usually more than people expect. During how life insurance underwriting works, an insurer may collect your application answers and the authorizations you signed, any exam or lab results, records from your doctors, a report from the MIB database, a prescription history report, and a motor vehicle record. Some programs add other outside data. The insurer also keeps its own notes: the underwriter's worksheet, the decision, and any correspondence.

After a policy is issued, the file grows: premium history, changes of beneficiary or address, loans, and the claim file if there is a claim. Policy records are generally kept for as long as the policy is in force and for some period afterward, but the retention period is set by the insurer's own rules and by state law, so ask the insurer if it matters to you.

The distinction that helps most is between two kinds of record. Some are consumer reports compiled by a separate reporting company, like the MIB file and the prescription report. Others are the insurer's own file: what it wrote down and what it received from your doctors. Different rights attach to each.

Do I have a legal right to see my underwriting file?

It depends on the state. Many states have an insurance information and privacy law based on the NAIC's Insurance Information and Privacy Protection Model Act (Model 670). Where a state has adopted it, an applicant can generally ask to see recorded personal information the insurer holds, ask to correct it, and ask for the specific reasons for an adverse underwriting decision. Not every state has adopted that model, and the details differ where it has. The privacy and your life insurance data: who sees it and your rights guide explains the layers of law.

If your state has no such act, you still have federal rights over any consumer report the insurer used. And nothing stops you from asking the insurer for a copy of your file. Many will provide the application and the reports on request, even where the law does not strictly require it. A polite written request to the company's privacy or underwriting department costs nothing.

Two practical points. First, put the request in writing and keep a copy, with the date. Second, say plainly what you want: "a copy of my application, the reports used in my underwriting, and the specific reasons for the decision."

What is a consumer report, and why does the label matter?

A consumer report, under the federal Fair Credit Reporting Act (FCRA), is a report from a reporting company that bears on things like your health or character and is used to make decisions about you. The MIB file and the prescription history report are both treated this way. The label matters because it brings specific rights: you can generally get a copy, you can dispute what is wrong, the company must investigate, and an insurer that takes adverse action partly because of the report must tell you so and identify the company.

A doctor's chart sent to the insurer is not a consumer report. That is a record held by your doctor, and your rights over it come from a different source, which is covered below.

Requesting the reports

How do I get my MIB file?

The MIB (originally the Medical Information Bureau) holds coded information from earlier applications to member insurers. You can request your file free once a year, and a second copy at no charge if an insurer tells you that an MIB record influenced a rating or decline, according to MIB. The request can be made online, by phone or by mail; MIB lists the current methods on its site, and you should use its official page rather than a third-party site that might charge a fee.

You will only have a file if you applied in the last seven years for individually underwritten life, health or disability coverage with an MIB member and the insurer reported something of underwriting significance. If you never applied, or had only group coverage, the answer may be that no file exists. That is a useful answer too.

Two things MIB's file does not contain: it does not record how you were rated, and it does not say whether you were accepted or declined. The file is a set of codes plus the names of the companies that received them. For more, see The MIB report: what insurers know about your history.

How do I get my prescription history report?

First find out which company the insurer used. The adverse-action notice, if you received one, must name the reporting company. If you did not get a notice, ask the insurer or the agent. Prescription reporting companies provide a free copy of your report on request; the Consumer Financial Protection Bureau's published list of consumer reporting companies describes how one prominent vendor handles this, and its entry gives the website to use. The FCRA also gives you a right to a free copy after an adverse action that relied on the report.

When the report arrives, read it as if you were an underwriter reading about a stranger. Check the drug names, the dates, the doctors and the pharmacies. Look for medications you never took, fills from places you have never been, and fills that you picked up once but stopped. These are the common mistakes. The how insurers check your prescription history guide describes what such reports include and leave out.

Can I see the medical records the insurer collected from my doctors?

There are two routes. The first is the insurer. Under a state insurance information act, you may be able to request a copy of the recorded personal information, which can include medical records it gathered. Some state laws handle medical information differently, for instance by providing that the insurer may send it to a doctor you designate rather than directly to you. The details vary by state.

The second route is your own doctor. Federal health privacy rules, which apply to doctors and hospitals but, as a general matter, not to life insurers, give patients a right to access their own medical records, usually within a time limit and sometimes for a reasonable copying fee. If you want to know exactly what the insurer saw, you can request your records from the provider and compare them to what the insurer says it has. If the insurer ordered an attending physician statement, the statement is a summary the doctor prepared for the insurer, and you can ask the doctor for a copy.

Disputing and correcting

How do I dispute an error?

Start by deciding where the error lives, because the fix goes to the source.

1. In the MIB file. Dispute it with MIB, using its dispute process. MIB investigates, which can involve contacting the insurer that reported the entry. If the information cannot be verified or is wrong, it is corrected or deleted. If you still disagree, the FCRA lets you add a short statement of dispute to your file.
2. In the prescription report. Dispute it in writing with the reporting company. The FCRA requires it to investigate and to correct or delete anything it cannot verify.
3. In your doctor's chart. Ask the doctor to correct or amend it. Providers have procedures for amendment requests. A doctor will not usually delete something that happened, but can add a note or fix a mistaken entry.
4. In the insurer's own file. Write to the insurer, identify the error and attach proof. Where a state information privacy act applies, it often includes a right to request correction.

For any dispute, be specific. "This is wrong" is weak. "The report shows a prescription for [drug] filled on [date] at [pharmacy]; I have never filled a prescription there, and I have attached a letter from my doctor listing my medications" gives the investigator something to verify.

After the reporting company corrects the record, tell the insurer. Do not assume the correction flows through automatically. Send the corrected report with a request that the decision be reconsidered, as Declined for life insurance? What to do next and asking for a better rate class later describe. The scenario post four scenarios where an automated underwriting decision goes wrong follows four hypothetical households through that sequence.

How long does it all take?

There is no single answer, and anyone who gives you one number is guessing. These are the pieces:

• Receiving a report you asked for. Depends on the company and the method. Online requests can be quick, mailed requests slower. Check the company's own site for its current process.
• A reporting company's investigation of a dispute. The FCRA generally gives the company about 30 days to complete a reinvestigation, with a possible extension in some circumstances. Treat that as a ceiling in the normal case, not a promise of speed.
• The insurer's response to a records request. Set by state law where a state act applies, and otherwise by the insurer's own practice. Some state rules give a specific number of business days; ask your state insurance department what applies to you.
• The insurer's reconsideration of the decision. Entirely up to the insurer. Reconsideration is usually a courtesy rather than a right.

Plan on a few weeks for a clean dispute and a couple of months if there is back and forth. If you need coverage in the meantime, an independent agent may be able to place you elsewhere while the dispute runs.

What if the error is in my doctor's chart rather than a database?

This is the slowest to fix, and the most important, because a wrong chart entry can reappear in every future application. Ask the practice's records department how to request an amendment. Put the request in writing and explain what is wrong and what evidence shows it. If the practice agrees, it will usually add a correction to the record. If it declines, you can generally ask to attach a statement of disagreement.

Keep in mind that a doctor has professional reasons to record what was observed at the time. A diagnosis made on an old visit that has since been ruled out is typically not deleted; instead, a later note records the change. That later note is exactly what an underwriter needs. In that case the best fix is not deletion but a current statement from the doctor on where things stand.

Edge cases and next steps

Will asking for my own records hurt my chances of coverage?

Requesting your own MIB file or prescription report is not an insurance application, and it does not turn you into a higher risk. What can affect a later application is what the records contain, not whether you looked at them. Many applicants check their records before applying precisely so that mistakes can be fixed before an underwriter sees them. The one thing to avoid is the reverse: do not hide anything you find. If the file contains something accurate that you forgot, answer the application honestly. what happens if you lie on a life insurance application explains why a mismatch between your answers and the records is the thing insurers worry about.

What if the insurer ignores my request or refuses?

Escalate in steps.

1. Send a second written request by a trackable method and set a date for a reply.
2. Ask for the privacy or compliance department rather than customer service.
3. File a complaint with your state insurance department, which handles privacy and underwriting-practice complaints at no cost. how to file a complaint against a life insurer walks through the process. Attach your first request, so the department can see the insurer was asked.
4. If a reporting company, not the insurer, is the problem, the Consumer Financial Protection Bureau accepts complaints about consumer reporting companies.
5. For a stubborn dispute over a consumer report, a consumer attorney can explain your options under the FCRA.

Can a beneficiary get the insurer's file after a death?

A beneficiary, or the executor of the insured's estate, can ask the insurer for the policy, the application and the claim file, particularly after a denial. If a claim is denied, a written denial should cite the policy provision relied on, and you can ask for the documents the insurer used. The insurer may not provide everything on request, and its willingness varies. Where the claim is denied or delayed, how to appeal a denied life insurance claim covers the next steps.

If the death was within the first two years of the policy, expect the insurer to have requested medical records, and you are entitled to ask what it found. A family that receives a rescission or a denial based on the application should treat the application copy as the first document to request.

How long do these records stick around?

MIB says it retains information for seven years from the application date, so an old entry eventually ages out. Prescription histories typically cover several years of fills, with the length set by the vendor. The insurer's own file may be kept longer, and policy records may be retained for the life of the policy. If you have a specific concern about how long a record is kept or deleted, ask the company for its retention policy and ask your state insurance department what the state requires.

Before you apply again

What should I do before my next application?

A short routine saves trouble:

1. Request your MIB file about a month ahead, if you have applied for coverage in the last seven years.
2. Request your prescription report from the vendor the insurers commonly use, and compare it to your pharmacy records.
3. Ask your doctor whether any chart entries are out of date and, if so, for a current summary.
4. Write down your medications, with the reason for each, and the date of your last relevant tests.
5. Answer every application question fully, consistent with those records.
6. If you find an error, fix it first. Applying with a known error invites a decline that you then have to appeal.

For the data insurers use and who can see it, myths about who can see your health data when you apply tests the common beliefs against how authorizations and privacy laws actually work.

Key takeaways

• Two kinds of record matter: consumer reports like MIB and prescription histories, covered by the FCRA, and the insurer's own file, covered mainly by state law that varies.
• You can generally request your MIB file free once a year and again after an adverse decision that relied on it, and you can ask for a prescription report from the vendor.
• Fix errors at their source, then tell the insurer and ask it to reconsider; a corrected record does not automatically reverse a decision.
• Expect weeks, not days, and escalate in writing to the insurer's compliance staff and then your state insurance department if you get no answer.
• Check your records before you apply; it costs nothing and is easier than appealing a decline.