INEM · LIFE INSURANCE
Medical opinions for life insurance
Medical support in assessing life insurance claims: serious illness, work incapacity and accident consequences. Claims assessment and pre-contract risk assessment are handled as distinct scopes.
HOW A REPORT IS PREPARED
From a question
to a reasoned report.
Keep scrolling — we show how an independent medical report is prepared.
Scope of the assignment
First we define the questions, the purpose of the report and the specialty required. The enquiry form contains no medical records.
Scope and fee are confirmed before commissioning.- 01
Assignment
We agree the questions, the purpose and the specialty.
- 02
Completeness of records
We check whether the records can answer the questions and identify gaps.
- 03
Specialist analysis
A physician of the appropriate specialty assesses the case material.
- 04
Quality check
We verify completeness, reasoning and consistency with the agreed scope.
- 05
Finished report
A signed report with reasoning and stated limitations.
Claims assessment is not the same as risk assessment.
In claims handling we assess the records of an event that has already occurred. In medical risk assessment we interpret records before the contract is concluded — as underwriting support. These are two distinct scopes, agreed separately.
Example cases: question, scope, result
Serious illness
Do the records confirm a diagnosis covered by the policy terms?
DOCUMENTS NEEDED
- Clinical records
- Test results (incl. histopathology)
- Policy terms and conditions
SCOPE OF ANALYSIS
Diagnosis, chronology, relevant clinical findings and the medical criteria supplied with the assignment and the policy terms.
WHAT YOU RECEIVE
A report stating what the records confirm and what they do not — with reasoning and limitations.
Work incapacity
What functional limitations follow from the records and what is the prognosis?
DOCUMENTS NEEDED
- Treatment history
- Test results
- Description of job duties
SCOPE OF ANALYSIS
Functional limitations, course of treatment, prognosis and the job duties and assessment criteria supplied with the assignment.
WHAT YOU RECEIVE
A structured assessment of work incapacity against the supplied criteria.
Accident consequences
Which consequences of the injury are documented and how are they linked to the event?
DOCUMENTS NEEDED
- Injury records
- Imaging results
- Previous assessments
SCOPE OF ANALYSIS
Injury consequences, causation, prior conditions and the appropriate impairment criteria supplied with the assignment.
WHAT YOU RECEIVE
A description of the consequences with references to the records — without assessing the benefit amount.
Medical risk assessment
What do the records say about risk before the application is accepted?
DOCUMENTS NEEDED
- History and medical records
- Test results
- Questions for the specialist
SCOPE OF ANALYSIS
Specialist interpretation of records for underwriting — before the contract is concluded, not at claims stage.
WHAT YOU RECEIVE
A report supporting the terms decision; the insurer makes the decision.
Synthetic examples — they do not depict real patients. The scope depends on the individual case.
What you receive
- A signed report answering the agreed questions
- References to the criteria supplied with the assignment and the policy terms
- A list of the records reviewed and the stated limitations
- Identification of gaps or the need to complete the records
How cooperation works
- 1
Enquiry
You describe the type of cases and the expected scope — no medical records in the form.
- 2
Scope and fee
We agree the questions, specialties, report language, fee and timing — before commissioning.
- 3
Analysis and quality check
A specialist physician reviews the records; the report undergoes a completeness and reasoning check.
- 4
Finished report
You receive a signed report with reasoning, the list of records and stated limitations.
Related pages
Frequently asked questions
Do you also assess applications before the contract is concluded?
Yes — medical risk assessment for underwriting is a separate scope, agreed independently of claims handling.
Who decides on the benefit?
The insurer. Our report is medical support for the process and replaces neither the insurer's decision nor an official assessment.
The report provides medical support for the process. The decision on benefits or insurance terms rests with the insurer.
Let us discuss your cases
The enquiry form requires no records or medical details. Scope, report language and fee are confirmed before commissioning.