Medical Underwriting for Health Insurance

Medical underwriting is a process which is used by the insurance companies to determine the health status of an individual applying for health insurance policy. This health information collected is then evaluated by the insurers to determine whether to offer coverage, up to what limit and on what conditions and exclusions. Thus, medical underwriting can determine the acceptance of declining of a risk and also the terms of cover.

medical-legal (ML) evaluation

In workers’ compensation, the independent assessment of an employee that results in the preparation of a narrative medical report prepared and attested to in accordance with the state labor code. It must be performed by either a qualified medical evaluator, agreed medical evaluator, or the primary treating physician for the purpose of proving or disproving a contested workers’ compensation claim.

Medical-legal expense

Any costs and expenses incurred by or on behalf of any party, the administrative director, the board, or a referee for x-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical testimony, or interpreter’s fees, for the purpose of proving or disproving a contested workers’ compensation claim.

Medically (or psychologically) necessary services

Medical or psychological services that are considered appropriate care; that meet standards of good medical practice; that are generally accepted by qualified professionals to be reasonable and adequate for the diagnosis and treatment of illness, injury, pregnancy, and mental disorders; that are not provided mainly for the convenience of the patient or the physician; or that are reasonable and adequate for well-baby care.