MIB Records, Prescription History, and How Insurers Investigate Life Insurance Claims

When a life insurance claim triggers an investigation — usually because the death occurred within the two-year contestability period — the insurer does not simply review your application. It pulls data from sources most families have never heard of. Understanding what these databases contain and how insurers use them helps you anticipate objections and respond effectively.

The MIB: What It Is and What It Contains

The MIB (formerly the Medical Information Bureau) is a member-owned database used by approximately 420 life and health insurance companies in the US and Canada. When you apply for individual life insurance, the insurer may report coded information about your health history, lifestyle, and risk factors to the MIB. An MIB-member insurer may check for prior records, with your authorization, when considering a later application.

What the MIB records include:

• Coded medical conditions reported during prior insurance applications (cardiovascular issues, diabetes, mental health conditions, substance use)
• Hazardous activities disclosed during underwriting (aviation, scuba diving, motorsport)
• Prior insurance application outcomes (declinations, rated policies, withdrawn applications)
• Hazardous vocation or avocation information, including aviation-related risks

What the MIB does not contain:

• Actual medical records, test results, or physician notes
• Prescription drug history (that comes from a separate database)
• Information from employer-sponsored group policies (group coverage typically does not involve individual underwriting)

Why It Matters for Claims

During a contestability investigation, the insurer compares your original application answers against MIB records. If you answered "no" to a question about heart disease but the MIB shows a cardiac condition code from a prior application with a different insurer, that discrepancy triggers a deeper investigation.

You have the right to request your own MIB file. Under the Fair Credit Reporting Act (in the US) and provincial privacy legislation (in Canada), you can obtain a copy by contacting the MIB directly. If the insurer is using MIB data to deny your claim, you should review the file for errors — MIB codes are entered by individual underwriters and can be incorrect.

Prescription Database Searches

Insurers may obtain prescription fill histories from third-party services during contestability investigations. Examples include:

Milliman IntelliScript — provides prescription-history reports based on records from pharmacy benefit managers. Available data may include the drug name, prescribing physician, and fill date; the records available can differ by individual.

ExamOne (Quest Diagnostics) — provides similar prescription history data and is also used during the initial underwriting process.

What Insurers Look For

The insurer compares prescription records against the application. Common flags include:

• Undisclosed medications for chronic conditions — a prescription for metformin (diabetes), statins (cholesterol), or anticoagulants (cardiac) that was not disclosed
• Psychiatric medications — prescriptions for antidepressants, anti-anxiety medications, or antipsychotics that contradict a "no mental health treatment" answer
• Pain management prescriptions — opioid prescriptions that may indicate a substance use issue or chronic pain condition
• Timing discrepancies — a prescription filled shortly before the application that suggests the applicant knew about a condition and omitted it

Prescription records are factual — they show what was filled, not what was diagnosed. An insurer cannot conclude from a statin prescription alone that the deceased had heart disease. But combined with medical records, it builds a pattern.

Autopsy Reports and Toxicology

For claims where the cause of death is relevant to coverage (accidental death riders, suicide exclusions, contestability investigations), insurers request the autopsy report and toxicology results from the medical examiner or coroner.

The autopsy report establishes the cause and manner of death — critical for AD&D claims where the benefit only pays if death was accidental. Toxicology results show substances present at the time of death.

Post-Mortem Redistribution: A Critical Technical Issue

Toxicology results from autopsies can be misleading because of a phenomenon called post-mortem redistribution. After death, drugs stored in organs and fatty tissue leach back into the bloodstream, artificially inflating measured concentrations. A blood alcohol level or drug concentration measured at autopsy may be significantly higher than what the person actually had while alive.

Insurers sometimes use inflated post-mortem levels to deny AD&D claims by arguing the death was caused by intoxication rather than the accident. If you are challenging such a denial, a forensic toxicologist can provide expert testimony explaining post-mortem redistribution and why the autopsy levels do not reflect the deceased's living state.

Similarly, post-mortem fermentation can create alcohol in the body from natural decomposition processes, producing a false positive for alcohol intoxication in someone who was completely sober at death.

How to Respond to an Investigation

If your claim is under investigation:

1. Do not panic. An investigation does not mean the claim will be denied. Carriers investigate all contestability-period deaths as a matter of routine.
2. Cooperate with reasonable requests. Provide the medical records and authorisations the carrier asks for. Refusing or delaying gives them grounds to extend the investigation.
3. Review the original application. Get a copy from the insurer. Compare every answer against what you know about the deceased's medical history. Identify any discrepancies before the insurer does.
4. Request your MIB file. Check it for errors or outdated codes that could be misinterpreted.
5. Document everything. Track every communication, every document sent, and every deadline.

If the investigation results in a denial based on material misrepresentation, you have the right to appeal. The Life Insurance Claims Toolkit includes templates for responding to investigation requests and structuring your appeal if the claim is denied during the contestability period.