In good form — making insurance paperwork more inclusive

Insurance paperwork is discriminatory, according to InsurePride’s recent Worth the Risk Report, with respondents expressing frustration that the options provided don’t match their circumstances.

The Worth the Risk Report found that insurance applications and claims forms are often narrow and exclusionary.  

“Required forms, surveys and questionnaires should reflect and represent the diversity of the community," says Metz Ronan, co-chair of InsurePride.

"Forms that aren’t inclusive of gender diverse and non-binary options can give the perception to LGBTQ customers that [insurance] is potentially not a safe or welcoming space for them.” 

Forms that are not inclusive make it difficult, and at times impossible, to collect complete and accurate information. This can lead to many problems in assessing claims and may even lead to claims not being paid.

The survey found that correct acknowledgement of gender on policy documents was very important to trans and gender-diverse customers, who rated this as much more important than the price of the product. [1]

According to one industry professional quoted in the report, updating our systems to match customer reality regarding gender options is vital. “Currently a lot of companies insist on truthful disclosure, however, [they] don't have the capacity to record a customer's reality.” [2] 

In addition, the uncertainty and financial hardship of paying for policies without knowing whether claims will be paid is an issue that needs to be addressed by the industry and individual insurance companies.

Rigid and unaccommodating forms can have dire consequences for insurance customers. Many trans and gender-diverse consumers are concerned that the forms don’t enable them to list their true gender identity, and that this may result in their insurance coverage being invalidated.

“I am worried that I am paying in vain, and my kids won't access any insurance cover if I pass away because I did not disclose my gender identity,” one respondent wrote. [3]

Another said, “I have been living as a woman, and had gender confirmation surgery. Why should I get life insurance and then on my death, have my kids subjected to the dead-naming, the misgendering? At a time when they are at their lowest in terms of grief?”

The stress of anticipating transphobia 

Worryingly, a large proportion of trans and gender-diverse respondents anticipated and confronted transphobia from insurance companies when updating names and genders. Over 70 per cent reported difficulty updating their or their partners’ or families’ names and genders. [4]

In the words of one respondent, “One [insurance company] had particularly difficult hoops to jump through when updating my name/gender. They didn't have a form for it, didn't have a clear pathway.” [5] This was not an isolated event. It was a frequent complaint from respondents.

The requirement to provide a birth certificate is another particular sticking point. As one respondent stated, “There was no option to alter gender without providing personal documents such as a birth certificate, even though that wasn't needed to initially sign up.” [6]

To make matters worse, there is confusion over whether a birth certificate would be required to process a claim. 

“I am legally male on all documents except my birth certificate. I read in the PDS that in the event of a claim, I will be asked for documents. That might be my license which is male, or my birth certificate. If they get my birth certificate, they could void my insurance immediately as I would have ‘lied’ on my application and policy,” [7] another respondent said.

A few small changes

Updating forms is an important step in developing a more inclusive environment. A few small changes can make a huge difference in providing accurate data, and ensuring trans and gender-diverse customers feel safe and welcome.

Many insurance forms collect information on sex (often listing male or female as the only options) and gender (often limiting options to man or woman).

Gender-diverse customers need to be able to select or provide information that reflects their reality. Most forms fail to make that possible. 

“Forms are very binary and there is a lack of non-binary options for pronouns and gender on forms,” one respondent said. [8] Another non-binary respondent stated, “I was discriminated against by multiple insurance companies when it came to selecting either a gender or trying to advocate for an option for non-binary.” [9]

Many forms ask about titles, such as Mr, Ms, Mx, Dr etc. Titles are often used in formal communication and may be considered a form of respect. But forms that only include binary options (Mr, Ms) or options that reveal relationship status (Miss, Mrs), disrespect consumers for whom these terms don’t apply.

While titles are usually not relevant or needed, many forms make providing this information compulsory. One survey respondent wrote: “None of them have Mx., so I have to settle for Ms or Miss. Most of them FORCE an answer.” [10]

The Worth the Risk Report found that it was rare for insurance forms to include gender-neutral titles.” [11] It urges insurers to “review their practices” so that “titles are only used where required.” [12] Where titles are required, forms should include non-binary titles, such as Mx.

Titles and pronouns

Instead of assuming a gender and title, customers could be asked “What would you like us to call you?” This would allow those who want to be called by their title to provide this information, without forcing others to provide it unnecessarily.

Alternatively, if a title is needed, forms could provide a range of options for titles, including non-binary titles, such as Mx. Forms could also include a space for consumers to add a title that has not been listed. The option of not using a title should be available too.

It is also recommended that forms include a section for asking about pronoun/s. Some non-binary people use multiple pronouns, so the form could provide enough space ¾ such as a full line ¾ for listing pronouns.

Where people list more than one pronoun, it is worth asking which pronoun they prefer to use in the insurance space.

Forms could also include the option “no pronouns”, or provide enough space for people who don’t use pronouns to note this on the form.

Where forms ask about postal address, it is important to include space to list an alternative name (and title, if needed). This protects the privacy of trans and gender diverse people who are not out to other members of their household. [13]

Forms could use inclusive language throughout. For example, when asking about the composition of families, gender-inclusive language such as parent/guardian should be used.

The sex assigned at birth

The Worth the Risk Report challenges the perception that “insurers must record a customer’s sex assigned at birth.” [14], It argues that sex assigned at birth is rarely relevant, and can often result in trans and gender diverse customers having documents that do not reflect their gender identity.” [15]

The report advises insurance providers “to carefully think through why they are collecting data or asking questions about sex or gender”. [16]

“A person with a family history of breast cancer is still at a higher risk of breast cancer even if they are a trans man. So, if a question about family history of breast cancer is only asked for female customers, it fails to capture trans men —  and some non-binary people — who may also be at risk,” [17] the report notes.

Making assumptions based on sex or gender could result in inaccurate assessments for trans or intersex consumers, as well as cisgender (people who identify with the gender they were assigned at birth) consumers who may have had body parts removed as part of their medical treatment.

InsurePride and other advocates stress that forms should only seek information on sex and/or gender where it is relevant. In these instances, the specific reason for collecting the information should be clearly stated, and privacy protections should be outlined,” the report recommends. [18]

“Some conditions are affected by biology,” the Worth the Risk Report acknowledges, adding that “where it can affect health, asking about both sex and gender is legitimate.” [19]

In those cases, the form should include two separate questions: First, “What is your gender?” with the options: Woman/Non-binary/Man/Other, and if the information is not vital, “Prefer not to say”.

The second question could be phrased as “Do you have lived trans experience (i.e your gender identity does not align with your sex assigned at birth)?”, with options Yes/No/Prefer not to say. Of course, the option “prefer not to say” should only be included only if the information is not vital. [20]

Simple and clear processes

The Worth the Risk Report also calls for simple, clear and comprehensive processes for changing names and gender markers, including removing dead names and former genders and titles from all records. [21]

Some insurance providers have developed uncomplicated processes. “After changing my legal name and gender, I needed to update my details on my car insurance. It wasn't a difficult process compared to other situations where I had to do the same,” [22] one respondent wrote.

Although affirming processes are possible, not all providers make these changes. Many keep excluding trans and gender-diverse customers or treat them disrespectfully.

“I was misgendered for… all my insurances - car, house, and home,” one respondent reported. Another stated, “I have had to repeatedly correct dead name use, despite legally changing my name some time ago.” [23]

While lack of clear processes is harmful for trans and gender-diverse consumers, this can also have a negative consequence for insurers. Insurance providers who fail to accommodate trans and gender-diverse consumers risk losing their customers.

In the words of one respondent, “Changing names is always a bit of a nightmare – it’s generally easier just to cancel your insurance with one company and then sign up for a different company.” [24]

Providers with discriminatory attitudes also risk attracting negative reviews, which can have far-reaching impacts on public perceptions of the insurer.

Updating forms and processes is an important step in making insurance spaces safer and more welcoming for trans and gender-diverse customers.

How to make products more inclusive

• Training sales and service staff on LGBTIQA+ issues and inclusivity 
• Only collecting information on title, gender or relationship status, unless it is necessary for the insurance product 
• Simplifying processes to update titles, names and gender 
• Including non-binary options for gender 

Dos and Don'ts

DO:

• Ensure proper privacy protections are in place, and convey this clearly to consumers/ potential consumers
• Review practices regarding names, genders and titles
• Revise forms to make them more inclusive
• Only ask for necessary information
• Use gender-inclusive language (e.g. parent/guardian)
• Only use titles (Ms, Mx, Mr etc) where they are required
• Include non-binary titles such as Mx, Dr, Prof
• Include space for consumers to add their own titles
• Allow consumers to opt out of listing a title
• Include a section for consumers to note their pronouns, with enough space to list multiple pronouns, and their preferred pronoun for dealing with insurance matters
• Provide space for consumers to note if they do not use pronouns
• Include space for consumers to list an alternative name (and title, if required) when listing postal address
• Carefully consider why you are collecting data on a consumer’s sex or gender.
• When seeking information on gender and/or sex, provide the specific reasons for needing this information, and outline privacy protections
• Where information on sex or gender is crucial, include non-binary options such as “non-binary” and “other” and/or provide space for respondents to identify their own gender

In cases where information on both sex and gender is needed, it is advisable to use two separate questions, for example:

What is your gender?

• Woman
• Non-binary
• Man
• Other
• Prefer not to say (include this option only if information is not vital).

Do you have trans experience (i.e. your gender identity does not align with your sex assigned at birth)?

• Yes
• No
• Prefer not to say (include this option only if information is not vital).

Don't

• Ask for unnecessary information
• Require consumers to supply titles or honorifics (Mr, Ms, Mx etc) where this is not needed (e.g. titles, sex)
• Collect data on sex, gender or relationship status where this is unnecessary or irrelevant
• Ask consumers to identify their sex unless it required for risk ratings
• Make assumptions based on perceived sex or gender
• Make assumptions based on voice or appearance
• Use deadnames or previous genders or titles
• Misgender consumers
• Ask why the consumer chose that particular name
• Laugh at/make fun of trans and gender-diverse consumers
• Insult trans and gender-diverse consumers
• Treat trans and gender-diverse consumers rudely or disrespectfully

Notes

[1] Worth the Risk, pp. 23-24. Correct gender was ranked 3.95 out of 5 for importance, compared with 2.65 for price.

[2] Anonymised Worth the Risk survey response

[3] Anonymised Worth the Risk survey response

[4] Worth the Risk, p. 24

[5] Anonymised Worth the Risk survey response

[6] Anonymised Worth the Risk survey response

[7] Anonymised Worth the Risk survey response

[8] Anonymous respondent, Worth the Risk survey

[9] Anonymous respondent, Worth the Risk survey

[10] Anonymous respondent, Worth the Risk survey

[11] Worth the Risk, p. 24

[12] Worth the Risk, recommendation 14 (d), p. 25.

[13] https://rainbowhealthaustralia.org.au/media/pages/research-resources/inclusive-practices-for-non-binary-clients/3002223371-1709686055/inclusive-practices-for-non-binary-clients-ra.pdf

[14] Worth the Risk, p. 24

[15] Worth the Risk, p. 24

[16] Worth the Risk, p. 22

[17] Worth the Risk, p. 22

[18] Worth the Risk Report, recommendation 14 (b), p. 25

[19] Worth the Risk, p. 29

[20] Anonymised Worth the Risk survey response

[21] Recommendations 14 (g), (h) and (i), Worth the Risk Report, p. 26

[22] Anonymised Worth the Risk survey response

[23] Anonymised Worth the Risk survey responses, cited on p. 7 of the Worth the Risk Report

[24] Anonymised Worth the Risk survey response, cited in Worth the Risk Report, p. 25