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PubMed2004

Life insurance, living benefits, and physician-assisted death.

One of the most significant concerns about the legalization of physician-assisted death in the United States relates to the possibility that a chronically or terminally ill person would choose to end her or his life for financial reasons. Because we believe that the life insurance industry is uniquely poised to help minimize any such incentive, we submit that it has a moral obligation to do so. In particular, we propose that the industry encourage greater flexibility in the payout of policy benefits in the event an insured should be diagnosed with a terminal illness or suffer from intractable pain.

Euthanasia↗
PubMed2006

Mortality of Swedish horses with complete life insurance between 1997 and 2000: variations with sex, age, breed and diagnosis.

The aim of this study was to evaluate the potential usefulness of the database maintained by the Swedish insurance company Agria for providing mortality statistics on Swedish horses. Mortality statistics (incidence rates and survival) were calculated, both crudely and stratified by sex, age, breed, breed group and diagnosis, for the horses with complete life insurance, which covers most health problems. The total mortality was 415 (95 per cent confidence interval [CI] 399 to 432) deaths per 10,000 horse-years at risk, and the diagnostic mortality, including only deaths with an assigned diagnosis, was 370 (95 per cent CI 355 to 386) deaths per 10,000 horse-years at risk. The diagnostic mortality of geldings was 459 (95 per cent CI 431 to 487), of mares 345 (95 per cent CI 322 to 365) and of stallions 214 (95 per cent CI 182 to 247) deaths per 10,000 horse-years at risk. The mortality rates increased with age and differed widely between breeds. Survival analysis showed that the median age at death of the horses enrolled before they were one year of age was 18.8 years. The most common cause of death or euthanasia was joint problems, which were responsible for 140 (95 per cent CI 130 to 149) deaths per 10,000 horse-years at risk. The results of multivariable models developed by using Poisson regression generally agreed well with the crude results.

Age Distribution↗
PubMed1993

A survey of medical directors of life insurance companies concerning use of genetic information.

Rapid advances in our ability to test persons presymptomatically for genetic diseases have generated increasing concern that genetic information will be abused by insurance companies. Reasoning that the insurance companies may have the strongest interest in using genetic data and that the medical directors of those companies with responsibility for rating applicants would be a good source of information on the use of such data, we conducted a large survey of medical directors of North American life insurance companies. We received responses from 27 medical directors. Our results suggest that (1) few insurers perform genetic tests on applicants, but most are interested in accessing genetic test information about applicants that already exists; (2) the degree of insurers' interest in using genetic test results may depend on the face amount of the policy applied for and on the specificity and sensitivity of the test; (3) many companies employ underwriting guidelines with respect to certain genetic conditions but may not always have specific actuarial data in house to support their rating decisions; (4) a considerable degree of subjectivity is involved in most insurers' rating decisions; and (5) some of the medical directors who responded to our survey are not fully informed about certain basic principles of medical genetics.

Ethics, Medical↗
PubMed2003

Cost-benefit analysis of electron beam CT as a life insurance coronary disease risk assessment tool.

Electron beam CT (EBCT) or ultrafast CT is a diagnostic imaging technique that can identify calcium deposits within coronary arteries. Intra-coronary calcium is associated with coronary artery atherosclerosis. EBCT imaging has been advocated as a "better" way to screen for coronary artery disease. By producing a measure of the amount of calcium present, it may provide a non-invasive risk assessment tool that can predict the risk of future coronary events and death. Medical literature concerning identification and assessment of coronary risk using EBCT in the clinical setting is reviewed. The primary purpose is to illustrate one approach to a simple "back of the envelope" cost-benefit analysis (protective value) comparing EBCT with exercise electrocardiography as a life insurance coronary disease risk assessment tool. The performance and results of this analysis are contingent on a number of critical assumptions that are outlined in the text. The analysis limitations, and the future research required to refine the results are reviewed. With optimum levels of EBCT test performance, favorable thresholds of test costs, and long-term mortality data useful for assessment of value preservation, EBCT might prove to be a valuable risk assessment tool from a cost-benefit perspective under certain circumstances. Answers to key clinical research questions from prospective studies in asymptomatic cohorts are essential for refinement of a cost-benefit estimate.

Coronary Disease↗
PubMed2003

"Cancer in the family" and genetic testing: implications for life insurance.

The potential for discrimination when applying for insurance can be of concern for individuals with a family history of cancer or of a genetic disorder and who are considering genetic counselling or genetic testing. The actual incidence of "genetic discrimination", however, is not known, despite considerable media coverage of this issue. The clinical details required by insurers have received less attention. We obtained primary application and personal statement forms used by 21 different underwriters of voluntary life insurance and found substantial differences in the information requested about family history and genetic testing. All insurance applications, however, contained a duty of disclosure that would require revealing the result, if known by the applicant, of a genetic test in a family member. Therefore, decisions made by family members can affect insurance applications, and people considering genetic testing may also need to consider the implications of the results for other family members. Health practitioners should balance the potential benefits of appropriate genetic testing against potential restriction to life and income-protection insurance when advising people about genetic testing.

Australia↗
PubMed1988

Establishment of life insurance benefits, 1986.

In 1986, Nanjing County in Fujian Province, China, established life insurance policies for only children. Families with only one child paying insurance premiums of 40 yuan will be refunded medical expenses exceeding 200 yuan incurred in caring for the child from birth to age 16.

Asia↗
PubMed1997

[Suicide and life insurance. Evaluation of suicide cases].

A retrospective evaluation of 521 life assurance contracts belonging to 468 persons who had committed suicide within the first 3 years of contract was performed. Contract data such as tarif, sum assured and duration do not differ from those of the other customers. Except for a few there were hardly any persons who acquired life assurance under speculative purposes, such as the intention to gain financial advantages for their relatives at the expense of the community of all insured persons by claiming life insurance benefits after suicide. By means of these results, one can easily state that the 3 years' exemption period according to the German rules and regulations for life assurance is an effective barrier against misuse in case of suicide. The incidence of suicide cases among all mortality cases cannot be established due to peculariarities of the German insurance market. Other evaluations were performed as to age, sex and marital status of the persons involved, the point in time when suicide was performed, the methods chosen and possible motives. Psychiatric problems such as depression and addiction can be found in the past medical history of many persons. The criterium of exclusion of free will was found in 14.4 percent of all cases.

Female↗
PubMed1996

Life insurance and inflammatory bowel disease: is there discrimination against patients?

The aims of this study were to compare and contrast the attitude of major insurance companies to patients with inflammatory bowel disease (IBD) and to a Consultant Gastroenterologist (JFM) requesting guidelines for patients with IBD. The experience of patients in Leicester with insurance companies was also investigated. A standard letter requesting information regarding the likelihood of loading on life assurance in connection with a mortgage was sent to 50 major insurance companies from a typical patient. A similar letter was constructed from a consultant gastroenterologist (JFM) to the same 50 insurance companies requesting simple guidelines for patients with IBD when applying for various types of insurance. A questionnaire investigating the experience of patients with IBD when applying for insurance was also sent to 100 patients with IBD selected at random from the Leicestershire data base of patients with Crohn's disease and ulcerative colitis, 39 insurance companies responded to the request for information by a typical patient, (response rate = 78%). 24 were split between those who thought the patient would be accepted at normal rates (n = 7) and those who would request an increased premium (n = 17). Only 27 companies replied to the letter by a consultant gastroenterologist requesting general guidelines, (response rate = 54%). There were only 17 overlapping replies to the two letters. Of these 17 overlapping replies, five companies (30%) informed the patient to expect increased premiums whilst advising the consultant a similar patient could expect normal rates. Six companies conferred (35%), telling both the patient and the consultant to expect normal rates. Either one or both of the remaining six companies (35%) felt unable to comment without either specific details of the patient or a medical examination. 69% of patients responded to the questionnaire. Over half (54%) had applied for an insurance policy. More than a third of patients had required either a medical examination (36%) or a report from their GP (41%) before being accepted for a policy. 39% of patients had received an additional loading on their policies because of IBD including two patients who had been turned down altogether. In conclusion patients with IBD are clearly discriminated against by insurance companies. Life tables should be amended to take account of the low mortality recognised in recent years. Patients should be aware of the difficulties that currently exist.

Adult↗
PubMed1998

[AIDS and life insurance in Germany. 10 years successful risk management].

The introduction of AIDS specific measures by the German life assurance industry in 1988 was an important step towards prevention of adverse selection by the well known risk groups. In retrospect one can state that in the eighties there was a tendency of risk groups for inappropriately high insurance coverage. This could be curtailed with the introduction of a question as to a positive HIV test in each proposal form and a mandatory HIV test for every policy exceeding DM 250,000. These tendencies could very nicely be demonstrated by studies of own AIDS cases. The claims for death and disability benefits because of AIDS are as of now compared to the total claims of minor importance.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The use of genetic tests and genetic information by life insurance companies: does this differ from the use of routine medical information?

Questions regarding insurance companies' access to and use of genetic test results and genetic information have been raised since the advent of the Human Genome Project. The ability to place applicants of similar risks in groups, a process known as underwriting, is critical to the availability and affordability of individually underwritten life, disability income, and long-term care insurance. This paper focuses on how life insurance companies use medical information and particularly genetic test results and other genetic information in the risk assessment process. Issues and concerns raised about differences between routine medical information and genetic information are addressed and policies with regard to privacy and confidentiality are presented.

Confidentiality↗
PubMed1995

[Obligation to verify information by the life insurance carrier in overly generalized responses to application questions].

According to supreme court practice which to some extent has been criticized in literature, life assurance companies are obliged, to establish clear circumstances before closing of contract. Should reasonable queries with the client, intermediary or attending physician be neglected, for instance in case of a reply being held too general in respect of the state of health, so the risk exists, that due to this behaviour the right of rescission or avoidance, respectively, cannot be claimed any more because of offending the preliminary contractual obligation to notify.

Germany↗
PubMed2004

Conversion of mortality ratios to a numerical rating classification for life insurance underwriting-revisited.

This is a commentary requested by the J Insur Med Editor to accompany a reprinting in this 2004 issue of my 1988 article on "Conversion of Mortality Ratios to a Numerical Rating Classification for Life Underwriting" (J Insur Med 1988;20:54-61). Topics discussed in this commentary include the distinction between short-term and long-term mortality follow-up in certain conditions, the format and the introductory text of the US Decennial Life Tables, the distinction between mortality rate and mortality probability, averaging mortality rates over a period of years, and the great value of the exemplary follow-up study used in the 1988 article.

Actuarial Analysis↗