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PubMed1986

The proof in law of suicide.

The certification of suicide as the manner of death is frequently contested in court by the victim's survivors, particularly when there are life insurance benefits at stake. The evidence upon which the opinion of suicide is based must, therefore, meet the standard of proof required in law, if it is to be sustained by the courts. This standard of proof and some of its contingent common law doctrines are discussed, with references to several judicial opinions from cases which involved contested suicides.

Coroners and Medical Examiners↗
PubMed1986

When it pays to be insane: three unusual legacies of insanity.

Although the law generally does not permit an individual to profit by his own wrongdoing, that equitable principle may be inapplicable in the case of an individual who has been adjudicated insane (and therefore has not committed a wrong in the eyes of the law). This paper discusses three unusual legacies of a determination of insanity: the inheritance cases (permitting the insane killer to inherit from his own victim), the life insurance cases (permitting the beneficiary to recover when the insured commits suicide while insane), and the effect of insanity on publication rights agreements in sensational criminal cases.

Forensic Psychiatry↗
PubMed1981

[Arterial hypertension. Medico-social and medico-legal problems].

After a brief mention of the incidence and clinical signs of hypertensive disease, stress is laid on certain social and legal medicine aspects relating above all to various prevention and medical education intervention and to rehabilitation. For an evaluation of the working capacity of the hypertense, a classification is proposed which can also be utilised for the purposes of judging pensionable invalidity as well as for assessing the risk increase coefficient for life insurance. The higher mortality percentage in relation to the seriousness of the diseases is pointed out.

Health Education↗
PubMed1994

Costs to business for an HIV-infected worker.

We use a Markov model to calculate the expected medical, disability, employee replacement, life insurance, and pension costs to a business firm for an HIV-infected employee. This analysis differs from previous HIV/AIDS cost analyses because we take the perspective of a business firm rather than of society, and we focus on the expected costs over a time frame relevant for business decision making. The maximum expected five-year cost to a business firm for an HIV-infected employee is estimated at $32,000, with an average expected cost of $17,000. These expected employment-based costs are less than the lifetime medical AIDS costs to society for an individual, which are estimated at more than $85,000. Employment-based costs are most influenced by the type of benefits provided under employer-based health insurance plans.

Commerce↗
PubMed1993

Health and safety hazards associated with farming.

1. Farming is a dangerous occupation with many potential physical, chemical, and biological hazards. Hazards include noise, machinery, motor vehicles, electricity, temperature extremes, pressurized hydraulic fluids, grain storage facilities, hand and power tools, repetitive motion, vibration, chemicals, dusts, gases, and infectious agents. 2. Psychosocial factors related to agriculture include stress, economic considerations, poor access to health care, and injuries to minors who begin working at a young age. 3. Many who farm also work at other jobs. Farm related illnesses and injuries can be costly to non-farm employers in terms of lost work time, medical insurance, and life insurance. 4. Occupational health nurses can promote agricultural occupational health through companies that employ farmers and through community organizations, thereby contributing to a better understanding of farm related hazards and developing strategies for reducing these hazards.

Accidents, Occupational↗
PubMedDate not supplied

Effects of alcohol and prescription and over-the-counter drug use on liver enzyme profiles.

Liver function tests are commonly ordered during routine checkups or in an effort to identify the cause of underlying disease. Elevated liver enzymes usually indicate a disease or an insult to the liver, the main causes of which can be hepatitis (caused by virus infection or chemical exposures) or cirrhosis of the liver due to alcohol abuse. Results from the Metropolitan Life Insurance Testing Laboratory confirm national data showing a slow rise in the percentage of "free-living" persons with elevated liver enzymes. The percentage of "abnormal" results increased despite unchanged analytic methods or quality control measures during the data gathering period. In addition, the proportions of abnormal enzyme levels have increased while U.S. per capita alcohol consumption has decreased and sales of over-the-counter medications that elevate liver enzymes have increased. Thus, it is increasingly more difficult to determine the true cause of elevated liver enzymes. As more Americans self-medicate and as more prescription drugs become available over-the-counter, which can have subtle or overt effects on liver enzyme secretion, the causes for abnormal enzyme levels will remain difficult to interpret. Continued monitoring of liver enzyme levels and the prevalence of drug and alcohol use are necessary to determine if the noted rise in abnormal levels is associated with increased morbidity or adverse outcome.

Drug Interactions↗
PubMedDate not supplied

Average charges for cholecystectomy open and laparoscopic procedures, 1994.

Claims to Metropolitan Life Insurance Company by group health insureds and their dependents for an open cholecystectomy averaged $16,260 in 1994 versus $12,930 for a laparoscopic cholecystectomy. Laparoscopic procedures accounted for 71.1 percent of the cholecystectomies charged to MetLife in 1994, up slightly from the 70 percent in 1992. The charges for the open procedure varied by almost twofold among the 10 study states with at least 25 open surgeries; similar between-states variation was also evident among the 16 states in which at least 50 laparoscopic surgeries were performed. Florida, Illinois, Louisiana, California and Texas each reported average total charges above the average for both procedures; whereas Ohio and New Jersey reported the lowest total charges for an open cholecystectomy and Ohio and Michigan had the lowest laparoscopic average total charges. Hospital charges accounted for 77 percent of the total charges for an open procedure and for 69 percent of the laparoscopic surgeries. For both forms of surgery this proportion was the lowest in New York (65 and 48 percent, respectively). Length of stay averaged 6.5 days for the open cholecystectomy and 3.1 days for the laparoscopic procedure.

Age Distribution↗
PubMed1997

[Expert systems in risk assessment. Risk or opportunity?].

Experts underwriting systems in the risk selection of individual life insurance have a high place value and are, in future, indispensable in the daily underwriting process. The chance to reduce drastically dual operations enables the insurance companies to make more cost-efficient underwriting decisions. The rapidly advancing technology develops not only new dimensions for individualism and for providing customer service but also for a fast underwriting process which is of great benefit to the insurers who are up against stiff competition. The qualified underwriter and the physician will be relieved of standard work and have more time in investing their knowledge and know-how in the underwriting process which calls for an absolutely individual reflection. New activities are inevitably ahead of this group of persons: Maintenance and attendance of the experts system! A task with which the quality of such a system stands and falls. We are expectant to see what the future has in store for this field.

Artificial Intelligence↗
PubMed1997

Actuarial considerations on genetic testing.

In the UK the majority of life insurers employ relatively liberal underwriting standards so that people can easily gain access to life assurance cover. Up to 95% of applicants are accepted at standard terms. If genetic testing becomes widespread then the buying habits of the public may change. Proportionately more people with a predisposition to major types of disease may take life assurance cover while people with no predisposition may take proportionately less. A model is used to show the possible effect. However, the time-scales are long and the mortality of assured people is steadily improving. The change in buying habits may result in the rate of improvement slowing down. In the whole population, the improvement in mortality is likely to continue and could improve faster if widespread genetic testing results in earlier diagnosis and treatment. Life insurers would not call for genetic tests and need not see the results of previous tests except for very large sums assured. In the UK, life insurers are unlikely to change their underwriting standards, and are extremely unlikely to bring in basic premium rating systems that give discounts on the premium or penalty points according to peoples genetic profile. The implications of widespread genetic testing on medical insurance and some health insurance covers may be more extreme.

Actuarial Analysis↗
PubMed2006

Employer-paid nonmedical costs for patients with diabetes and end-stage renal disease.

INTRODUCTION: Disease conditions such as end-stage renal disease (ESRD), which have severe consequences of disability and mortality, can generate substantial costs for large employers providing life insurance and disability insurance benefits. This study is the first to examine such disease-related nonmedical costs for employers and models the following employer-paid costs for ESRD in patients with diabetes: 1) life insurance benefits, 2) disability benefits, and 3) cost of replacing a worker. METHODS: We simulated a hypothetical cohort of 10,000 individuals with the age and sex distribution of a typical employee population in the United States. Data sources for the model parameters included the United States Renal Data System and proprietary life insurance and disability insurance claims databases. In addition, we used published information to identify the structures of typical employee benefits programs and annual salary information and to estimate the cost of replacing lost workers. RESULTS: The study estimated that employers may incur life insurance costs of 55,055 dollars per ESRD-related death, disability insurance costs of 31,671 dollars per ESRD-related disability, and worker replacement costs of 27,869 dollars per ESRD-related lost worker. Overall, the total monthly cost per employee with ESRD and diabetes was 5439 dollars. CONCLUSION: Our study finds that, other than the large direct medical costs documented in literature, ESRD onset also results in substantial nonmedical costs for employers. As employers continue to debate changes in the structure of future health plan benefits to reduce health care costs, they should consider potential indirect cost savings of providing affordable access to medical care that prevents or delays disability and mortality in their workers.

Diabetes Mellitus↗
PubMed1997

Viatical settlements: easing the financial burden.

Most types of life insurance policies can be sold. Viatical companies can purchase the life insurance policies of people who are terminally ill and pay those people a lump sum; the payment the patient receives is tax free and can be used to pay medical expenses while the patient is still living.

Cost of Illness↗
PubMed1983

Healthcare institutions can use two no-cost incentives to hold key employees.

There are now a number of excellent life insurance companies offering Single Premium Life Insurance and 401(k) Salary Reduction plans. However, when the special Single Premium Life pension supplement is offered in conjunction with the fully tax-sheltered voluntary employee 401(k) Salary Reduction program, management is providing a professional approach to helping their key employees/executives plan for their future. In doing so, the healthcare facility is assured of remaining competitive in today's changing environment.

Administrative Personnel↗
PubMed2004

Anorexia nervosa: a 63-year population-based survival study.

As eating disorders attract increasing publicity, more affected individuals will seek medical attention. Many will have needs for life insurance. Due to selection bias, most of the literature on anorexia nervosa (AN) presents an unfavorable prognosis. Therefore, the impairment is considered an adverse life insurance risk. This review is from an unselected, community population. The demographics of the study population and its expected mortality are similar to a population purchasing life insurance products. Comparative experience over 63 years of follow-up reveals mortality ratios and excess death rates similar to those expected for the population. High-risk comorbid diagnoses of depression and alcoholism are discussed.

Actuarial Analysis↗
PubMed1991

Achievement of life goals by adult survivors of modern treatment for childhood cancer.

To assess the impact of the diagnosis and modern treatment of childhood cancer on achievement of adult goals, the authors evaluated employment, health and life insurance coverage, marriage, divorce, and reproduction in 227 former pediatric cancer patients. Each area was evaluated in relation to a common set of disease and demographic factors that included age at follow-up, age at diagnosis, gender, marital status, history of disease recurrence, and diagnosis. Patients were younger than 20 years of age at diagnosis, and their diagnoses were made between January 1, 1960, and December 31, 1984. The median age at diagnosis was 11.4 years, and the median age at follow-up was 26.6 years. The percentage of unemployed male respondents did not differ from population norms. The percentage of unemployed female respondents, however, was slightly higher than that of the United States population. Approximately 11% of the survivors reported some form of employment-related discrimination, a level significantly lower than that of prior reports. Company-offered health insurance was provided to 92.4% of full-time and 90.0% of part-time employed respondents. Life insurance was purchased by 60% of full-time employed men and 55% of women. These percentages were lower than those reported for the United States population. Twenty-four percent of those with life insurance had difficulty obtaining it. Fifty-eight percent of the subjects were married or lived as married. The percentages of married men and women were significantly lower than United States norms. Twenty percent of those who were married or lived as married have divorced or separated or no longer live as married. Women aged 20 to 24 years were less likely to marry, and women aged 35 to 44 years had a significantly higher frequency of divorce than similarly aged United States women. In general, the history of childhood cancer did not influence the decision to marry or live as married but was occasionally (20%) important in the decision to dissolve a marital relationship. Many former patients indicated that their diagnosis and treatment for childhood cancer influenced their decision to have children. The current study suggests that most former pediatric cancer patients achieve adult life goals. Additional research is necessary to define those populations at greatest risk of failure to achieve these goals.

Adolescent↗
PubMed2002

Entrepreneurial "mining" of the dying: viatical transactions, tax strategies and mind games.

Conceptually, entrepreneurship is seen as the engine that drives a robust economy, promotes a favorable quality of life, and assures the availability of the attributes needed for meaningful living. However, like many popular concepts in this world, its limitations are normally not well acknowledged. A grouping of entrepreneurial ventures which as recently come into existence deals with the personal fiscal issues associated with the end-of-life phase of the human cycle. While generally praised as humanitarian services for society, that are assuredly within legal bounds, these activities have potentially significant negative implications. When examined from an ethical perspective, some questionable practices became apparent. Three such undertakings in particular have to do with the terminally ill and are examined in this paper. The first, viatical transactions, is defined as the transfer of a life insurance policy's ownership to someone who does not have an insurable interest in the life of the insured individual. The second, creative tax shelters for wealthy people involved in estate planning, involves hiring unrelated parties, particularly those who are young and in failing health, to do the dying for the principal. The third, mind games, involves curtailing the use of medical resources for the dying. The justification for this is rationing scarce medical resources.

Aged↗