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PubMed1989

[Insurance legislation aspects and peculiarities of occupational legislation in AIDS and HIV infection].

Major aspects of the German insurance legislation regarding AIDS are being discussed. I. The structure of the statutory health and social security scheme is described; problems of coverage of persons with HIV Infection/AIDS in case of accident or unemployment are discussed (medical treatment, social security, pension). II. Private health insurance schemes are scrutinised as to the conditions for persons with HIV infection/AIDS. The aspect of coverage for children in private health schemes is also taken into account, and the differences between statutory and private health insurance schemes are considered. III. Criteria for life insurance contracts are described: it depends on the amount of money insured whether or not life insurance companies demand medical examination and HIV test from the policy holder. IV. Criteria for acknowledgement of AIDS as an occupational disease are pointed out. In particular, injuries at the place of work in connection with HIV-infected material, as well as methods of prevention, are discussed. V. Finally, labour legislation is investigated as to its consequences for persons with HIV infection/AIDS; the different aspects for employer and employee are considered, and problems like employment of persons with full-blown AIDS and termination of employment are explained.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Cause of death statistics (III). Sources for insurance medicine: cardiovascular diseases and selected causes of death].

Among cardiovascular diseases coronary artery disease ranks first as cause of death in the age group that is of importance for life insurance. It is the main cause of death in males age 30 and up. More females die from cerebral hemorrhage than from coronary artery disease. From age 50 upwards coronary artery disease is also the main cause of cardiovascular death in females. Over two thirds of all deaths due to gastrointestinal diseases are caused by liver disease, mainly cirrhosis of the liver. Chronic obstructive pulmonary disease causes two thirds of all respiratory deaths. Accidental deaths seem to be a male privilege, since only 20 per cent females are involved. Especially young males are at risk to get killed in an accident. The particular situation of accidents in the elderly mainly due to falls is discussed. Neurological, psychiatric illnesses, alcohol and drug addiction are discussed briefly. Males in general are more prone to commit suicide than females who account for only one quarter of all suicide deaths. Hanging was the preferred method. Young males especially are in danger of killing themselves. The importance of this new method of compiling vital statistics for life insurance purposes is discussed. These are the conclusions: 1. Main risk for life insurance is death due to cancer, mainly of the alimentary and respiratory tract. This applies to the population at large. In females breast and genital cancer are of crucial importance. 2. In males cardiovascular diseases cause slightly more deaths than tumors. From age 30 on coronary artery disease is the main cause of cardiovascular death.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

[Validity of various obesity indices calculated from height and weight in adult females using the underwater-weighing method as a reference].

We evaluated association between excess percent body fat (%Fat) and various obesity indices calculated from height and weight in 322 adult females. %Fat was measured by the underwater-weighing method, and obesity indices were based on the following 5 methods; Broca-Katsura method (Katsura method), Kato-Wataya method (Kato method), Japan Society for the Study of Obesity method (BMI method; based on the body weight at which BMI is 22), Meiji Life Insurance Co. method, and Table and Figure for the Assessment of Obesity and Leanness by the Ministry of Health and Welfare (MHW method). %Fat was 30% or more (obese) in 73 females (22.7%), 25-30% in 97 (30.1%), 20-25% in 88 (27.3%), and less than 20% in 64 (19.9%). The correlation coefficient between the obesity indices and %Fat were 0.71 for the Katsura method, 0.70 for the Kato-method, 0.72 for the BMI method, 0.70 for the Meiji Life Insurance Co. Method, and 0.63 for the MHW method, being significant for all methods (P < 0.01). When the cut-off point was set as 110% for each obesity index, sensitivity was the highest for the Katsura method (67.1%), and specificity was the highest for the Meiji Life Insurance Co. method (95.2%). Receiver operating characteristic (ROC) curves were similar in figure for the Katsura method, Kato-method, BMI method, and Meiji Life Insurance Co. method. For the MHW method, however, the curve was slightly farther from the point of sensitivity of 100% and 1-specificity of 0% than the others. Excess fat accumulation could not be accurately assessed by the obesity indices calculated from body height and weight. Validity was similar among the obesity indices except for the MHW method.

Adult↗
PubMed1984

Insurance premium reductions. A motivating factor in long-term hypertensive treatment.

Elevated blood pressure substantially increases mortality and requires, therefore, high premium payments for life insurance coverage. Most life insurance companies are willing to reduce the cost of yearly premiums when blood pressure is successfully treated and controlled for several years. Physicians should bring these facts to their patients' attention as a motivating factor to improve adherence to therapy.

Adolescent↗
PubMed1980

Group life & Health Insurance Co. v. Royal Drug Co.: the McCarran-Ferguson Act and Health Service Plans.

Until recently, contractual relationships between health care providers and health insurers appeared to be immune from antitrust scrutiny. The Supreme Court ended this apparent immunity in Group Life & Health Insurance Co. v. Royal Drug CO., 440 U.S. 205 (1979), holding that insurance plans offering goods and services to policyholders are not exempted by the McCarran-Ferguson Act from the federal antitrust laws. By denying a McCarran-Ferguson exemption, the Court did not decide the ultimate issue--whether the insurers in fact had violated federal antitrust law. This Note reviews Royal Drug in light of precedent and of the purpose of the McCarran-Ferguson Act. This Note contends that the result in Royal Drug follows logically and consistently from the Court's earlier readings of the Act, but that the Court's reasoning is unclear and, even under its strongest reading, unconvincing; hence, an alternative approach to interpreting and applying the McCarran-Ferguson Act is suggested. Finally, this Note analyzes the application of Royal Drug by lower federal courts and discusses its implications for the interface of health law and antitrust law.

Commerce↗
PubMedDate not supplied

BC human rights tribunal rules on discrimination by London life.

In June 1999, a British Columbia human rights tribunal ruled that London Life Insurance Company had violated the province's Human Rights Act in 1994 by refusing to sell life insurance (on his own life) to an HIV-negative man on the basis that his wife is HIV-positive.

British Columbia↗
PubMed1993

Adult survivors of childhood cancer. Employment and insurance issues in different age groups.

Survivors of adult forms of cancer have noted discrimination in obtaining employment appropriate to their abilities/training and in securing comprehensive, affordable health and life insurance. Among survivors of childhood cancer, these problems are complicated, because most survivors of childhood cancer have no employment record and only family-related insurance before the onset of cancer. Relative to these issues, adults who are survivors of childhood cancer can be divided into two groups, i.e., those who are younger and those older than 30 years of age. In the older age group (30-50 years), the general indicators of economic achievement and insurability are similar to those of control subjects. Exceptions in this age group include denial of entry into the uniformed services and rejection of applications for life insurance. Survivors who are 20-29 years of age have a wider range of areas in which there is variance from control subjects, including educational achievement, employment, workplace relationships, and the ability to obtain health and life insurance.

Adult↗
PubMed1999

Improving prognosis of type 1 diabetes. Mortality, accidents, and impact on insurance.

OBJECTIVE: Individuals with type 1 diabetes applying for insurance (life, health, accident, etc.) may either see their application being declined by the insurance company or find their premiums being substantially higher than the standard premium. During the last 40-50 years, the prognosis of patients with type 1 diabetes has improved dramatically, partly as a consequence of improved metabolic regulation and partly due to introduction of better treatment for late diabetic complications. The aim of the present study was to determine whether the increased premiums paid by diabetic patients for life insurance and accident insurance reflect the true risk of a diabetic individual. RESEARCH DESIGN AND METHODS: Mortality: 3,000 type 1 diabetic patients were followed for 12-51 years. The impact of age, sex, year of diagnosis, and development of nephropathy on excess mortality was analyzed. Accidents: A cohort of nearly 7,000 members of the Danish Diabetes Association participating in group accident insurance was followed for 3 years. The risk and outcome of accidents in the diabetic group was compared with similar risks in a nondiabetic group. RESULTS: Mortality: Over a 40-year period, the median life expectancy of type 1 diabetic patients increased by more than 15 years. The decrease was predominantly explained by a decreasing incidence of nephropathy, so that a simple model for estimating insurance premiums (including age of diagnosis, sex, and presence or absence of diabetic nephropathy) could be established. Accident insurance: Individuals with type 1 diabetes experienced a risk of accidents that was not in excess of that found in two control groups, and the outcome (degree of disability) after the accidents did not differ between the diabetic and the nondiabetic group. CONCLUSIONS: Type 1 diabetic patients still have a mortality in excess of nondiabetic individuals. Life insurance premiums should, however, always reflect the changing prognosis of type 1 diabetes and thus, continuous monitoring and revisions are needed. For accident insurance, we found no increased risk of accidents; thus, diabetic individuals should be offered accident insurance on normal terms.

Cohort Studies↗
PubMed1994

Beta-2 microglobulin as a marker for HIV infection.

Beta-2 microglobulin is a sensitive surrogate test for HIV infection for use in jurisdictions where HIV antibody tests are not allowed to be performed on life insurance applicants by law/regulation. The advantage of beta-2 microglobulin over T cell testing, which is a surrogate test also used by the life insurance industry for detecting HIV infection, is the stability of B 2M in serum over long periods of time.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Screening of insurance applicants: experience in international insurance medicine].

Following a brief historical look at international developments in medical examinations of life insurance applicants, the paper goes on to examine the criteria used today for screening in clinical medicine. There are great similarities between the main reasons for screening in clinical medicine and insurance medicine. On the one hand, there is the need to detect a disease early in its history. On the other, the need to identify risk factors. The procedures used by life insurers are also described. The USA is taken as an example to show the direction that international developments are taking. Future aspects are considered with particular regard to future availability of genetic tests. An insurance medical discussion on genetic tests is followed by a description of the debate on the ethics of biotechnology in the Council of Europe and European Parliament. A conceivable scenario is developed which assumes the future availability of genetic test results in doctors' surgeries. The decisive factor here is that the insurer continues to have full knowledge of the applicant's state of health at the time of application. Only by this way can antiselection be avoided. This is followed by a detailed representation of the responsibility that insurance medicine and insurers have in connection with screening modalities. Genetic tests are not used by insurers today. There exists a kind of wait-and-see attitude which amounts to something like a moratorium. The time until further decisions are made should be used to gather further scientific findings and also to correct possible misconceptions at all relevant levels.

Cross-Cultural Comparison↗
PubMed1999

[Greater success by cooperation between claim review experts and the police].

The examination of claims settlement in life assurance usually begins when police investigation is finished. During the acute phase of police investigation there is very rarely contact between the police and the life insurance company concerned. The advantages of early cooperation are demonstrated by two case reports. Immediate communication during the first four days after death initially helps the police investigators; later the life insurance company profits from the accelerated examination of the insured event.

Adult↗
PubMed2003

The lean service machine.

Jefferson Pilot Financial, a life insurance and annuities firm, like many U.S. service companies at the end of the 1990s was looking for new ways to grow. Its top managers recognized that JPF needed to differentiate itself in the eyes of its customers, the independent life-insurance advisers who sell and service policies. To establish itself as these advisers' preferred partner, it set out to reduce the turnaround time on policy applications, simplify the submission process, and reduce errors. JPF's managers looked to the "lean production" practices that U.S. manufacturers adopted in response to competition from Japanese companies. Lean production is built around the concept of continuous-flow processing--a departure from traditional production systems, in which large batches are processed at each step. JPF appointed a "lean team" to reengineer its New Business unit's operations, beginning with the creation of a "model cell"--a fully functioning microcosm of JPF's entire process. This approach allowed managers to experiment and smooth out the kinks while working toward an optimal design. The team applied lean-manufacturing practices, including placing linked processes near one another, balancing employees' workloads, posting performance results, and measuring performance and productivity from the customer's perspective. Customer-focused metrics helped erode the employees' "My work is all that matters" mind-set. The results were so impressive that JPF is rolling out similar systems across many of its operations. To convince employees of the value of lean production, the lean team introduced a simulation in which teams compete to build the best paper airplane based on invented customer specifications. This game drives home lean production's basic principles, establishing a foundation for deep and far-reaching changes in the production system.

Commerce↗
PubMed1986

The insanity defense to suicide.

The certification of suicide as the manner of death can result in either the complete loss or a significant reduction in life insurance benefits to the victim's survivors. It is, thus, not uncommon for these beneficiaries to contest suicide as the manner of death. Insanity is a recognized defense in law against suicide. It is recognized in law that, in some cases, an insane man cannot intentionally destroy himself. However, it is also recognized that life insurers can exclude suicide by an insane man from coverage. This article discusses the common law doctrines upon which the insanity defense to suicide is based, with references to judicial opinions from cases which involve contested suicides and the issue of insanity.

Coroners and Medical Examiners↗
PubMedDate not supplied

AIDS: MetLife's experience.

The national health burden created by AIDS/HIV disease has had a significant impact on the insurance industry. In an analysis of the MetLife health and life insurance claims from 1986 through 1989, it was found that a total of $323,900,000 has been paid for AIDS/HIV disease. This figure and related information from those years were based on the Company's underwriting and claims files, with personal and group operations reported separately. Personal life insurance claims rose from 344 in 1986 to 874 in 1989 with the dollar amounts increasing from $3.2 million to $8.9 million. In 1989 there were 689 group life claims with a face amount of $31.5 million and 6,450 people who received group medical claim payments for a total of $111.2 million. In 1989 AIDS claims comprised 1.61 percent of MetLife claims--up from 0.4 percent in 1986.

AIDS Serodiagnosis↗
PubMed2004

Screening potential elderly preferred markers: exploratory analysis of Cardiovascular Health Study (CHS) data.

The Cardiovascular Health Study (CHS) analyzes risk factors for coronary heart disease and stroke in people age 65 and older. Since CHS is designed to comprehensively study cardiovascular risk factors in an elderly population, it provides a unique opportunity to study the association of risk factors with mortality, as well as morbidity risk. With the growth of the elderly as population and life insurance market segments, the need to more precisely stratify mortality within a standard risk group of the elderly has grown as well. This exploratory analysis assesses medical factors that could be used to improve mortality risk stratification within a "standard" mortality population, using the CHS public use data set. Participants with a personal history of cardiovascular disease, diabetes, or major electrocardiographic abnormalities were excluded from the analysis in order to mimic a standard life insurance selection process. Then, Cox proportional hazards regression was used to study 10 medical risk factors. This model suggested that forced vital capacity >80% predicted, serum creatinine <1.5 mg/dL (133 mcmol/L), hemoglobin >11 g/dL (110 g/L), and serum albumin >3.5 mg/L (35 mmol/ L) are significantly associated (p = 0.05) with favorable mortality. C-reactive protein <1 mg/L is associated with favorable mortality at borderline significance levels (p = 0.09). On the other hand, a family history of cardiovascular disease (MI and/or stroke) and low BMI (<26 kg/m2) are associated with unfavorable mortality in the analysis. Total to HDL cholesterol ratio of <6, presence of supine systolic blood pressure < or = 140 mmHg, and the presence of minor rest electrocardiographic findings were not statistically significant factors in the multivariate model. Further assessment of the predictive value of the "significant" medical factors identified is required in insured lives.

Aged↗
PubMed2003

Mortality in the Swiss HIV Cohort Study (SHCS) and the Swiss general population.

Because of high death rates in the past, patients with HIV-1 cannot obtain life insurance. We measured mortality rates in the Swiss HIV Cohort Study (SHCS) from 1997 to 2001 and compared them with those of the Swiss reference population. In patients who were successfully treated with highly active anti-retroviral therapy (HAART), and who were not also infected with the hepatitis C virus, excess death rates were below five per thousand per year. Patients with successfully treated cancer have much the same excess death rates but are not excluded from life insurance policies.

Adult↗
PubMed2001

[Validity of various indices of obesity calculated from height and weight data for adult males use of the underwater-weighing method as a reference].

PURPOSE: We evaluated associations between excess body fat (%Fat) and various indices of obesity calculated from height and weight data. METHODS: In 147 adult males, %Fat was measured by the underwater-weighing method, and obesity indices were generated by the following 5 approaches: the Broca-Katsura (Katsura method), the Kato-Wataya (Kato method), Japan Society for the Study of Obesity (BMI method; based on the body weight at which the BMI is 22), and the Meiji Life Insurance Co. methods, and the Tables and Figures for Assessment of Obesity and Leanness published by the Ministry of Health and Welfare (MHW method). RESULTS: %Fat was 20% or more (obese) in 67 males (45.6%), 15-20% in 39 (26.5%), 10-15% in 35 (23.8%), and less than 10% in 6 (4.1%). The correlation coefficients between the obesity indices and %Fat were 0.612 for the Katsura method, 0.590 for the Kato-method, 0.611 for the BMI method, 0.612 for the Meiji Life Insurance Co. method, and 0.550 for the MHW method, being significant in each case (P < 0.01). When the cut-off point was set as 110% for each obesity index, sensitivity was highest with the Kato-method (82.1%), and specificity was highest with the Meiji Life Insurance Co. method (93.8%). With the MHW method, the receiver operating characteristic (ROC) curve was slightly farther from the point of sensitivity of 100% and 1-specificity of 0% than the others. CONCLUSION: Excess fat accumulation can not be accurately assessed by obesity indices calculated from body height and weight data. Validity was similar among obesity indices examined.

Adult↗