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PubMed2004

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Humans↗
PubMed2002

Analysis of accelerated death benefit claims at a Japanese life insurance company.

We studied accelerated death benefit (ADB) claims at the Dai-ichi Mutual Life Insurance Company (Dai-ichi Life). The ADB provision is designed to pay all or a portion of the death benefit if the insured is expected to die within 6 months. Dai-ichi Life paid 243 ADB claims and did not pay 17 ADB claims between December 1994 and March 1998. Of the 260 ADB claims, 253 (97.3%) were caused by malignant neoplasm, 2 by intracranial hemorrhage, 2 by angina pectoris, 1 by dilated cardiomyopathy, 1 by hepatic cirrhosis, and 1 by bleeding gastric ulcer. The age range of the 243 paid claims at the time when the attendant physician predicted a life expectancy below 6 months was 21.6-72.6 years (48.7 +/- 8.7 years [Mean +/- SD]). By the end of March 2000, 236 cases were followed up among the above 243 paid ADB claims. Of the 236 followed-up cases, 149 (63.1%) died within 6 months and 203 (86.0%) died within 1 year. The range of survival periods of these 236 cases was 6-1516 days (210 +/- 237 days). Of the 217 dead cases due to malignant neoplasm, 45 (20.7%) died of gastric cancer, 44 (20.3%) of lung cancer, 24 (11.1%) of liver cancer, 16 (7.4%) of colon cancer, 13 (6.0%) of rectum cancer, and 12 (5.5%) of pancreatic cancer.

Adult↗
PubMed2004

Prompt-pay legislation: is it a solution?

Prompt-pay laws, whose purpose is to ensure prompt and equitable settlement of health care claims, have been enacted in 48 states and the District of Columbia. The laws were enacted in reaction to the growth of managed care plans, despite the fact they apply to all health plans. Are they working? The author explores this question in the context of New York State, although the lessons learned may be applied to any jurisdiction in which these statutes have been enacted.

Cooperative Behavior↗