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Should criminal law principles be applied to life insurance claims made by the beneficiaries of an insured person who commits suicide? Any discussion of the criminal law and the M'Naghten test of criminal responsibility, as sometimes used by the courts and recommended by the authors, obfuscates the resolution of contemporary issues.
In the age group that is of importance for life insurance, tumors of the alimentary tract are the main cause of death. Lung cancer takes place number 2 in the male and breast cancer in the female population. In females age 30 to 60 breast cancer is the killer number one of all tumors. Tumors specific to the female sex account for about half of all cancer deaths in that age group. In children and young adults under age 30 leukemia takes first place of all malignancies. Age specific problems are shown in cross-sections and longitudinal sections. In general the overall mortality of tumors rises with age. In the young, death due to tumors is a rare event. The difference between the clinical incidence of tumors and the frequency of tumors as causes of death was elaborated.
The purpose of this paper is to explore briefly the nature, development and implications of the relationship between medical practitioners and life assurance companies. The aim is to elucidate the development both of the medical profession and the life insurance business--two important aspects of economic and social change in the nineteenth and early twentieth centuries which are usually treated separately. The focus is primarily, though not exclusively, on Scottish companies as they carried out a disproportionately large amount of the UK life assurance business by the mid-nineteenth century. The insurance industry's increasing, and increasingly systematic, tapping of medical expertise enabled it to raise profits by reducing losses on standard policies and by venturing out into types of business previously thought too risky. While nineteenth-century medical therapeutics may have left much to be desired, medical involvement in insurance suggests that medical practitioners were by no means ineffective. At the same time, a substantial proportion of the medical profession gained valuable part-time appointments which helped to alter the diagnostic techniques of the profession more generally. Thus insurance turns out to be an especially important element in the 'non-healing' aspects of medicine, with spin-offs for the healing side as well.
Methods have been described for evaluating the statistical validity of insurance experience studies and the translation of medical literature studies to life insurance ratings. These have not seen widespread adoption in the insurance literature. This article is intended to encourage the use of these existing methods and describe other methods in the biostatistical literature.
Since the diagnosis post traumatic stress disorder (PTSD) was included in the American diagnosis system DSM-III in 1980, the ongoing scientific discussion has led to a shift in the definition of the so called A-criterion (trauma criterion) away from the general theory that the disease-causing event has to be outside normal human experience towards the point of view that it is more or less determined by the subjective experience of the individual. Without wishing to become involved in the discussion, in the publication the author tries to explain, on the basis of references to basic concepts found in insurance law (accident, initial damage, suitability of event, objectivity, epidemiological considerations), that in social insurance as well as in non-life insurance an objective insured event which has a severe emotional impact on the individual is a prerequisite for payment. The conclusion is that not every mental disorder which occurs after an insured event and which has quite rightly been classified as PTSD (or partial PTSD) on the basis of the symptoms involved in accordance with ICD-10/DSM-IV (criteria B-D) necessarily results in payment under insurance law.
In this study 4435 insurance applications to the Swiss Life insurance company ("Rentenanstalt") by individuals aged 20-39 years from the time period 1950-1990 were evaluated. Each application contained the self-reported body weight, height, and other informations such as martial status or city of residence. For each individual the body mass index (BMI) was computed and the prevalence of overweight and obesity for each year was calculated using standard definitions. This is the first study which tries to determine the prevalence rates of overweight and obesity in Switzerland over time. The absolute body weight (kg) increased continuously from 1950 to the year 2000. The most pronounced increase was seen in individuals (aged 20-29 years) above the 90th percentile of body weight and BMI, i.e. already overweight and/or obese individuals showed the largest increase in body weight. In men (aged 20-29 years) the prevalence of overweight increased between 1980 and 1990 by more than 10% to a prevalence rate of 25%. In women (aged 20-29 years) the prevalence of overweight increased continuously from 1960 onward and reached a rate of 10.5% in 1990. In the age group of the 30-39 years old individuals no change in the prevalence rates was observed. These data suggest that there is a trend for an increased prevalence of overweight in Switzerland. Since the study sample was not representative for the Swiss population the results have to be interpreted with caution only. Nevertheless the results are in agreement with the trends in other countries and it can be assumed that similar developments do occur also in Switzerland.
As late as the 1950s, elevated blood pressure was considered by many expert physicians to be necessary for the adequate perfusion of vital organs. Although the morbidity and mortality risks of hypertension were known at that time to insurance companies, which often refused life insurance policies to people with high blood pressure, there was a lag in the recognition of the dangers of hypertension in the medical community. Following the pioneering efforts of researchers who began to treat patients with malignant hypertension, the results of clinical trials and population studies, and the availability of effective antihypertensive agents, hypertension management improved rapidly. This review traces the history of hypertension management from the 1940s, when President Franklin Delano Roosevelt died of a cerebrovascular accident-a result of uncontrolled hypertension-to today, when a large number of patients, even those with less severe hypertension, are being treated successfully, with a resulting dramatic decrease in hypertension-related vascular disease.
The uncertain need for long-term care (LTC) services is a risk that is best protected by insurance. However, current LTC funding in the United States relies heavily on personal payment and public welfare and only lightly on social insurance and private insurance. This method is akin to sitting on a two-legged stool, which is likely to be unstable. This brief describes a "three-legged" funding model where social insurance would provide basic LTC protection that would be supplemented by private insurance and personal payment. The model would mobilize public and private resources more effectively by linking LTC insurance to social security, private life insurance, and other financial products.
Data on over 222,000 Swedish dogs enrolled in life insurance in 1992 and 1993 were analysed. There were approximately 260 deaths per 10,000 dog-years at risk. Breed-specific mortality rates and causes of death are presented for breeds with more than 500 dogs at risk that had consistently high or low rates. Breed-specific mortality ranged from less than 1 per cent to more than 11 per cent. True rates and proportional statistics for the cause of death were calculated for the entire insured population (250 breeds) and cause-specific mortality rates were calculated for the breeds with the highest risk of dying of the most common causes. Trauma, tumours and problems related to the locomotor system together accounted for more than 40 per cent of all deaths or euthanasias. Although limited to insured dogs, these data cover approximately one-third of all Swedish dogs and provide baseline mortality data for further population-based studies on health and disease.
Arguments against the possible use of genetic test results in private health and life insurance predominantly refer to the problem of certain gene carriers failing to obtain affordable insurance cover. However, some moral intuitions speaking against this practice seem to be more fundamental than mere concerns about adverse distributional effects. In their perspective, the central ethical problem is not that some people might fail to get insurance cover because of their 'bad genes', but rather that some people would manage to get insurance cover because of their 'good genes'. This paper tries to highlight the ethical background of these intuitions. Their guiding idea appears to be that, by pointing to his favourable test results, a customer might make an attempt to 'sell his body'. The rationale of this concept is developed and its applicability to the case at issue is critically investigated. The aim is to clarify an essential objection against the use of genetic information in private insurance which has not yet been openly addressed in the academic debate of the topic.
Accurate prognostication in congenital heart disease is vital for purposes of obtaining insurance, yet can be problematic for patients, physicians and insurers. This article discusses the scope of the problem, and describes the process of evaluating life insurance. Mortality data as well as predictors of adverse outcomes for individual congenital heart lesions are reviewed. Practical tips for patients and their physicians are given to aid in successful application for insurance. To expand the possibility of future patients obtaining insurance coverage, the ongoing reporting and constant updating of very long-term survival data in congenital heart disease is emphasized.
Obesity is regarded by insurance companies as a substantial risk for both life and disability policies. This risk increases proportionally with the degree of obesity. Mortality statistics for life insurance were the earliest indicator that the cost of obesity to the individual was a decreased life span and increased illness, particularly that affecting the cardiovascular and musculoskeletal systems. The prevalence of coronary heart disease rises with increases in the body mass index in both men and women. Cigarette smoking greatly augments these risks in both sexes. Hypertension and diabetes are very common in obese persons and add further to the risks of vascular disease. Abdominal obesity (when the abdominal girth measured round the umbilicus exceeds the maximum measurement round the hips) is correlated with the risk of cardiac disease and stroke, independently of bodyweight. Insurance companies consider abdominal obesity as unfavourable and rate it accordingly. Obesity (even that of moderate degree) greatly increases the chances of disability due to cardiovascular disease or musculoskeletal illness. In one study of 51 522 adult Finns, 25% of disability pensions in women were found to result directly from obesity. Obesity causes increased health expenditure, decreased life span and productivity, and premature retirement. Insurance companies are compelled to build these risks into their policies. However, because the excess mortality occurs late in mild to moderate obesity, some companies may minimise this risk for life policies that mature early.
OBJECTIVE AND METHODS: We describe the insurance behaviour of subjects (n=271) who had previously taken a predictive genetic test for hereditary non-polyposis colorectal cancer (HNPCC); 31% of them were mutation positive, indicating a high risk of cancer. One year after testing, subjects were sent a questionnaire including questions about their present life and health insurance before participation in the study, and their actual and planned purchase of the insurance policies during the testing programme which compromised a pre-test counseling session, a period for reflection, the testing, and a test disclosure session. RESULTS: Thirty percent reported that they already had a life insurance and 14% a health insurance before participating in the study. The mutation-positive subjects possessed a health insurance significantly more often than the mutation-negative individuals (21 vs. 11%, p=0.02) and similar trend was observed for life insurance (36 vs. 28%, p=0.12). Life and health insurance policies purchased just before testing was reported by 3 and 2% of the subjects, respectively. Life and health insurance policies purchased after testing were reported by 3 and <1% respectively, and planned purchase by 3 and 2%, respectively. No statistically significant differences were found between the groups defined by mutation status in reports of life or health insurance behaviour during or after the programme. CONCLUSION: According to self-reported data, the mutation-positive subjects did not differ from the others in the purchase of life or health insurance policies. However, the mutation-positive individuals reported that they possessed health insurance policies before entering the study more often than their counterparts.
Access to comprehensive health care coverage for congenital heart disease patients is often limited because of their "preexisting condition." Life insurance may be difficult to obtain if the congenital lesion carries a higher than standard mortality rating. Various insurance program options are available to many of these patients. Knowledgeable health care professionals can assist these individuals to obtain the needed coverage, enabling better medical and financial security for this growing patient population.
By means of a retrospective study with an analysis of the data of 12,743 postmortem examinations over a period of 10 years 630 autopsy cases have been ascertained which had a connection to an insurer. Considerable differences in the reaction and behaviour in the event of damage have been found between public and private insurers. In the course of preliminary investigations by professional/trade associations or pension offices in general an immediate and consistent reaction for this group of insured persons--which has been recorded "purely accidentally"--is to be observed through initiating or analysing of postmortem investigations. Quite in contrast to these findings private insurers to only a small percentage made use of their contractual possibilities of a postmortem control and--if at all--mostly delayed, especially in those cases where the costs of such an investigation were to be debited to the insurer's account. In most cases private insurers made use of the results of postmortems by scientific organisations, courts or professional associations. According to the results of an examination following the rules of forensic medicine of postmortem findings an insurance contract conditions, in more than 50 p. c. of the cases the medical preconditions for the performance of the insurance contract had to be denied. A critical comment should follow: in quite a number of undisclosed cases a regulation of accident and life insurance claims is carried through in which unfounded decisions are taken without any postmortem controls.
The main objective of this study was to describe the incidence of mammary tumors (MTs) and the survival after MTs, in female dogs between 3 and 10 years of age (insured for veterinary care and with life insurance in a Swedish animal-insurance company) from 1995 to 2002. Measures of incidence are presented crudely, by breed and across age categories and birth cohorts (1991-1998). The survivals until MT diagnosis and after a MT diagnosis were computed. The overall incidence for any MT claim was 111 dogs per 10,000 dog-years at risk (DYAR). The overall MT rate in the 1992 and 1993 birth cohorts was 154 dogs per 10,000 DYAR. The incidence for any MT claim increased with age and varied by breed, from 319 dogs per 10,000 DYAR in the English springer spaniel to 5 dogs per 10,000 DYAR in the rough-haired collie. At the ages 6, 8 and 10 years, 1%, 6% and 13% respectively, of all females had at least one MT claim. The MT mortality was 6 deaths per 10,000 DYAR and increased with age. The overall-case fatality was 6%.
Angina pectoris or chest pain is the main symptom of coronary insufficiency which may lead to reversible or irreversible ischaemia. It must be distinguished from other cardiac or thoracic causes. Nervous or functional disorders hardly influence life expectancy. Unstable angina pectoris, pre-infarction syndrome or post-infarction angina cannot be accepted for life insurance. We have divided stable angina pectoris into four classes in accordance with the NYHA classification. We have indicated the relevant extra mortality. Separate consideration must be given to additional factors adversely affecting the risk.
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