Modify The Survival Requirement
To The Editor:
When I was medical director at a direct writing company, the claims administrators occasionally turned to me for an opinion about life expectancy in accelerated death benefit claims. The contract defined eligibility as “life expectancy less than 1 year.” But life expectancy is poorly suited to consideration of terminal illness. Life expectancy refers to the average duration of survival for a population. The variation around that average, or the range of possible survival, is sometimes very large. I struggled in the same ways that Glen Bobo describes in his March 29 article.
Average life expectancy is not what the public or physicians mean by terminal illness. Terminal illness relates more to the maximal possible survival rather than the average. In most diseases, medical literature and personal anecdotes include exceptional cases with long survival. There is also the problem that the claim may arrive during treatment. If it is known that a few cases will respond very successfully to treatment, I sometimes advised that the company defer the claim until we had established the outcome of treatment.
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Eventually, I developed my own approach, to rely on the kind of statistic that Mr. Bobo cites in the first paragraph of his article: “a disease with a survival rate of only 9% after a year.” I reasoned that the intent of accelerated death benefit is to pay under circumstances that nearly all people would die within the 1-year “life expectancy” in the policy definition. Data on average survival is often difficult to obtain and distorted by unusual outcomes. By contrast, actuarial survival statistics are easier to find. They also enable attending physicians to finesse the conflict that surrounds the preservation of therapeutic hope in dismal circumstances.
The industry would be well served to modify the survival requirement for accelerated death benefits in our contracts. We could achieve the implicit goal of the benefit and avoid the conflicts and anguish depicted in the article. The definition of a qualified claim should be conditions with > 90% mortality (< 10% survival) at 1 year.
The views expressed are those of the author, not Gen Re LifeHealth.
Thomas Ashley, MD
VP and Chief Medical Director
Gen Re LifeHealth
Put ADB In All Policies