Our Achilles Heel?

Hank George FALU, CLU, FLMI
Broker World • April 2003

“…many adults currently choose CAM therapies to treat their most serious medical problems.”

David M. Eisenberg, MD,
Harvard University
Annals of Internal Medicine
135(2001):344

CAM is the new acronym for complementary and alternative medicine. Which, in turn, speaks to a broad array of therapeutic interventions—some ancient, others ultra-modern—standing at the gates of conventional medicine and finally being heard, as in:

• Increasing the prevalence of their collective use by 25 percent in the final decade of the previous century.
• Escalating the number of visits to their sundry practitioners over the same interval from 427 million to 629 million (an imposing number challenging primary care medicine).
• Jacking up net expenditures for their goods and services by a staggering 45 percent to a total of $21 billion and climbing.

Why would these growing domains of therapy, often seen now as supporting rather than corrupting the work of mainsteam medicine, represent an Achilles heel for insurers?

Four giant reasons could have serious implications for insurers’ bottom lines.

1. Those availing themselves of CAM tend to be disproportionately in our best markets. Article after article detailing the portrait of the “typical” CAM user with a chronic disease like cancer or rheumatoid arthritis shows that the patient is more highly educated, affluent, and—ominously—apt to have severe disease. Failure of conventional therapy, inability to tolerate side effects/complications of therapies, disease relapse/recurrence, and emotional comorbidities send chronic disease patients in desperate search of alternatives.
2. A substantial number of those who avail themselves of alternative and complementary remedies do so without disclosing the facts to their personal physicians. Even more do so without informing physicians who are treating them as specialists in chronic diseases. This unfortunate reality has significant implications for treatment outcomes (some nontraditional remedies may interact adversely with such treatments as anticancer chemotherapy and anticoagulation for acute coronary syndromes). This also means that physician reports secured by underwriters will not often contain details of CAM use.
3. Companies do not include non-prescription drug questions on their applications for insurance. At several recent gatherings of continent-wide life underwriting study groups, a show of hands of members representing major carriers has revealed that virtually no companies have included a Part II question related to the use of non-prescription treatments. This means that unless insurers take pains to ask about CAM on telephone interviews, they miss their only opportunity to inquire about this growing domain of medical intervention. How can we continue not to know when these increasingly relied-upon remedies are being used by proposed insureds and still hope to avoid significant antiselection?
4. What most underwriters (and I’d wager, most medical directors as well) don’t know about CAM would fill a book. This presents a clear and present danger to risk management.

Let’s say a client applies for life insurance, and he has a history of liver cancer—a disease with a dismal prognosis.

He does not, for whatever reason, disclose this history in a cogent manner during the paramedical. However, he does acknowledge that he indulges in licorice root or mistletoe herb therapy during the telephone interview.

The underwriter, being unaware of the true implications of either intervention, and also being too inundated with new work to spend hours tracking these obscure remedies, approves the case. Whereupon, inexorably, the insured dies within the contestable period, and litigation ensues regarding failure to disclose the cancer history.

Do you believe plaintiff’s counsel can make a case that, while the deceased did not disclose everything, he did own up to indulging in a CAM remedy—widely understood (and documented in the literature) as being used for either chronic liver disease or advanced cancer? Would the jury be inclined to believe that the underwriter “blew it” and that the insurer is trying to cover up the mistake and cruelly deny the widow her just due?

Bet on it. True, nothing is ever this cut and dried or simplistic; but be assured that this inevitable scenario will surely be seen as a tempting basis to litigate a denied death claim.

And winning such a case may prove as costly as paying that claim for the insurer.

The time has come to expand our consciousness and acquire an adequate working knowledge of those aspects of CAM that have a bearing on the risk domains we appraise. For life, LTC and critical illness insurance, that list is mercifully much shorter than for DI and major medical insurance.

The most urgent aspect? Ingested remedies, most notably herbs and, of course, shark parts (that seem to have a loyal following among a subset of cancer patients).

After that, nutritional supplements, acupuncture, chelation therapy, chiropractic, and aromatherapy. All of these have their place in the treatment of chronic diseases significant to most domains of mortality and morbidity risk.

The good news? The subjects to be learned are fascinating and may contain nuggets of personal wellness value as well.