93 Loss of insurability: an inadequately elucidated harm of screening and overdiagnosis

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Abstract

Objectives

We sought to understand the process of underwriting life insurance and assessing risks, particularly about how positive screening tests and their follow-up might affect insurabilty and premium costs.

Method

We searched for evidence of company policies about how risks are assessed and the thresholds used to decide to increase the cost of policies, or decide not to insure a proposal. We also searched the insurance business journals for articles discussing this issue.

Results

Only limited information is available because much is regarded as commercial in-confidence. We found one article that explicitly described reduced life insurance eligibility as a potential harm of cancer screening. We focussed on cancer screening results and their implications. Some companies have rigid rules, such that almost any cancer diagnosis will not be accepted. Others will postpone acceptance for varied lengths of time. Some have nuanced understanding of the limited risk after diagnosis of cervical pre-cancers, and papillary thyroid cancers. However, since overdiagnosis that occurs in many cancers is indistinguishable from fatal disease, it is largely treated the same.

Conclusions

The implication is that people should be warned that having a positive screening test may cause inappropriate loss of insurability, so that they should be sure to obtain any needed life insurance before having such tests. Physicians need to be aware of this hazard to financial health caused by well-meaning screening.

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