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Insurers must use head to understand the heart

Congenital heart disease (CHD) sufferers have been unfairly refused life cover because insurers have not properly understood their condition, according to a Gen Re report.

Life/Health Chief Medical Adviser John O’Brien says there are varying degrees of the disease and surgical correction means 85% of babies born with CHD will live to adulthood.

One in 100 children are born with the condition, and an estimated 1 million US adults live with it.

Dr O’Brien says insurers need to understand the details of a potential customer’s CHD to make an accurate and fair risk assessment.

For example, someone with a simple defect such as a small hole between heart chambers can have near-normal expected mortality.

“More complex CHD can have very high mortality, particularly if surgical correction isn’t an option.”

Despite such variances, people with CHD have a higher incidence of premium loading or outright refusal for cover.

One study showed “severity didn’t appear to influence the decision – those with mild disease were just as likely to be refused, or to have premium loadings, as people with complex conditions”, he said.

About 40% of applicants who were initially declined life insurance were later offered cover, while 30% with complex CHD obtained cover at standard rates. 

“While this may suggest difficulty in underwriting people with CHD, it also hints that current practice may have room for improvement,” Dr O’Brien said. 

CHD causes the heart structure to be compromised or miss essential parts, meaning chambers and valves do not function properly.

Long-term complications include arrhythmias, heart failure and infective endocarditis – infection of the heart’s valves or inner lining.

A study of people with complex CHD found 20% required hospitalisation during a year, while 6% required two to four hospitalisations.

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