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Friday, June 1, 2007
Medical advice for life underwriters

Bronchitis means inflammation of the mucous membrane of the bron¬chial tubes. It can occur in attacks (acute bronchitis) or be persistent (chronic bronchitis).

Acute bronchitis is usually due to infection. In an otherwise healthy person this will present little risk to the sufferer’s life and can, therefore, be disregarded by the underwriter.
However, if it is disclosed on a proposal form an underwriter may call for a report from the medical attendant to check that this is not becoming a chronic problem. The chronic form of bronchitis is closely linked to cigarette smoking.
Once the disease develops, if smoking continues, chronic bronchi¬tis will usually progress through various distinct stages. In the early stage there is an increase in bron-chial mucus causing frequent throat clearing and coughing, especially af¬ter the first cigarette of the day.
On medical examination the chest will usually show no abnormality. If smoking is given up, the minor dam¬age to the bronchi will resolve.
In the intermediate stage of chronic bronchitis, recurrent inflammation will have produced permanent scar¬ring in the walls of the bronchi, caus¬ing shortness of breath on exertion but not with ordinary day-today ac¬tivities.
On examination, a wheeze will often be detected in the chest, and lung function tests will be reduced. If smoking is stopped, symptoms will resolve and progression of the dis¬ease will be halted, although the permanent damage will remain.

The late stages of the disease is characterised by shortness of breath and coughing. There will be a marked narrowing of the bronchi. In very severe cases there will be shortness of breath at rest, a bluish tinge occurring at the extremities, known as cyanosis, and a constant productive cough.
If smoking is stopped, symptoms may improve but progression of the disease cannot be halted. Death will usually result from heart and lung failure.
In most cases the underwriter will call both for a report from the medical attendant and a medical examina¬tion. Any rating will largely depend upon the stage of the disease, re¬flected by the severity of the symp¬toms and lung function tests.
Symptom severity is indicated by the degree of shortness of breath, time off work, the requirement of continu¬ous treatment and signs on examina¬tion. Other factors which will influ¬ence the rating are age (the younger the proposer, the higher the rating) and cigarette smoking.
For life policies, the ratings for chronic bronchitis can range from a small extra premium for mild cases to declinature for the worst cases. The disabling nature of the disease renders sufferers a poor prospect for permanent health insurance and the majority of such cases will attract high ratings if not declinature.

Copyright © Insurance Times and Investments® Vol:20.5 1st June, 2007
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