An issue was brought up with one of my clients last week that reminded me of a topic I don’t think I’ve ever written about. Lloyd’s of London, the ultimate EU royalty insurance company, takes a dim view of obesity, pregnancy, smoking, and in some cases mental illness.
The aristocrats of insurance (Mass Mutual, and Guardian in some cases) accept prejudicial views that “obesity” is “self-caused” and contributes to other claimed physician disabilities that “if it were not for the insured’s obesity, they would be able to work.” In other words, obesity is viewed as “something insureds do to themselves” that deliberately guides them to, or contributes to, a disabled state of being.
“Smoking” is similarly viewed by American insurers. For example, several insurers took issue with an insured’s continued smoking while filing cardiac claims, including one for a heart attack. The denial letter clearly stated that since smoking is contraindicated medically for the heart that the insureds continued smoking adversely affected “getting better”, meaning improved enough to return to work.
The problem with the self-blame game is where do you draw the line. For example, if an insured submits a claim for Type II diabetes, can it be denied because it was discovered the insured ate Snicker Bars and carbohydrates all day? Or, perhaps the insured ate too much fast food and was sedentary. Or even if the insured has a family history of diabetes?
Cardiac issues can be discredited because the insured didn’t exercise, or ate too much saturated fat, or any other reason that can be blamed directly on the insured that indicates a deliberate lifestyle. Where does it end?
Insurance companies have also taken a dim view on paying claims when females either plan on becoming pregnant, or get pregnant while on disability. They allege that taking care of a newborn infant is equivalent to “Light Functional Capacity” and I’m not sure I disagree with that evaluation – it does take a lot of energy to care for an infant.
Lloyd’s recently called a treating physician (and got through, by the way) about a person’s obesity, not her claimed disability of neuropathy. Lloyd’s objective is transparent though — if the insured lost weight the neuropathy wouldn’t be impairing. If this same woman lost 100 lbs. and became malnourished Lloyd’s could use the same rationale -“she did it to herself by not eating enough.”
<p class="just"It's really crazy using "self-blame" to allege insureds deliberately cause disability by their own poor living habits and lifestyles. Disability policies and contracts do not "set-up" provisions that eliminate poor life-style choices, although life insurance does by increasing premium for various activities and prior health problems that contribute to the risk of death.
Disability Plans and policies define the nature of the insured’s inability to work in real time without blaming insureds for how they got the disease in the first place. Insureds generally feel bad enough about their disabilities without insurance companies blaming and shaming them for any poor choices they made in the past.
Still, there are certain insurance companies who look to discredit claims based on the “blame game” and allegedly what you did to cause your own disability. I think as adults we all realize there is a cause and effect to nearly everything we do, yet applying that concept to disability insurance review is about as crazy as it gets.
