This is the eighth article in our Expert Underwriting Series. In a complex industry, understanding diverse health conditions and concerns can help you become more efficient and confident in your role as a life underwriter. Check out the full series to get an overview of longstanding and emerging trends in life underwriting and read on to hear from Garen Markarian, Senior Underwriter, on the impact and key considerations associated with epilepsy.
Why is epilepsy an important topic for life underwriters?
Epilepsy is a chronic neurological disorder primarily characterized by sudden or recurring seizures which can vary significantly in their severity, duration, and frequency. While all forms of epilepsy are characterized by seizures, not all seizures are indicative of epilepsy. National studies have shown that each year an average of 15,500 people discover that they have the condition, contributing to approximately 0.6% of the total population of Canada who have the disorder. Given these statistics, it’s not uncommon for a life underwriter to evaluate the insurance policy of an applicant with a history of epilepsy.
“I’m applying for insurance, and I have epilepsy.”
An applicant applying for life insurance may often question whether they are eligible for coverage, how their premiums will be affected, and what information they will need to disclose. To answer these questions, let’s start off by outlining the classification of seizures.
Identifying Epilepsy: Classification of Seizures
Generalized seizures are ones when there is activity involving the entire brain (left and right hemispheres), whereas Focal (previously known as “Partial”) seizures are when activity originates in one part of the brain. The six Generalized seizures include absence (petit mal), tonic-clonic (grand mal), atonic (drop attacks), clonic, tonic and myoclonic types. The two main categories of Focal seizures are Focal with retained awareness (previously referred to as “simple partial seizure”), and Focal with a loss of awareness (previously referred to as “complex partial seizures”).
Other forms of seizures include a combination of Generalized and Focal types, Infantile spasms, Febrile seizures, Nocturnal, Reflex (television), and Psychogenic Non-Epileptic Seizures (PNES). Although these divisions can be further expanded into Non-Motor and Motor symptoms (the presence of physical movement), for this article we’ll refer to the condensed grouping.
- Absence (petit mal)
- Tonic-Clonic (grand mal)
- Atonic (drop attacks)
- Focal with retained awareness (simple)
- Focal with a loss of awareness (complex)
Increased Risk Associated with Epilepsy
In one US study, it was estimated that patients with epilepsy have a mortality rate that is 1.6-9.3 times higher than that of the general population. The reason for the increased risk is due to the contributing factors including underlying neurological disorders in symptomatic epilepsy, sudden unexpected death in epilepsy (SUDEP), accidents during an epileptic attack, Status Epilepticus (SE), treatment-related deaths, and suicide.
The Link between Depression and Epilepsy
Depression is the most frequent psychiatric comorbidity in people with epilepsy, estimated at ranging between 30 to 35%. It has been shown that there is a complex pathogenic relationship between these two disorders, where symptoms of depression act as an aura (warning sign of a seizure). The type of epilepsy, hormones, psychosocial factors, and side effects from medications all influence these symptoms.
Asking the Right Questions for Assessment
During the application process, an underwriter will be looking for information that will provide insight on how well the seizures are controlled. Typically, the underwriting process will include asking questions for purposes of gathering the following information.
The type and severity of the seizures.
This will greatly impact the assessment since an underwriter will need to know whether the seizures are secondary (i.e. due to a tumor, infection or head injury), or idiopathic (arising from an unknown origin). Further investigation with an MRI of the brain, an electroencephalography (EEG), and medical history may reveal important underlying information that will help assess the type.
The date of diagnosis:
Generally, the more recent the diagnosis, the less predictable the symptoms will be. Often epilepsy diagnosed within 6 months or 1 year (depending on the type), could be too risky and the application should be carefully considered. Furthermore, the age of onset may offer evidence for determining the type and severity of the disorder.
The date of the last seizure, duration of the symptoms, and frequency:
Perhaps the most beneficial piece of information will be the date of the last seizure, and how often they occur. This will directly impact the type of decision. The absence of symptoms for many years will indicate less activity and better control. On the other hand, frequent seizures, or ones that last up to 30 minutes may demonstrate poor compliance with treatment and may even cause damage to the brain, or even death.The treatment, neurological evaluation, and degree of control:
Not every individual with a history of epilepsy requires ongoing medication. Some people may have only one or a few seizures in their lifetime. Compliance with medication, in addition to a complete neurological assessment will be a good indicator of how well the symptoms are controlled.
Another element to consider is whether the applicant has a valid driver’s license, or whether it has been revoked. According to the Ontario Highway Traffic Act, a physician is required under law to report anyone over 16 who they believe is not able to safely drive. To have a valid license means that the anti-epileptic medication appears to have prevented the seizures without impairing consciousness (drowsiness), and the individual has been free of seizures for at least 6 months.
Before making a decision, gather ALL of the information
There are multiple variables to take into consideration when assessing an applicant’s history of epilepsy, making it essential for life underwriters to gather a considerable amount of information before making a decision.
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Garen joined LOGiQ³ as an underwriter in January 2016. In addition to over 10 years of experience in the insurance industry, he has completed the LOGiQ³ Underwriting Training Program. He has an undergrad degree in Neuroscience from The University of Toronto, and a post-grad diploma as a CRA from The Michener Institute.