Volume 2 Number 1 - March 9, 1996
A survey of 85 British melanoma patients found 11 who
were rejected for mortgage or life insurance, one for a pension plan, and
one for inheritance tax. One patient had been refused emigration and three
had been refused entrance into the armed forces.1 Difficulties
with insurance, mortgages, emigration, and entrance into the armed forces
are not limited to patients in Britain.2,3 We have all heard of
a patient with melanoma who has been denied insurance. There is very
little information in the medical literature regarding these issues.
Sometimes we are asked what a diagnosis of melanoma will do to a person's
insurability. We have also heard from colleagues who suggest that
pathologic diagnoses should be tailored to best serve patients in their
life circumstances. What is going on in the Knoxville area? I asked two
local insurance agents to help me.
Life insurance companies have guidelines for underwriting
melanoma patients based upon the time interval since diagnosis, the
microscopic and clinical stage of the tumor and the anatomic location.
Clark level and Breslow thickness have been used to place melanoma
patients in rating classes. Availability and cost of polices are then
based upon these ratings.4,5,6
Northwestern Mutual Life Insurance may underwrite life
and disability insurance for melanoma patients. Insurability is related to
microscopic and clinical stage of tumor and to the interval since
diagnosis. Patients with multiple tumors, metastasis or more than one
recurrence within five years would be declined. Patients with Stage I
disease (no metastasis) would be considered for standard disability and
for select life insurance. They could be reconsidered for standard.
Patients with Stage II disease are rated in 4 levels depending on
thickness of tumor in millimeters. If the thickness is not known, the
insurance might be declined or would probably be highest rating (very
expensive). The cost for select insurance for melanoma patients is based
upon their rating. After 5 or more years since diagnosis, the patients may
be reconsidered and some may qualify for standard
policies.4
Aetna and The Guardian also may insure melanoma patients.
I sent brief descriptions of three hypothetical melanoma patients who are
applying for life insurance. The responses from Aetna and The Guardian
follow each below.7
|
|
CASE |
AETNA |
THE GUARDIAN |
|
1. |
28 YOM, superficial spreading melanoma, Level II, 0.68 mm. No
clinical evidence of nodal or distant disease. |
Term: Standard plus extra $5.00/thousand for three years.
Universal life: Standard. |
Insurable, annual extra $5.00/thousand for three years from the
date of treatment. |
|
2. |
43 YOM, superficial spreading melanoma, Level III, 1.2 mm on
shoulder. Removed two years ago, no evidence of recurrence or
metastasis. |
Standard with $10.00/thousand for four years. |
Not insurable until two years from removal. Thereafter, insurable
with extra $10.00/thousand for four years. |
|
3. |
48 YOM, nodular melanoma removed from cheek. Level III, 2.8 mm.
Disease free for six months. |
Declined for first two years; postponed one additional year.
After three years, standard with extra $15.00/thousand for five
years. |
Not insurable for first three years. Thereafter, extra
$15.00/thousand for five years. |
I was advised that "ratings for melanoma patients vary
from company to company based on underwriting philosophy, mortality
assumptions, and other factors".5 It is interesting to see how
similar the responses from Aetna and The Guardian are. It seems that
insurance companies are aware of vagaries of diagnostic terminology in
melanoma pathology. For example, patients with a diagnosis of "atypical
melanocytic hyperplasia" are rated similar to patients with "melanoma in
situ".8
Are melanoma patients allowed to enter service in the
Armed Forces? According to the Army Recruiting and Processing Center in
Knoxville, any history of melanoma disqualifies an individual for entrance
into the Armed Forces of the United States.9
We should all be aware of the social implications that
our diagnoses have for our patients. It is disconcerting to know that some
patients with thin melanomas may be adversely effected or penalized
socially for a diagnosis that may carry no risk for morbidity or
mortality. In our laboratory, however, pathologic diagnoses are based upon
published microscopic criteria for melanoma. We do not "adjust" our
diagnoses to social circumstances. We believe that this is the proper
practice to ensure uniformity to melanoma diagnoses and to provide
unbiased and meaningful information to our patients and their physicians.
Hopefully, other institutions will follow the insurance industry in
offering services and privileges to melanoma patients.
PBG
REFERENCES
1 Wilson D, Evans J. Non-medical implications of
malignant melanoma. Br J Plastic Surg 1993:46:158-9.
2 Muller WA, Erlanger M. Das maligne melanom in der
lebensversicherung. Dicke oder anatomische schicht? (Malignant melanoma in
life insurance -- thickness or anatomic layer) Versicherungsmedizin
1994:46(6):193-5.
3 Wall L, Singh G, Heenan P. Life Insurance penalties on
patients with cutaneous malignant melanoma [letter]. Medical Journal of
Australia 1991:154(9):638.
4 J. Todd Williams, 618 South Gay Street, Suite 100
Knoxville, TN 37902-1606, (423) 525-7997.
5 Michael Lynch, Chief Underwriter, The Guardian,
Northeast Regional Office, P.O. Box 26120, Lehigh Valley, PA 18002-
6120.
6 Burger WF. Cancer prognosis. Special emphasis on breast
cancer and malignant melanoma. Transactions of the Association of Life
Insurance Medical Directors of America 1991:74:133-43.
7 John H. Hildreth, CLU, 10259 Kingston Pike, TN,
37922-3222, (423) 691-4652.
8 Wagner RF, Murphy CM. Risk classification of life and
health insurance applicants with atypical melanocytic hyperplasia or
malignant melanoma in situ. Cutis 1992:50:352-4.
9 U.S. Army Examination Center, Medical Section, 9745
Truckers Lane, Knoxville, TN 37922, (423) 531-8091.
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