COPD and Life Insurance. Will Your Claim be Denied?
We see a lot of life insurance claims denied for COPD, or Chronic Obstructive Pulmonary Disease. And many of these claims shouldn’t have been denied. This article explains some of the things most relevant about COPD and getting life insurance claims paid when the insurer is challenging the insured’s medical history for this condition.
If you have a life insurance claim that was denied for COPD contact us to get your claim paid.
1-888-428-4868
According to the COPD Foundation, Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness.
Umbrella being the most important word in relation to life insurance policies and claims, especially for those that are being challenged by the claims examiner. The way the medical community thinks of COPD is that there are various physical conditions that impair a person’s ability to breath normally. It’s not, in and of itself, the condition. It’s the result of a condition. This is important because a patient being treated by a doctor may be told they have bronchitis, but the medical record may have notes that say the patient has COPD. Then, when this person is filling-out a life insurance application, and the application asks whether they have been diagnosed or treated for COPD, their answer is probably going to be “No”. This answer is accurate as far as the person knows – how many people actually read their own medical files? But the insurance claim examiner will jump on the opportunity to deny the claim for misrepresentation of a medical condition.
Four Stages of Chronic Obstructive Pulmonary Disease
There are four stages of COPD, according to the Mayo Clinic. The stages and symptoms of COPD are:
Mild. Your airflow is somewhat limited, but you don’t notice it much. You cough and have mucus every once in a while.
Moderate. Your airflow is worse. You’re often short of breath after doing something active. This is the point where most people notice symptoms and get help.
Severe. Your airflow and shortness of breath are worse. You can’t do normal exercise anymore. Your symptoms flare up frequently, also called an exacerbation.
Very Severe: Your airflow is limited, your flares are more regular and intense, and your quality of life is poor.
The life insurance industry uses the same classifications when underwriting a new policy. Generally, if a person is diagnosed as having Mild COPD then they will be insurable without any extra cost or penalty. A Moderate diagnosis is often still insurable, but with an increased premium. And, a Severe or Very Severe diagnosis is usually declined for coverage.
Where the life insurance industry veers from the medical industry in their use of these classifications, especially when a death claim has been made, is that insurers make their own determination of whether a person’s condition was Mild, Moderate or Severe. They don’t rely on the doctors who performed the diagnostic exams. This is a big disadvantage for anyone awaiting a death claim from a policy where the insured had some form of copd and it isn’t an acceptable way to investigate a life insurance claim.
COPD is commonly misdiagnosed and used as a label for various breathing conditions. In fact, in order to determine whether or not a person should be diagnosed as having COPD, one of a few diagnostic exams must be administered. If none of these have been performed, then there isn’t a true diagnosis of copd and the proposition that a life insurance claim can be denied for non-disclosure of a condition that was never properly diagnosed is known as Unfair Claims Handling, and is a legal violation in all US states.
Treatments for Chronic Obstructive Pulmonary Disease
The diagnostic tests administered to determine COPD, according to WebMD, may include:
Lung (pulmonary) function tests. Pulmonary function tests measure the amount of air you can inhale and exhale, and if your lungs are delivering enough oxygen to your blood.
Spirometry is the most common lung function test. During this test, you’ll be asked to blow into a large tube connected to a small machine called a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs.
Spirometry can detect COPD even before you have symptoms of the disease. It can also be used to track the progression of disease and to monitor how well treatment is working. Spirometry often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry.
Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure.
CT scan. A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer.
Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide.
Laboratory tests. Laboratory tests aren’t used to diagnose COPD, but they may be used to determine the cause of your symptoms or rule out other conditions. For example, laboratory tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin (AAt) deficiency, which may be the cause of some cases of COPD. This test may be done if you have a family history of COPD and develop COPD at a young age, such as under age 45.
Determining if a life insurance claim should be denied for copd includes investigating the treatment the insured was using. It’s hard to argue that someone using oxygen would be insurable, but that’s an extreme. Other treatments for copd, which are indicative of mild conditions can include inhalers, antibiotics, steroids, and Theophylline. Someone using these treatments is very likely insurable by most life insurance policies. Therefore, a proper claim investigation has to consider the type of treatment as well as the amount of medication and the length of time under treatment.
Contestable Life Insurance Claims and Chronic Obstructive Pulmonary Disease
There are many factors that have to be investigated when life insurance claims are denied for copd. An insurer may not have done enough investigation before they denied your life insurance claim. We dig deep into the history of the insured and apply the insurers own criteria of evaluation to get our clients claims paid, even if they’ve been denied.
If you need help with a life insurance claim where the insured had or is being accused of having any form of copd and the insurer is challenging your claim, contact us for representation. We’ve successfully gotten over $100 million paid to our clients from life insurance claims.
1-888-428-4868
Also See:
Life Insurance Claim Denied for Diabetes
Life Insurance Claim Denied for Sleep Apnea
Life Insurance Claim Denied for Anemia
Life Insurance Claim Denied for Cancer
Life Insurance Claim Denied for Drunk Driving
Life Insurance Claim Denied for Depression
Life Insurance Claim Denied for High Blood Pressure