[Is family history dispensable?]. / Ist die Familienanamnese verzichtbar?

As an element of risk assessment in applications for life insurance, family medical history has a particular significance since given impairments can occur more frequently within families. Family history is not only genetic in nature. Depending on the impairment, it is also explained by external factors. There has been little literature on this topic so far, although the spectrum of family history-related impairments is very large, and their effect is highly dependent on the type of product. This paper presents a new method for assessing the effects of information contained in family history on claims, based on typical age patterns for German life insurance products (life, disability and long term care insurance), using the example of breast cancer and schizophrenia. This method helps life insurers to better understand what impact questions on family history during the stage of application have on the risk. Thus, the study contributes to the often discussed question on how essential questions on family history are.

[Contentious diseases--a medico-social phenomenon from an insurance medicine perspective]. / Schwer objektivierbare Erkrankungen aus der Sicht der Versicherungsmedizin.

A group of illnesses that are difficult to assess objectively, comprising such conditions as fibromyalgia, chronic fatigue syndrome, attention-deficit hyperactivity disorder, whiplash injury, and last but not least a multitude of somatoform disorders, has become a growing concern to Western health care systems and insurance industries. Thus far, the medical literature has failed to provide informative overviews of this group, which at first glance admittedly seems to be rather heterogeneous. If at all, the disorders have been grouped together under the term ,,controversial illnesses" to differentiate them from other diseases. The insurance industry - and claims departments, in particular - are increasingly having to deal with this rapidly growing phenomenon, which affects not only life business, but also health, worker's compensation and motor third-party liability. When paying compensation and settling claims, insurers are often left with a feeling that the illness may have been ,,imaginary" or aggravated. Is there a common basis for this new disorder mega-trend - independent of the recognition of the conditions by medical associations? This article aims at providing an overview of the common characteristics of the group of disorders, including a description of the key physical, psychological and social aspects. In particular, it is intended to deepen insurers' understanding of the risks arising from social change. The article also examines the disorder prevalence in Western societies and the possible causes of the significant increase.

[New challenges in multiple sclerosis]. / Neue Herausforderungen bei der Multiplen Sklerose.

After decades of prevailing fatalism concerning multiple sclerosis new hopes emerge at the horizon of both the diagnostic and therapeutic section catalyzed by a new understanding of the neurodegenerative disease process. The rapidly evolving MRI techniques enabled an analysis of CNS tissue injury in terms of structure and chemical composition. Based on studies with serial MRI scans, multiple sclerosis is increasingly considered as a dynamic disease process, in which not only the myelin but also the axons are damaged already in a very early stage. The introduction of interferon therapy caused much attention and great hope both among patients and clinicians. Unfortunately clinical studies require a large number of patients and long periods. Obviously if treated early enough and consistently, patients with the relapsing-remitting form of multiple sclerosis suffer less exacerbations, MRI lesions and disease progression in comparison to patients not treated by interferons. But sustained improvement in terms of extramortality and extramorbidity can only be expected in the medium term.

[Medical risk assessment at the turn of the century. International developments and trends--exemplified by some typical changes]. / Medizinische Risikoprüfung an der Jahrtausendwende. Internationale Entwicklungen und Trends--dargestellt an einigen typischen Veränderungen.

This article analyses the effects that the increasing amount of medical information available today can have on risk assessment, using examples taken from the fields of serological laboratory diagnosis (HIV, Hepatitis C) and sonographic and molecular genetic examination methods. In general, it can be said that new methods of diagnosis help achieve a more exact and refined prognosis, although their results cannot always be implemented consistently, especially in so-called borderline cases. The second section provides a detailed analysis of access to and availability of medical information in proposal forms, drawing on experience gained from the most important markets.

Prognostic aspects of the metabolic syndrome.

Is the "good life" syndrome taken seriously enough in medicine underwriting? We all know the insurance applicant with the typical signs of having lived the "good life" of Western industrialized countries: overweight with slightly elevated blood lipid levels, hypertension and, not uncommonly, slightly elevated liver functioning tests and hyperuricaemia. Though it bears witness to an overindulgent lifestyle, this constellation of findings is quite often accepted as normal. This article describes the "good life" syndrome as a clinical entity, discusses the significance of the syndrome for medical underwriting and identifies prognostic factors. It deals mainly with those stages of the condition in which neither diabetes mellitus nor coronary heart disease (CHD) has yet developed.

Medical underwriting on the eve of the millennium.

This article discusses the effects of the profusion of medical data on daily underwriting and then attempts to derive conclusions as to future developments in this field. Whereas the volume of medical information is constantly increasing, access to this information is in many cases being rendered difficult as a result of a highly critical attitude to the insurance industry on the part of applicants and medical practitioners. The second part of this article looks more closely at the handling of medical information and makes reference in this regard to the experience of insurance medical officers and directors of underwriting departments in the most important international markets.

[Prognostic aspects of metabolic syndrome. Is the "good living" syndrome regarded seriously enough in general insurance medicine practice?]. / Prognostische Aspekte des metabolischen Syndroms. Wird das Syndrom "Gutes Leben" in der versicherungsmedizinischen Praxis ernst genug genommen?

Metabolic syndrome is characterized by a large number of metabolic disorders, the findings being generally a combination of insulin resistance, obesity, hypertension, dislipidemia and pathological glucose tolerance or diabetes mellitus type II. Metabolic syndrome is diagnosed too seldom in view of the fact that a prevalence of at least 10% must be assumed for the population as a whole. Besides genetic predisposition, environmental factors such as diet, physical inactivity and nicotine and alcohol consumption play a decisive role in its clinical manifestation. The paper briefly examines the pathophysiological connections between the individual findings, with the central role of insulin resistance being emphasized. With a multifactorial therapy, in which non-medicamentous treatment is predominant, it must be assumed that on the whole compliance will tend to be poor. Prognostically the syndrome is serious, very frequently resulting in premature atherosclerosis. The paper concludes with a consideration of the underwriting of metabolic syndrome, one of the points being that the extramortality rates of the individual impairments should not be applied additively.

[MEDRISK--an expert system for medical risk assessment]. / MEDRISK--Ein Expertensystem für die medizinische Risikoprüfung.

The Munich Reinsurance Company has developed a rule-based expert system for assessing substandard risk in life, disability and accidental death benefit. It is one of the most comprehensive medical expert systems yet conceived and currently includes entries for over 7500 impairment terms. Based on the most up-to-date insurance medical knowledge MEDRISK allows underwriters, irrespective of their level of experience, to process both simple and highly complex cases. The system which takes account of the interactive effect that can exist between different impairments as well as the influence which occupational factors can exert, always produces consistent and case-specific decisions. The number of impairments and types of insurance included in MEDRISK can be expanded. After tests at Munich Re and at a number of insurance companies, the system ist now ready to be launched in German speaking markets.

[Value of laboratory diagnosis of liver function from the insurance medicine viewpoint]. / Wertigkeit der Labordiagnostik der Leber aus versicherungsmedizinischer Sicht.

After a brief passage on the reliability and special features of the most important liver values, this paper deals with the diseases of the liver most frequent in everyday rating practice from the angle of specific laboratory patterns and enzyme processes, putting emphasis on prognostic aspects. Special mention is made of the most recent diagnostic findings in the field of virus hepatitis. Furthermore, the influence of alcohol on the liver values is explained in detail. In a résumé, GPT, Gamma-GT and cholinesterase are regarded as sufficient for classifying almost 98% of all diseases of the liver, the limited significance of liver values as "functional parameters" being stressed, however.