Citation

Deshauer D. CMAJ 2019; 191(23): E640-E641.

Affiliation

Department of Psychiatry, University of Toronto, Toronto, Ont.

Copyright

(Copyright © 2019, Canadian Medical Association)

DOI

10.1503/cmaj.181058

PMID

31182461

Abstract

In the early 20th century, the rating of higher risk, “substandard” applicants for life insurance was largely the purview of physicians known as medical directors of life insurance companies.1,2 Medical directors from the United States and Canada met annually between 1889 and 1991 under the umbrella of the Association of Life Insurance Medical Directors of America to update their knowledge at a time of rapidly evolving medical technologies. The work of this association contributed to a standardized process called automated underwriting, in which paramedical workers gathered key information from insurance applicants over the telephone and then assigned a risk score to each application. This score was constantly refined and tested according to its predictive value.3,4 Applications were routinely crosschecked with the Medical Information Bureau, a shared industrial database that had kept track of all life insurance applicants (including those who had been turned down) since 1902. By the 1960s, when combined with carefully crafted exclusion clauses, automated underwriting had become so effective that it often supplanted medical directors.

One kind of risk assessment, however, seemed to require ongoing expert attention. Life insurance companies had long mistrusted any applicant with a history of mental illness, fearing they would commit suicide. Between 1952 and 1962, the Metropolitan Life Insurance Company reported that suicide was its fifth leading cause of death leading to a policy payout, and it was unclear how this risk could be managed more effectively.5 Suicide clauses, written since the 19th century, had been proven hard to enforce, and screening questions were inadequate ...

Language: en