Genetics are obviously one of the important factors in assessing longevity and in performing life underwriting. Family history is asked about on virtually every application for life insurance. Longevity helps in looking for preferred issues, and hurts when the pervasive pattern is an increased risk of early disease. Whether it be a tendency toward a disease that does run in an individual’s DNA, a preponderance toward a specific type of cancer, or a process that has a known percentage of occurring in an individual’s lifetime, all are taken into account during the underwriting process.
Some genetic diseases, such as Huntington’s disease, have a more severe underwriting consequence than others. For instance, if heart disease runs strongly within a family, behavior may be modified and treatments may be instituted to markedly decrease this risk. When there is a strong chance an organ will be involved with cancer (such as in BRCA positive individuals), intervention may be undertaken to decrease this risk (as Angelina Jolie did with prophylactic organ removal surgery). In certain genetic inheritance however, such as Huntington’s disease, there is a genetic inevitability to developing a disease for which there is no cure or beneficial intervention and that must be taken into account upfront.
Huntington’s disease thankfully isn’t that common—it affects less than one in ten thousand individuals. It distributes in a pattern called autosomal dominant inheritance. That means if a parent is affected with the disorder, there is a 50 percent chance an offspring will eventually come down with the disease as well. For instance, if a father or mother has one of two genes for the disease, its 50/50 the child will inherit either the affected or unaffected one. As such, both sexes are affected equally. As will be touched on later, there is the ability to know if a child is affected by using genetic testing virtually at birth.
Huntington’s disease has a particularly sad progression. At first, small abnormal movements such as grimaces, blinks and jerks start to appear. Muscles in time become very uncoordinated, movement slows, walking, eating, drinking and speaking become progressively impaired. Impulse control decreases and depression, memory loss and irrational behavior often follow. The disease is almost uniformly fatal within 15 years of the initial onset, and the last years are usually spent with nursing assistance and dementia.
On the face of things even trying to cover and price for Huntington’s Disease, knowing 50 percent of people will be affected and die significantly before a normal life expectancy, would seem impossible, but the early age of onset of symptoms helps give a window of insurability for those who don’t choose to be tested for the gene. The disorder begins to manifest as early as age 25, so if by age 30 someone with a history of Huntington’s in the family is unaffected the risk decreases by about five percent. By age 40 without symptoms the risk may be closer to one third, and those unaffected at age 50 have an increased mortality as a whole but a slowly diminishing chance they have the gene.
It is certainly a matter of individual discretion whether to be tested for the Huntington’s gene when there is a definitive family history. Not everyone wants to know what their individual mortality is or whether they are standing under the sword of Damocles, and of course many are able to better plan their lives and decide family planning as well if they pursue the knowledge. Either decision can be priced for, except the one that is one of antiselection—where the individual knows the outcome of genetic testing but does not admit same to the potential insurer. While a claim of eventual fraud (and perhaps non-payment of a claim) benefits no one, an insurer has only one chance to go after pertinent information that is properly disclosed when making its decision. So the process may be a bit longer than usual when such a condition is involved. Of course, Huntington’s disease that has been ruled out by genetic testing is underwritten normally.
There is discretion in underwriting genetically modified disease on the whole, because so many things may be done to decrease a risk of coming down with a disease. Likewise, the appearance of many diseases that have heredity behind them may be postponed with optimal care, and often greatly diminished by prophylactic surgery of a potentially involved body organ and more intense surveillance along the way to intercede earlier in the process. Huntington’s disease, however, is at this time still a non-modifiable and inevitable disease if inherited genetically and a difficult underwriting situation for all involved.
