Tag: insurance coverage

Austerity and identity formation: How welfare cutbacks condition narratives of sickness

Abstract:

In recent years, Swedish sick insurance has become more restrictive. In this article, we analyse how people not being granted payments, despite being seriously ill, are affected. Scholarship on identity formation and sickness stress the importance of constructing narratives in order to come to terms with one’s situation. Our analysis of 30 qualitative interviews with people diagnosed with ME/CFS shows that workfare politics conditions such identity formation and often prevents it from taking place.

Interviewees describe extreme stress as a result of their contacts with the Social Insurance Agency (SIA), which results in a perpetual crisis that is renewed with each new denied application. In particular, the sense of not having a future means that it is hard to construct narratives to make sense of one’s situation. To escape the perpetual crisis, some people have politicised their situation, constructing a narrative about themselves as suffering from oppressive politics. Others have escaped by not applying for sick insurance or other social insurances. But generally speaking, the most common effect of being denied sick insurance is an ongoing crisis that leads to deteriorating health.

Source: Altermark N, Plesner Å. Austerity and identity formation: How welfare cutbacks condition narratives of sickness. Sociol Health Illn. 2022 Sep;44(8):1270-1286. doi: 10.1111/1467-9566.13545. Epub 2022 Sep 6. PMID: 36066495. https://onlinelibrary.wiley.com/doi/10.1111/1467-9566.13545 (Full text)

Long COVID – One Year On

Abstract:

Long COVID is now a recognized complication of acute COVID-19 infection. As the COVID-19 pandemic moves into its third year, the prevalence of Long COVID continues to increase. Many individuals report symptoms lasting longer than a year, and a subset of this group is unable to work. This article will provide an update on Long COVID, with a particular focus on distinguishing it from other clinical entities. It will review several proposed disease mechanisms and will attempt to anticipate the impact on disability insurance.

Source: Timothy Meagher; Long COVID – One Year On. J Insur Med 2022; doi: https://doi.org/10.17849/insm-49-3-1-6.1 (Full text available as PDF file)

Documenting Disability in Myalgic encephalomyelitis/chronic Fatigue Syndrome (ME/CFS)

Abstract:

Background: According to the 2015 National Academy of Medicine report, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) “is a serious, chronic, complex, and systemic disease that frequently and dramatically limits the activities of affected patients.” ME/CFS affects between 1 and 2.5 million Americans, leaving as many as 75% unable to work due to physical, cognitive and functional impairment. Unfortunately, many doctors and lawyers lack the knowledge of how to properly document an ME/CFS disability claim, leaving patients unable to access disability benefits.

Objective: The goal of this article is to summarize the approaches used by experienced clinicians and lawyers in successful ME/CFS disability claims.

Methods: The authors reviewed the types of US disability insurance programs and the evidence commonly required by these programs to demonstrate ME/CFS disability.

Results: This article summarizes the range of methods used in successful US disability claims, which include documentation of the functional impact of post-exertional malaise and the use of methods that provide objective evidence of impairment.

Conclusions: Medical providers and lawyers can use these tested methods to obtaining disability benefits for people with ME/CFS. Physical therapists, occupational therapists, and other specialists play an important role in providing objective evidence for ME/CFS disability claims.

Source: Podell R, Dimmock ME, Comerford BB. Documenting disability in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) [published online ahead of print, 2020 Jun 16]. Work. 2020;10.3233/WOR-203178. doi:10.3233/WOR-203178 https://pubmed.ncbi.nlm.nih.gov/32568153/

Chronic fatigue syndrome poses management challenge

According to the Centers for Disease Control and Prevention, chronic fatigue syndrome affects between 1 and 4 million Americans. At least one fourth of these are unemployed or on disability because of CFS. Yet according to the CDC, only about half of those thought to suffer from CFS have consulted a physician for their condition.

Primary symptoms include unexplained fatigue for six months or more, in addition to any number of the following: cognitive dysfunction, postexertional malaise lasting more than 24 hours, unrefreshing sleep, joint pain without redness or swelling, persistent muscle pain, headaches of a new type or severity, tender lymph nodes, and sore throat. There are more than a dozen other less common symptoms.

Health plan medical directors find the situation vexing. “Like all managed care organizations, Independence Blue Cross struggles with establishing appropriate coverage policies and clinical programs to address conditions in which there is considerable clinical controversy,” says Donald Liss, MD, the plan’s senior medical director of clinical programs and policy. “Conditions such as chronic fatigue syndrome are particularly challenging because of the nonspecific nature of the diagnostic criteria, the lack of objective studies to confirm a diagnosis, and the wide spectrum of therapies prescribed.”

You can read the rest of this article here: http://www.managedcaremag.com/linkout/2010/10/24

 

Source: Atkinson W. Chronic fatigue syndrome poses management challenge. Manag Care. 2010 Oct;19(10):24-6. http://www.managedcaremag.com/linkout/2010/10/24 (Full article)

 

Contentious diseases–a medico-social phenomenon from an insurance medicine perspective

Abstract:

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.

 

Source: Regenauer A. Contentious diseases–a medico-social phenomenon from an insurance medicine perspective. Versicherungsmedizin. 2008 Mar 1;60(1):3-7. [Article in German] https://www.ncbi.nlm.nih.gov/pubmed/18405228

 

Life insurance MDs sceptical when chronic fatigue syndrome diagnosed

There’s no middle ground when it comes to chronic fatigue syndrome (CFS) – it is either a bona fide clinical entity or a trendy media-made disease with no basis in fact.

This division was evident during the recent annual meeting of the Canadian Life Insurance Medical Officers Association (CLIMOA), the doctors who advise health and life insurance companies on the morbidity and mortality risks of every disease state.

CLIMOA’s members meet annually for an update on therapeutic and laboratory diagnostic testing developments. There are currently 187 members from 128 North American companies and this year’s meeting in Toronto was the largest to date, with 112 members attending.

Dr. Richard Proschek shed more heat than light on the CFS issue with a presentation that concluded family physicians are diagnosing CFS in patients who clearly have other medical conditions that would account for their fatigue.

With an alleged epidemic of CFS looming, insurance companies are caught in a dilemma. Should they pay disability benefits to people being diagnosed with the controversial syndrome? They want to know if it’s a real disease and how much it’s going to cost them if large numbers of people become afflicted.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1452254/pdf/cmaj00222-0063.pdf

 

Source:  Olga Lechky. Life insurance MDs sceptical when chronic fatigue syndrome diagnosed. CMAJ. 1990 Sep 1; 143(5): 413–415. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1452254/