A doctor may consider a minor symptom clinically unimportant while an insurer requests tests and then imposes an exclusion or declines cover. The original article explains this through the differing purposes of clinical and insurance medicine.
Different focus Clinical medicine examines disease causes, diagnosis, treatment and prognosis to improve present health. Insurance medicine uses clinical knowledge, morbidity and mortality data and statistical analysis to estimate future illness, health and lifespan risks for underwriting and claims.
Different subject and time horizon Clinical care focuses on an individual patient’s current diagnosis, treatment and relief of suffering. Insurance medicine considers the proposed insured person’s current health and future morbidity and mortality to set corresponding terms. This is why applications ask about height, weight, occupation and past illnesses or injuries. Clinical assessment emphasises present treatment and control; underwriting takes a longer-term view.
Example: excess weight An overweight person with no other abnormality may not require specific clinical treatment beyond diet and exercise. An insurer may nevertheless assess higher future risks of hypertension or cardiovascular disease and classify the applicant as a substandard risk. The original article uses a possible premium increase of around 25% as an illustration, not a universal rate.
Example: previous cancer For a 40-year-old who had lung cancer five years earlier and completed treatment, a clinical assessment may focus on recovery. Underwriting may remain concerned about future critical illness risk associated with the history.
Why underwriting is cautious Insurance pools premiums among people facing risks. Underwriting guidelines help distinguish different risk profiles and set fair, corresponding terms so that the pool can function sustainably. Many contracts are lifelong or guaranteed renewable, meaning a decision now can have long-term consequences and individual terms may not simply be changed when health deteriorates later.
Both disciplines aim to make reasoned assessments, but for different purposes. The article encourages planning cover while healthy and answering health declarations honestly.
This article retains the context of its original publication. It is for general information and does not replace professional medical advice.
Back to health insights