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Are Life Insurers Denying Benefits for Deaths Related to COVID-19?

Social media has been abuzz with posts suggesting life insurance claims related to COVID-19 are being summarily denied. Much of the anxiety seems to stem from a news story titled: Would my life insurance policy cover COVID-19 related death?  

An anchor for the news organization that aired the piece shared it on Twitter below the tweet: 

Will your life insurance cover you if you die from #COVID19? 

Well, it depends. 

The tweet is accurate enough. As it would be if the reference to COVID-19 was deleted. Or if the tweet referred to another form of insurance. 

Claims sometimes are denied.  

According to the American Council of Life Insurers 2019  Fact Book, life insurance death benefits paid in 2018 totaled nearly $80 billion, up from $77 billion in 2017. Steadily rising annual payouts like the ones shown in the chart below don’t suggest an industry that spends a great deal of time slithering through loopholes to avoid paying legitimate claims.  

“Life insurance claims are rarely denied,” says Triple-I chief economist Dr. Steven Weisbart. “When they are, it’s typically because the policies had lapsed due to non-payment of premium or the policyholders had provided inaccurate or misleading information at the time of application or renewal.” 

Even in the event of a material misstatement on a life insurance application – say, the applicant lied about a significant health issue – the insurer has to discover the misrepresentation within a defined “contestability period.”  

If the policyholder dies within that period, which typically lasts two years from the date of purchase, Dr. Weisbart says, the insurer can investigate whether the information the applicant provided was accurate. If the policyholder dies after the contestability period ends, the insurer is out of luck.    



Insurers don’t make money by rejecting claims. They make money by underwriting accurately, investing wisely, and making customers happy enough to recommend them to friends and family. 


Compare the chart above, showing the billions of dollars in death benefits paid, with the chart below showing that contested claims are only a tiny fraction of those paid – and bear in mind that many, if not most, of those contested claims ultimately ended up being paid.

Regulated and closely watched 

Insurance is one of the most heavily regulated and closely scrutinized industries in the world, and claims payment is at the heart of the insurance customer experience. Insurers don’t make money by rejecting claims. They make money by underwriting accurately, investing wisely, and – as with any other business – making customers happy enough to recommend them to their friends and family. 

Unfortunately, many people – including much of the media – simply don’t understand how insurance works: how premiums are set, what types of risks are excluded (or that exclusions are even “a thing”), and how reserves and policyholder surplus work.  

This is demonstrated in some of the contentious discussions around COVID-19-related business interruption claims. In the case of business interruption, most of the denied claims have been against policies that specifically exclude losses related to infectious disease. Moves are now afoot to retroactively rewrite those contracts – to the immediate detriment of the insurance industry and longer-term danger to the people and businesses that depend on insurance – as well as anyone who ever enters into any contract ever again.  

I know of no life insurance policy that specifically excludes death from infectious disease. It’s possible some “dread disease” policies that cover specific conditions, such as cancer, might not be paid if COVID-19 – rather than the disease insured against – is deemed to be the cause of death. Or that a life claim might be denied if premium payments were missed or a policyholder smoked or engaged in some other activity associated with high coronavirus mortality that they’d denied on their application less than two years earlier.  

So, yes: Some claims may be denied. But such denials are rare and – social media agitation notwithstanding – don’t imply nefarious behavior on the part of insurers.  

Financial First Responders 

As the economic impact of the pandemic makes it difficult for consumers to keep current on their bills, states have begun to mandate that life insurers keep policies in force, even if policyholders miss payments. At the same time, insurers – facing big financial hits across the many categories of risk they cover (including recent tornadoes and the upcoming hurricane and wildfire seasons) – are doing a lot to support their customers and the communities in which they do business during this crisis. 

Insurers are financial first responders when it comes to just about any loss-creating event the average person might imagine. Media organizations would do their consumers a greater service by clarifying that role and helping them understand how best to shop for the insurance they need than by dropping scary, misleading tweets on an already anxiety-filled public.

FAQs about COVID-19’s Impact on Workers’ Comp

Dr. John W. Ruser, President and CEO of the Workers’ Compensation Research Institute (WCRI), contributed this Q&A about the role workers’ compensation insurance plays in the coronavirus pandemic.

Dr. John Ruser

During this pandemic, many workers (nurses, police, grocery store clerks, transit professionals, etc.) are considered essential, potentially putting them at heightened risk for contracting COVID-19. A key question, of course, is whether a worker who contracts COVID-19 is compensated under workers’ compensation for income loss and medical expenses.

Below are some frequently asked questions that get posed to me as president and CEO of the Workers Compensation Research Institute (WCRI), which is an independent, not-for-profit research organization that provides high-quality, objective research and statistical information about public policy issues involving the various state workers’ compensation insurance systems in the United States.

Q1: Is COVID-19 covered under workers’ compensation and if not, why not?

A1: Historically, communicable diseases, like the flu, have generally not been covered.  Workers’ compensation covers injuries and illnesses that arise out of and in the course of employment. It is generally difficult to establish work-relationship for a disease that could be contracted anywhere. Indeed, some states’ statutes bar compensation for communicable diseases. In the past few weeks, though, a number of states have taken steps to expand workers’ compensation coverage to include COVID-19 for certain groups of workers.

Q2: What is the course of action for states seeking to cover essential workers impacted by COVID-19?

A2: Some states consider that their current laws, regulations and procedures are sufficient to provide compensation for workers who demonstrate that they contracted COVID-19 at work. Other states have changed their rules, either by executive order or by legislation, to increase the likelihood that a worker who contracts COVID-19 may be eligible for workers ’ compensation. The states vary in terms of the scope of workers covered and in terms of the burden of proof required by an ill worker to establish work-relatedness. A number of states’ laws and orders cover only first responders or health care workers. Others expand coverage to include other groups of workers deemed to be essential, e.g., grocery workers. In some states, the worker may be eligible for workers’ compensation if they can demonstrate that their illness was the result of their employment or occupation. In other states, for the workers covered, there is a presumption that their illness arose from work, though that presumption can be rebutted.

Q3: Is this is the first time coverage has been expanded for conditions that may arise outside of work and how are workers’ compensation laws changed?

A3: No, for example, we have seen workers’ compensation coverage expanded to include those, particularly first responders, who witness a traumatic experience and as a result have post-traumatic stress disorder (PTSD) and can no longer perform their duties.

Q4: Is workers’ compensation administered at the state or federal level?

A4: Individuals injured on the job while employed by private companies or state and local government agencies are covered by workers’ compensation programs administered by the states. The essential features of the states’ workers’ compensation systems are similar, but they may vary in terms of the compensability of some conditions, the amount of benefits paid and other features. Federal and some other workers are covered by four disability compensation programs administered by the US Department of Labor.

Q5: What does workers’ compensation cover and are the benefits across the country the same?

A5: Workers’ compensation covers all medical benefits and wages lost while off work due to the injury. It covers the first dollar of medical care and there are statutory formulas for the income benefits that replace lost wages. WCRI’s workers’ compensation laws reports are a great resource to identify the similarities and differences across workers’ compensation systems in U.S. states and Canadian provinces.

Q6: Is WCRI working on any research that will help us better understand the impact of COVID-19 on state workers’ compensation systems?

A6: WCRI has a wealth of studies that provide a pre-COVID baseline for evaluating the impact of the virus on workers’ compensation claims. This includes WCRI’s CompScope™ Benchmarks studies, which compare a range of workers’ compensation performance metrics across 18 states. In the future, we will evaluate the impact of the virus on the composition of claims and their costs, how the virus may have affected the delivery of care to injured workers and the impact of that on worker and claims outcomes, including duration of disability.

CORONAVIRUS WRAP-UP: PROPERTY AND CASUALTY (4/27/2020)

Accounting Rules
NAIC Working Group Approves Flexible COVID-19 Accounting Rules
Automobile Insurance
How the Coronavirus Could Change U.S. Personal Auto Insurance
Business Interruption
Travelers, Insured Law Firm Spar Over Civil Authority Business Income Loss Claim
States Seek to Force Insurance Companies to Pay Those With Business Interruption Policies
Covid-19 Business Interruption Existential Threat, Reinsurance Capital Availability Key: Willis Re
Credit Insurance
Governments should backstop trade credit
Litigation
The Race Is on to Lead Business Interruption Insurance Litigation
What Won’t Cure Corona: Lawsuits
6 Types Of Employment Lawsuits To Expect In The Wake Of COVID-19
Editorial: Stopping a Lawsuit Epidemic
Kudlow: Businesses shouldn’t be held liable for employees and customers getting coronavirus
Corporate America Seeks Legal Protection for When Coronavirus Lockedowns Lift
Profits & Losses
Coronavirus Costs Weigh on Travelers’ Profit
Coronavirus Will Be Largest Event in Insurance History, Says Chubb CEO
Coronavirus To Be Largest Industry Loss Ever: Chubb’s Greenberg & Lloyd’s Neal
Covid-19 P&C Insurance Industry Loss Estimated $40bn – $80bn: Dowling
Chubb Classifies Covid-19 as a Catastrophe Event
Covid-19 Claims Manageable, But Reinsurers Face Formidable Challenges: Willis Re
Specialty Lines
Companies Can Expect Higher D&O Rates, Lower Limits: Experts
Lack of Adequate Insurance Puts Healthcare Workers At Risk of Malpractice Lawsuits
Workers Compensation
States Easing Path to Workers Compensation Benefits for Coronavirus Workers
Changing Virus Guidance Creates Balancing Act For Essential Employers
Employers Pushing Back as States Expand Work Comp to Cover COVID-19
Workplace Safety For COVID-19 Essential Workers
From the Triple-I Blog:
TRIPLE-I CEO AMONG PANELISTS DISCUSSING BUSINESS INTERRUPTION INSURANCE LEGISLATION
INSURERS RESPOND TO COVID-19 (4/24/2020)
CORONAVIRUS WRAP-UP: LIFE AND HEALTH INSURANCE (4/22/2020)
CORONAVIRUS WRAP-UP: DATA AND VISUALIZATIONS (4/20/2020)

Triple-I CEO Among Panelists Discussing Business Interruption Insurance Legislation

Sean Kevelighan

Triple-I CEO Sean Kevelighan today joined legislators and legal experts to discuss proposed measures that could retroactively rewrite business interruption insurance policies.

“The insurance industry is applying forward-thinking solutions to take care of its customers, communities, and employees during the COVID-19 crisis,” Kevelighan said, citing more than $10 billion so far returned to customers through premium relief; $200 million in charitable donations; and insurers pledging not to lay off employees during the crisis and implementing innovative solutions to conduct daily operations while respecting social distancing. “We’re deeply engaged in mitigating the economic impact of this pandemic.”

But the industry can only do these things – while keeping its promises to policyholders and preparing for impending catastrophes – if policyholder surplus isn’t eliminated, as it could be if some of the proposed legislative “solutions” were enacted.

Legislation has been discussed or introduced in Louisiana, Massachusetts, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, and South Carolina that would retroactively enact business interruption coverage into existing policies despite an absence of the physical damage required in property policies and/or express exclusions for communicable diseases in those policies.

Kevelighan explained how policyholder surplus provides a cushion that enables insurers to meet their obligations, even when large, unexpected catastrophes occur. He showed how retroactively rewriting insurance contracts could make it impossible for insurers to play their critical role as “financial first responders.”

The scenarios he discussed could cost the industry $150 billion and $380 billion per month – “quickly eliminating the surplus it has taken the industry centuries to accumulate.”

And they would do this in the midst of a tornado season that is shaping up to be the deadliest in eight years and as a “more active than normal” hurricane season approaches.

Kevelighan made his remarks during a webinar sponsored by the National Council of Insurance Legislators (NCOIL) and the Rutgers Center for Risk and Responsibility at Rutgers Law School. Other panelists included NCOIL President and Indiana Rep. Matt Lehman; New Jersey Assemblyman Lou Greenwald; and Jay Feinman and Adam Scales, Professors of Law at Rutgers Law School and Co-Directors of the Rutgers Center for Risk and Responsibility.

The panelists all expressed support for the creation of a COVID-19 Business Interruption and Cancellation Claims Fund, similar to the 9/11 Victims Compensation Fund enacted by Congress in 2001, for businesses suffering from costs related to the interruption of their businesses, as well as the many associations that have had to cancel events. Funded by the federal government and operated by a special federal administrator, it would facilitate distribution of federal funds and liquidity to impacted businesses during this time of incalculable business interruption.

Click here to view the presentation.

Insurers Respond to COVID-19 (4/24/2020)

The Insurance Industry Charitable Foundation (IICF), announced today that it has raised nearly $500,000 in just over 3 weeks through its national fundraising campaign, the COVID-19 Crisis: IICF Children’s Relief Fund.

IICF’s crisis relief campaign enables donors to focus resources on children at risk of food insecurity, educational disruption, family homelessness and other issues exacerbated by COVID-19. With the support of insurance companies, associations and individual industry professionals, funds raised will benefit 14 nonprofit partners operating throughout IICF’s four U.S.-based divisions.

Overall, U.S. insurers and their charitable foundations have donated approximately $220 million in response to the COVID-19 crisis. And well in excess of $100 million has been contributed internationally, according to Insurance Information Institute (Triple-I) estimates based on information collected by IICF.

Insurance industry contributions have gone beyond financial donations, as tracked by IICF. These efforts include:

  • More than 400,000 masks donated to frontline healthcare workers
  • An industrywide commitment to deliver more than 1 million meals to families in need
  • Hosting blood drives
  • Purchasing and donating to healthcare workers gift cards from small businesses
  • Offering no-cost life insurance policies to frontline healthcare workers
  • Providing additional time off to volunteer in the community
  • Increased matching of employee donations to local charities

In addition, insurance companies have made commitments not to furlough workers due to the pandemic. And U.S. auto insurers will return more than $10.5 billion to their customers nationwide as part of their COVID-19 response, Triple-I estimates.

To donate to the IICF Children’s Relief Fund, please visit the IICF website and designate the region of the country you’d like to support.

“For more than 25 years IICF has marshaled the philanthropic will and resources of the insurance industry in support of communities. By uniting philanthropically through the industrywide IICF Children’s Relief Fund, we’re able to help children across the country be safer and healthier. “

Bill Ross, CEO, IICF

Donations can also be made directly to IICF here to support the organization on a national level with its mission to help communities in need.

To view a list of insurance organizations that have made philanthropic contributions related to COVID-19 please click here and view IICF Children’s Relief Fund contributors.

Coronavirus wrap-up: life and health insurance (4/22/2020)

Health insurance

Buying health insurance? What to know during the coronavirus pandemic

Care providers may need $100B more as industry faces further COVID-19 losses

What to Do if You Can’t Pay for Insurance Due to Coronavirus

Health Insurance Rates Could Be Weirdly Stable: Actuaries

How Will COVID-19 Affect the Health Care Economy?

Life insurance

Certain US life insurers suspend senior applications

Consumers Looking To Buy Life Insurance

More States Mandating Forgiveness On Life Insurance Premiums

Implications of coronavirus for North American life and annuities writers

What an Annuity Giant Is Telling Investors About COVID-19 Risk

CORONAVIRUS WRAP-UP: PROPERTY AND CASUALTY (4/22/2020)

Automobile Insurance
Erie Insurance Offering $200M dividend to Auto Insurance Customers Amid Pandemic
If Miles Driven Are Down, Why Are U.S. Auto Crashes Up?
Business Interruption
Federal Lawsuits Target Insurers Over COVID-19 Business Interruption Claims
Covid-Fueled Supply Chain Disruption a Crunch Point for Insurance Claims
Businesses Contemplating Reopening Fear Lawsuits From Sick Patrons
Cannabis
20 Ways to Address Marijuana Reform Amid COVID-19
Directors & Officers
Top Exec With Coronavirus a Reportable Event? It All Depends
Financial and Business Impact
A.M. Best Forecasts Hit to Insurer Capital from Equity Exposures
Fraud
Pandemic Has Scam Artists Out in Full Force
Litigation
‘Act of God’ Disputes Are on Upswing
Travelers Hits Back With COVID-19 Claims Denial Suit
Fed-up Nurses File Lawsuits, Plan Protest at White House Over Lack of Coronavirus Protections
Travel Insurance
Impact of Covid-19 on Corporate Travel, Recovery & Way Forward
Cruise Ship Virus Losses May Hit Marine Liability Insurers
Workers Compensation
CA Virus Comp Costs Projected to Reach as High as $33.6B
Employers May Exclude Payroll to Employees Not Working for Workers’ Comp: NCCI
COVID-19 Presumptions May Lead to Billions in Workers’ Comp Losses

CORONAVIRUS WRAP-UP: PROPERTY AND CASUALTY (4/21/2020)

Automobile Insurance
Acting on ‘Thin’ Data, Auto Insurers Retain Flexibility With Premium Credits
Speeders Take Over Empty Roads — With Fatal Consequences
Business Interruption
Triple-I Economists: Enforced COVID-19 Business Interruption Payouts Would Damage Industry
Fight Over Pandemic Insurance Intensifies
Restaurants vs. Insurers Shapes Up as Main Event In D.C. Lobbying Fight
Cyber Risk
Hacking Against Corporations Surges as Workers Take Computers Home
Directors & Officers
D&O Insurance May Help Non-Public Companies With COVID-19 Claims
Financial Impact
Despite Recent Market Rally, Pandemic Will Continue to Hit Insurers’ Investments
COVID-19 to deter M&A activity in 2020: Conning
Kidnap & Ransom
Pandemic Exposes Organizations to Kidnap for Ransom Risk
Litigation
U.S. Businesses Bring Wave of Class Action Lawsuits Against Insurance Companies for Denial of Business Interruption Claims in Wake of COVID-19Pandemic
Hiscox Faces Legal Action From Chef Raymond Blanc: Reports
Ending Virus Shutdowns Too Soon Poses Legal Risk for Businesses
Reinsurance and Insurance-Linked Securities
Lack of Exclusions, Poor Wordings the COVID-19 BI Threats to Reinsurers & ILS
Workers Compensation
Utah Passes Bill to Provide First Responders With Comp for COVID
Comp Premiums Likely to Dip as Employment Declines: NCCI

From The Triple-I Blog:
MIXED REACTIONS TO WORKERS COMP COVID-19 EXPANSIONS

CORONAVIRUS WRAP-UP: Data and Visualizations (4/20/2020)

The coronavirus crisis continues to generate data that can be valuable for understanding and decision making. Below are just a few resources that may be of interest to insurers and the people and businesses they serve.

COVID-19 Mortality Projections for U.S. States
Graphs from the University of Texas COVID-19 Modeling Consortium show reported and projected deaths per day across the United States and for individual states.
The Verisk COVID-19 Projection Tool
The Verisk COVID-19 Projection Tool has been made available to enhanceunderstanding of the potential number of worldwide COVID-19 infections and deaths. It provides an interactive dashboard that leverages the AIR Pandemic Model.
How State Insurance Departments Are Responding to COVID-19
This interactive map from PC360 highlights bulletins and procedures released by state insurance departments as of April 15, 2020.
Tracking U.S. Small and Medium Business Sentiment During COVID-19
Small and medium-size businesses account for roughly 44% of the U.S. economy and provide employment to about 59 million people. McKinsey is tracking their sentiment to gauge how their views on economic activity, employment, and financial behavior—as well as their expectations about financial institutions and public authorities—change as a result of ongoing public and private interventions.

Mixed ReactionsTo Workers CompCOVID-19 Expansions

State workers’ compensation boards around the country are amending rules for benefits payouts related to coronavirus, and several states have expanded or are considering widening access to workers comp coverage for COVID-19 beyond first responders and health care workers.

Kentucky and Illinois this week implemented emergency orders to provide access to public-facing essential workers, such as grocery, pharmacy, Postal Service and day care workers. And Minnesota’s legislature unanimously approved a bill that guarantees people in high-risk jobs who contract COVID-19 workers comp coverage without having to prove the infection was a direct result of their job. Most licensed peace officers, firefighters, paramedics, nurses, health care workers, correction officers, workers at secure state facilities, workers at long-term care facilities, and child-care providers are among the classes included in the Minnesota measure.

Lawmakers in Louisiana and New Jersey also have proposed legislation to expand COVID-19 coverage beyond first responders and health care workers, who traditionally are covered if they are exposed to a communicable disease in the course of their work.

While employee groups and unions applaud these moves, the changes could hurt the workers comp industry, some experts warn.

Robert Hartwig, clinical associate professor and director of the Risk and Uncertainty Management Center at the University of South Carolina in Columbia, said the changes present “a potentially enormous and unfair burden on workers compensation insurers that’s completely unprecedented in history.”

Hartwig pointed to the difficulty proving that the transfer of a communicable disease occurred on the job and added, “This is potentially extraordinarily costly to workers comp insurers, but also to many large employers who have either very high-deductible programs or are largely self-insured.”

He said these changes also could be “potentially catastrophic” to workers compensation state funds.

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