This week, our Senior Underwriter, Karen McLeod provides the essential knowledge you need to know as a life underwriter with regards to Concussions for Critical Illness (CI) and Life Insurance. Let's get right into it!
Why are Concussions an Important Topic for Life & Critical Illness Underwriters?
As underwriters, we need to be aware of the signs and symptoms, prevalence, and those at increased risk for concussions in order to accurately assess the risk for life insurance and critical illness insurance. The media has shown the scale and impact in the past few years of the prevalence and incidences of concussions in our youth. Since this trend continues to grow, knowing the signs to look for when underwriting is beneficial for life underwriters to make informed assessments.
What is a Concussion?
Concussions are a type of acquired brain injury. Acquired brain injuries are defined by The World Health Organization as, “an injury to the brain which is not hereditary, congenital, or degenerative.” Each year, it is estimated that 160,000 Canadians sustain brain injuries. This number is rising as incidence and reporting rates continue to rise.
The effects of these injuries are diverse and are felt over time by more than one million Canadians who have an acquired brain injury. Brain injuries are increasingly common; they surpass the number of Canadians with breast cancer, spinal cord injury, multiple sclerosis, and HIV/AIDs combined.
A concussion is a mild Traumatic Brain Injury (TBI) caused by a blow, bump, or jolt to the head or body that causes the brain to shift back and forth in the skull. Left without professional attention, diagnosis, and treatment, the damage of a concussion can easily worsen as the brain may not have the opportunity to recover.
12 Signs and Symptoms
The World Health Organization identifies the following symptoms for concussions:
- Loss of consciousness
- Balance problems or dizziness
- Double or fuzzy vision
- Sensitivity to light or noise
- Feeling sluggish, foggy, or groggy
- Feeling unusually irritable
- Concentration or memory problems
- Slowed reaction time
Tip: Learn to recognize the signs and symptoms. Many of these symptoms may go unrecognized or undiagnosed. Watch carefully for the information provided in the Attending Physician’s reports and details provided on the application.
Who Sustains the Most Concussions?
Young athletes are at the highest risk for sustaining a concussion. The jostling of the brain within the skull is what causes the injury. This is why helmets do not protect against concussion, as the brain still jiggles upon impact. A helmet that prevents that jiggle has not yet been invented.
The Canadian Institutes of Health Research (CIHR) support research on injury prevention, including providing funding for 19 research projects on mild traumatic brain injuries. Their research focuses on the prevention, diagnosis and treatment for populations most at risk of suffering from these injuries, including children and youth, athletes, and seniors. As per the Government of Canada, 64% of hospital emergency department visits for 10 to 18-year-olds are related to sports participation, physical activity, and recreation. Among those 10 to 18-year-olds that are admitted for a sports-related head injury, 39% are actually diagnosed with concussions. Another 24% were diagnosed with possible concussions. Participation in sports such as football, soccer, and hockey amongst this age group have shown an increase greater than 40% in reported head injuries between 2004 and 2014.
The Federal/Provincial-Territorial Working Group on Concussions in Sport was created in 2015. Their role is to work to develop a harmonized approach to concussions. This approach includes the key components of awareness, prevention, detection, management, and surveillance. Their work will lead to the development of Pan-Canadian Concussion Guidelines, including return-to-play and return-to-learn protocols.
In June 2016, Ontario became the first Canadian province to pass concussion-related legislation. The Rowan’s Law Advisory Committee Act is named after a 17-year-old girl, Rowan, who died in May 2013 while playing a game of rugby. She suffered a concussion when she hit her head on the ground and is believed to have suffered two concussions earlier that week that had been left undiagnosed.
Tip: Know the normal growth and development milestones, as well as the natural aging process. This will aid in the recognition of abnormal symptoms and increased risks among applicants.
Insurers typically charge an increased rate for professional athletes. The increased risk is already factored in for collision sports such as hockey and football.
Why are Diagnoses Difficult to Make?
A concussion diagnosis is difficult for experts to make. There are close to 100 different symptoms, and the usual investigations such as an MRI and CT scan cannot diagnose a concussion. Undiagnosed concussions can lead to future neurological symptoms, including memory lapses, visual problems, and emotional changes. Repeated concussions have been linked to certain types of dementia.
Thankfully, within the past 10 years, there has been increased awareness, and General Practitioners have become more equipped to diagnose and treat concussions.
Former vs. Current Treatment
In the past, treatment for those that suffered a concussion was to lay in a dark room for an extended period of time to allow the brain to heal. Experts now believe that the treatment of choice is to gradually return to work, school, and other activities in order to prevent the symptoms from returning.
Experts are also recommending changes to popular sports. One suggestion from experts, including neurosurgeon Robert Cantu, is that there should be no heading of the ball before age 14 in soccer.
6 Key Complications
Possible complications of a concussion are:
- Post-concussion syndrome
- Post-traumatic headaches
- Post-traumatic vertigo
- Cumulative effect of multiple brain injuries
- Chronic Traumatic Encephalopathy (CTE)
Persistent and long-term symptoms could impact an individual’s ability to function socially and professionally at school or at work. Some of these symptoms include headaches/migraines, occasional confusion or dizziness and difficulty thinking, concentrating, remembering, or multi-tasking. Vision disturbances, such as blurred or double vision, can also occur as a result. Mood changes like anxiety and depression can develop, and some individuals may experience a loss of independence or have seizures.
Tip: Critical illness coverage may include loss of independence coverage, blindness, coma, or loss of speech. It is necessary for the underwriter to know and look for the potential risks, symptoms, and to know the right questions to ask of the potential insured.
What Does the Future Hold?
A new blood test has been developed by scientists from Children’s Health Research Institute and Western University that identifies whether or not an adolescent athlete has suffered a concussion. It is more than 90 percent accurate.
Researchers demonstrated that a blood test can now accurately diagnose a concussion using a form of blood profiling known as metabolomics. The blood is drawn from those with possible concussions within 72 hours of the incident. The scientists measure a panel of metabolites in the blood to search for distinct patterns that indicate a concussion has occurred. A concussion diagnosis cannot be made by looking at one individual metabolite but it can be made with a 90 percent accuracy by looking at sets of 20-40 specific metabolites.
With a multitude of possible symptoms, many of which are subjective, and concussions being under diagnosed, it can be a difficult task for the underwriter to accurately assess the risk at hand. Typically speaking, if the last concussion was over one year ago, with no sequelae and no associated depression, this could most likely be considered a standard risk for both Life insurance and Critical Illness insurance. It is necessary for underwriters of Life and Critical Illness insurance to be aware and educated in order to accurately assess the risk.