INSURANCE RISK ASSESSMENT IN LIFE AND HEALTH INSURANCE: THE ROLE OF FAMILY MEDICAL HISTORY
Keywords:
Insurance, Genetic Information, Family Medical History, Insurance Risk Assessment, Actuarial Activities
Abstract
The article examines the features of the use of family medical history for assessing insurance risks in life insurance and health insurance (including health insurance), and also identifies the main problematic aspects and challenges of using this actuarial tool.
As a result of the study, we find that the key features of using family medical history for assessing insurance risks are following: the comparability and substitutability of the family medical history of the insurance applicant with the results of his genetic tests; the risk of genetic discrimination; the risks of information asymmetry and adverse selection; the risk of the reliability and completeness of the family medical history of the insurance applicant; the unevenness of actuarial significance; the need for scientifically sound interpretation for use as a tool for assessing insurance risks; the frequent disorder of the rights and obligations of insurers and insured persons regarding the disposal of data on the family medical history of insurance applicants; the lifestyle of the applicant for insurance may affect the likelihood of genetic risks of developing diseases, which are determined on the basis of his family medical history.
Also, this research study evaluates and analyzes the main advantages and disadvantages of using the applicant's family medical history for insurance purposes during actuarial activities in the field of life and health insurance.
We find that currently in Ukraine in order to increase the efficiency of the Ukrainian insurance market in the context of optimizing the use of family medical history to assess insurance risks in life insurance and health insurance (including health insurance), it is necessary to conduct additional research to determine the practical features of using the family medical history of the applicant for insurance during actuarial activities in the field of life and health insurance. The results obtained will allow us to propose the most rational approaches to regulation that would best meet the interests of both insurers and policyholders.
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References
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Lane, M., Ngueng Feze, I., & Joly, Y. (2015). Genetics and Personal Insurance: the Perspectives of Canadian Cancer Genetic Counselors. Journal of genetic counseling, 24(6), 1022–1036. https://doi.org/10.1007/s10897-015-9841-9
Prince, A. E. (2016). Tantamount to Fraud?: Exploring Non-Disclosure of Genetic Information in Life Insurance Applications as Grounds for Policy Rescission. Health Matrix: The Journal of Law-Medicine, 26, 255–307.
Tiller, J., Morris, S., Rice, T., Barter, K., Riaz, M., Keogh, L., Delatycki, M. B., Otlowski, M., & Lacaze, P. (2020). Genetic discrimination by Australian insurance companies: a survey of consumer experiences. European Journal of Human Genetics, 28(1), 108-113. https://doi.org/10.1038/s41431-019-0426-1
Tiller, J., Lacaze, P., & Otlowski, M. (2022). The Australian moratorium on genetics and life insurance: evaluating policy compared to Parliamentary recommendations regarding genetic discrimination. Public health research & practice, 32(4), 3242235. https://doi.org/10.17061/phrp3242235
Newson, A. J., Tiller, J., Keogh, L. A., Otlowski, M., & Lacaze, P. (2017). Genetics and Insurance in Australia: Concerns around a Self-Regulated Industry. Public health genomics, 20(4), 247–256. https://doi.org/10.1159/000481450
Muto, K., Nagai, A., Ri, I., Takashima, K., & Yoshida, S. (2023). Is legislation to prevent genetic discrimination necessary in Japan? An overview of the current policies and public attitudes. Journal of human genetics, 68(9), 579–585. https://doi.org/10.1038/s10038-023-01163-z
Fraser, H., Gamet, K., Jackson, S., Shelling, A. N., Lacaze, P., & Tiller, J. (2023). Genetic discrimination by insurance companies in Aotearoa New Zealand: experiences and views of health professionals. The New Zealand medical journal, 136(1574), 32–52. https://doi.org/10.26635/6965.6116
Dixon, P., Horton, R. H., Newman, W. G., McDermott, J. H., & Lucassen, A. (2024). Genomics and insurance in the United Kingdom: increasing complexity and emerging challenges. Health economics, policy, and law, 19(4), 446–458. https://doi.org/10.1017/S1744133124000070
Otlowski, M, Barlow-Stewart, K, Taylor, S., et al. (2007). Investigating genetic discrimination In the Australian life insurance sector: the use of genetic test results in underwriting, 1999-2003. J Law Med, 14, 367-396.
Vukcevic, D., & Chen, J. (2018). Advances in genetics and their impact on life insurance. In Proceedings of Financial Services Forum 2018 Institute of Actuaries of Australia. URL: https://research.monash.edu/en/publications/advances-in-genetics-and-their-impact-on-life-insurance (дата звернення: 21.09.2025).
Barlow-Stewart, K., Taylor, S. D., Treloar, S. A., Stranger, M., & Otlowski, M. (2009). Verification of consumers' experiences and perceptions of genetic discrimination and its impact on utilization of genetic testing. Genetics in medicine : official journal of the American College of Medical Genetics, 11(3), 193–201. https://doi.org/10.1097/GIM.0b013e318194ee75
Thomas, R. G. (2018). Why Insurers Are Wrong about Adverse Selection. Laws, 7(2), 13. https://doi.org/10.3390/laws7020013
Prince, A. E. R. (2017). Insurance Risk Classification in an Era of Genomics: Is a Rational Discrimination Policy Rational?. Nebraska law review, 96(3), 624–687.
Barlow-Stewart, K., Liepins, M., Doble, A., Otlowski, M. (2018). How are genetic test results being used by Australian life insurers? European Journal of Human Genetics, 26, 1248–1256. https://doi.org/10.1038/s41431-018-0198-z
Fernando, A., Kondrup, E., Cheung, K., Uberoi, D., Joly, Y. (2024). Still using genetic data? A comparative review of Canadian life insurance application forms before and after the GNDA, FACETS, 9, 1-10.
Yanes, T., Tiller, J., Haining, C. M., Wallingford, C., Otlowski, M., Keogh, L., McInerney-Leo, A., & Lacaze, P. (2024a). Future implications of polygenic risk scores for life insurance underwriting. NPJ genomic medicine, 9(1), 25. https://doi.org/10.1038/s41525-024-00407-x
Rechfeld, F. (2024). Genetic testing in the Life & Health insurance industry. Swiss Re Management Ltd. URL: https://www.swissre.com/institute/research/topics-and-risk-dialogues/health-and-longevity/genetic-testing-in-life-health-insurance-industry.html (дата звернення: 05.09.2025).
Macdonald, А. (2011). The Actuarial Relevance of Genetic Information in the Life and Health Insurance Context, Office of the Privacy Commissioner of Canada.
Macdonald, A. S. (2024). Genetic testing and actuarial science. Annals of Actuarial Science, 18(1), 1-4. https://doi.org/10.1017/S1748499524000034
Prince, A. E. R., Suter, S. M., Uhlmann, W. R., & Scherer, A. M. (2022). The goldilocks conundrum: Disclosing discrimination risks in informed consent. Journal of genetic counseling, 31(6), 1383–1393. https://doi.org/10.1002/jgc4.1613
Karlsson Linnér, R., & Koellinger, P. D. (2021). Genetic risk scores in life insurance underwriting. Journal of health economics, 81, 102556. https://doi.org/10.1016/j.jhealeco.2021.102556
Joly, Y., Ngueng Feze, I., & Simard, J. (2013). Genetic discrimination and life insurance: a systematic review of the evidence. BMC medicine, 11, 25. https://doi.org/10.1186/1741-7015-11-25
Tada, H., Melander, O., Louie, J. Z., Catanese, J. J., Rowland, C. M., Devlin, J. J., Kathiresan, S., & Shiffman, D. (2016). Risk prediction by genetic risk scores for coronary heart disease is independent of self-reported family history. European heart journal, 37(6), 561–567. https://doi.org/10.1093/eurheartj/ehv462
Rodriguez-Rincon, D., Parkinson, S., Hocking, L., Evans, H., Hudson, E., & Morley, K. I. (2022). Assessing the Impact of Developments in Genetic Testing on Insurers' Risk Exposure. Rand health quarterly, 9(4), 5.
Haçarız, O., Kleinow, T., & Macdonald, A. S. (2021). Genetics, insurance and hypertrophic cardiomyopathy. Scandinavian Actuarial Journal, 2021(1), 54–81. https://doi.org/10.1080/03461238.2020.1795714
Bombard, Y., & Lemmens, T. (2010). Insurance and Genetic Information. In: Encyclopedia of Life Sciences (ELS). John Wiley & Sons, Ltd: Chichester. https://doi.org/10.1002/9780470015902.a0005203.pub3
Lacaze, P., Ryan, J., Woods, R., Winship, I., & McNeil, J. (2017). Pathogenic variants in the healthy elderly: unique ethical and practical challenges. Journal of medical ethics, 43(10), 714–722. https://doi.org/10.1136/medethics-2016-103967
Haçarız, O., Kleinow, T., Macdonald, A. S., Tapadar, P., & Thomas, R. G. (2021). Will Genetic Test Results Be Monetized in Life Insurance? Risk Management and Insurance Review, 23(4), 379-399. https://doi.org/10.1111/rmir.12159
Yanes, T., Blencoe, M., Howard, A., Tiller, J., Wallingford, C., Otlowski, M., Keogh, L., Lacaze, P., & McInerney-Leo, A. (2024b). Australian researcher's perspectives on the Australian industry-led moratorium on genetic tests in life insurance. American journal of medical genetics. Part A, 194(6), e63565. https://doi.org/10.1002/ajmg.a.63565
Tiller, J., & Delatycki, M. B. (2021). Genetic discrimination in life insurance: a human rights issue. Journal of medical ethics, medethics-2021-107645. https://doi.org/10.1136/medethics-2021-107645
Joly, Y., & Dalpe, G. (2022). Genetic discrimination still casts a large shadow in 2022, European Journal of Human Genetics, 30, 1320–1322; https://doi.org/10.1038/s41431-022-01194-8
Uberoi, D., Dalpé, G., Cheung, K., Kondrup, E., Palmour, N., Arawi, T., Arych, M., Ramiro Aviles, M. A., Ayuso, C., Bentzen, H. B., Blizinsky, K., Bombard, Y., Chandrasekharan, S., Chung, B. H. Y., de Paor, A., Doerr, M., Dove, E. S., Dupras, C., Granados-Moreno, P., Greenbaum, D., … Joly, Y. (2024). The Key Features of a Genetic Nondiscrimination Policy: A Delphi Consensus Statement. JAMA network open, 7(9), e2435355. https://doi.org/10.1001/jamanetworkopen.2024.35355
Tiller, J., Bakshi, A., Dowling, G., Keogh, L., McInerney-Leo, A., Barlow-Stewart, K., Boughtwood, T., Gleeson, P., Delatycki, M. B., Winship, I., Otlowski, M., & Lacaze, P. (2024). Community concerns about genetic discrimination in life insurance persist in Australia: A survey of consumers offered genetic testing. European journal of human genetics: EJHG, 32(3), 286–294. https://doi.org/10.1038/s41431-023-01373-1
Lee, A., Mavaddat, N., Wilcox, A. N., Cunningham, A. P., Carver, T., Hartley, S., Babb de Villiers, C., Izquierdo, A., Simard, J., Schmidt, M. K., Walter, F. M., Chatterjee, N., Garcia-Closas, M., Tischkowitz, M., Pharoah, P., Easton, D. F., & Antoniou, A. C. (2019). BOADICEA: a comprehensive breast cancer risk prediction model incorporating genetic and nongenetic risk factors. Genetics in medicine : official journal of the American College of Medical Genetics, 21(8), 1708–1718. https://doi.org/10.1038/s41436-018-0406-9
Joly, Y., Burton, H., Knoppers, B. M., Feze, I. N., Dent, T., Pashayan, N., Chowdhury, S., Foulkes, W., Hall, A., Hamet, P., Kirwan, N., Macdonald, A., Simard, J., & Van Hoyweghen, I. (2014). Life insurance: genomic stratification and risk classification. European journal of human genetics : EJHG, 22(5), 575–579. https://doi.org/10.1038/ejhg.2013.228
Arych, M., & Joly, Y. (2022). Genetic Discrimination in Access to Life Insurance: Does Ukrainian Legislation Offer Sufficient Protection against the Adverse Consequences of the Genetic Revolution to Insurance Applicants? Laws, 11(2). https://doi.org/10.3390/laws11010002
Lane, M., Ngueng Feze, I., & Joly, Y. (2015). Genetics and Personal Insurance: the Perspectives of Canadian Cancer Genetic Counselors. Journal of genetic counseling, 24(6), 1022–1036. https://doi.org/10.1007/s10897-015-9841-9
Prince, A. E. (2016). Tantamount to Fraud?: Exploring Non-Disclosure of Genetic Information in Life Insurance Applications as Grounds for Policy Rescission. Health Matrix: The Journal of Law-Medicine, 26, 255–307.
Tiller, J., Morris, S., Rice, T., Barter, K., Riaz, M., Keogh, L., Delatycki, M. B., Otlowski, M., & Lacaze, P. (2020). Genetic discrimination by Australian insurance companies: a survey of consumer experiences. European Journal of Human Genetics, 28(1), 108-113. https://doi.org/10.1038/s41431-019-0426-1
Tiller, J., Lacaze, P., & Otlowski, M. (2022). The Australian moratorium on genetics and life insurance: evaluating policy compared to Parliamentary recommendations regarding genetic discrimination. Public health research & practice, 32(4), 3242235. https://doi.org/10.17061/phrp3242235
Newson, A. J., Tiller, J., Keogh, L. A., Otlowski, M., & Lacaze, P. (2017). Genetics and Insurance in Australia: Concerns around a Self-Regulated Industry. Public health genomics, 20(4), 247–256. https://doi.org/10.1159/000481450
Muto, K., Nagai, A., Ri, I., Takashima, K., & Yoshida, S. (2023). Is legislation to prevent genetic discrimination necessary in Japan? An overview of the current policies and public attitudes. Journal of human genetics, 68(9), 579–585. https://doi.org/10.1038/s10038-023-01163-z
Fraser, H., Gamet, K., Jackson, S., Shelling, A. N., Lacaze, P., & Tiller, J. (2023). Genetic discrimination by insurance companies in Aotearoa New Zealand: experiences and views of health professionals. The New Zealand medical journal, 136(1574), 32–52. https://doi.org/10.26635/6965.6116
Dixon, P., Horton, R. H., Newman, W. G., McDermott, J. H., & Lucassen, A. (2024). Genomics and insurance in the United Kingdom: increasing complexity and emerging challenges. Health economics, policy, and law, 19(4), 446–458. https://doi.org/10.1017/S1744133124000070
Otlowski, M, Barlow-Stewart, K, Taylor, S., et al. (2007). Investigating genetic discrimination In the Australian life insurance sector: the use of genetic test results in underwriting, 1999-2003. J Law Med, 14, 367-396.
Vukcevic, D., & Chen, J. (2018). Advances in genetics and their impact on life insurance. In Proceedings of Financial Services Forum 2018 Institute of Actuaries of Australia. URL: https://research.monash.edu/en/publications/advances-in-genetics-and-their-impact-on-life-insurance (дата звернення: 21.09.2025).
Barlow-Stewart, K., Taylor, S. D., Treloar, S. A., Stranger, M., & Otlowski, M. (2009). Verification of consumers' experiences and perceptions of genetic discrimination and its impact on utilization of genetic testing. Genetics in medicine : official journal of the American College of Medical Genetics, 11(3), 193–201. https://doi.org/10.1097/GIM.0b013e318194ee75
Thomas, R. G. (2018). Why Insurers Are Wrong about Adverse Selection. Laws, 7(2), 13. https://doi.org/10.3390/laws7020013
Prince, A. E. R. (2017). Insurance Risk Classification in an Era of Genomics: Is a Rational Discrimination Policy Rational?. Nebraska law review, 96(3), 624–687.
Barlow-Stewart, K., Liepins, M., Doble, A., Otlowski, M. (2018). How are genetic test results being used by Australian life insurers? European Journal of Human Genetics, 26, 1248–1256. https://doi.org/10.1038/s41431-018-0198-z
Fernando, A., Kondrup, E., Cheung, K., Uberoi, D., Joly, Y. (2024). Still using genetic data? A comparative review of Canadian life insurance application forms before and after the GNDA, FACETS, 9, 1-10.
Yanes, T., Tiller, J., Haining, C. M., Wallingford, C., Otlowski, M., Keogh, L., McInerney-Leo, A., & Lacaze, P. (2024a). Future implications of polygenic risk scores for life insurance underwriting. NPJ genomic medicine, 9(1), 25. https://doi.org/10.1038/s41525-024-00407-x
Rechfeld, F. (2024). Genetic testing in the Life & Health insurance industry. Swiss Re Management Ltd. URL: https://www.swissre.com/institute/research/topics-and-risk-dialogues/health-and-longevity/genetic-testing-in-life-health-insurance-industry.html (дата звернення: 05.09.2025).
Macdonald, А. (2011). The Actuarial Relevance of Genetic Information in the Life and Health Insurance Context, Office of the Privacy Commissioner of Canada.
Macdonald, A. S. (2024). Genetic testing and actuarial science. Annals of Actuarial Science, 18(1), 1-4. https://doi.org/10.1017/S1748499524000034
Prince, A. E. R., Suter, S. M., Uhlmann, W. R., & Scherer, A. M. (2022). The goldilocks conundrum: Disclosing discrimination risks in informed consent. Journal of genetic counseling, 31(6), 1383–1393. https://doi.org/10.1002/jgc4.1613
Karlsson Linnér, R., & Koellinger, P. D. (2021). Genetic risk scores in life insurance underwriting. Journal of health economics, 81, 102556. https://doi.org/10.1016/j.jhealeco.2021.102556
Joly, Y., Ngueng Feze, I., & Simard, J. (2013). Genetic discrimination and life insurance: a systematic review of the evidence. BMC medicine, 11, 25. https://doi.org/10.1186/1741-7015-11-25
Tada, H., Melander, O., Louie, J. Z., Catanese, J. J., Rowland, C. M., Devlin, J. J., Kathiresan, S., & Shiffman, D. (2016). Risk prediction by genetic risk scores for coronary heart disease is independent of self-reported family history. European heart journal, 37(6), 561–567. https://doi.org/10.1093/eurheartj/ehv462
Rodriguez-Rincon, D., Parkinson, S., Hocking, L., Evans, H., Hudson, E., & Morley, K. I. (2022). Assessing the Impact of Developments in Genetic Testing on Insurers' Risk Exposure. Rand health quarterly, 9(4), 5.
Haçarız, O., Kleinow, T., & Macdonald, A. S. (2021). Genetics, insurance and hypertrophic cardiomyopathy. Scandinavian Actuarial Journal, 2021(1), 54–81. https://doi.org/10.1080/03461238.2020.1795714
Bombard, Y., & Lemmens, T. (2010). Insurance and Genetic Information. In: Encyclopedia of Life Sciences (ELS). John Wiley & Sons, Ltd: Chichester. https://doi.org/10.1002/9780470015902.a0005203.pub3
Lacaze, P., Ryan, J., Woods, R., Winship, I., & McNeil, J. (2017). Pathogenic variants in the healthy elderly: unique ethical and practical challenges. Journal of medical ethics, 43(10), 714–722. https://doi.org/10.1136/medethics-2016-103967
Haçarız, O., Kleinow, T., Macdonald, A. S., Tapadar, P., & Thomas, R. G. (2021). Will Genetic Test Results Be Monetized in Life Insurance? Risk Management and Insurance Review, 23(4), 379-399. https://doi.org/10.1111/rmir.12159
Yanes, T., Blencoe, M., Howard, A., Tiller, J., Wallingford, C., Otlowski, M., Keogh, L., Lacaze, P., & McInerney-Leo, A. (2024b). Australian researcher's perspectives on the Australian industry-led moratorium on genetic tests in life insurance. American journal of medical genetics. Part A, 194(6), e63565. https://doi.org/10.1002/ajmg.a.63565
Tiller, J., & Delatycki, M. B. (2021). Genetic discrimination in life insurance: a human rights issue. Journal of medical ethics, medethics-2021-107645. https://doi.org/10.1136/medethics-2021-107645
Joly, Y., & Dalpe, G. (2022). Genetic discrimination still casts a large shadow in 2022, European Journal of Human Genetics, 30, 1320–1322; https://doi.org/10.1038/s41431-022-01194-8
Uberoi, D., Dalpé, G., Cheung, K., Kondrup, E., Palmour, N., Arawi, T., Arych, M., Ramiro Aviles, M. A., Ayuso, C., Bentzen, H. B., Blizinsky, K., Bombard, Y., Chandrasekharan, S., Chung, B. H. Y., de Paor, A., Doerr, M., Dove, E. S., Dupras, C., Granados-Moreno, P., Greenbaum, D., … Joly, Y. (2024). The Key Features of a Genetic Nondiscrimination Policy: A Delphi Consensus Statement. JAMA network open, 7(9), e2435355. https://doi.org/10.1001/jamanetworkopen.2024.35355
Tiller, J., Bakshi, A., Dowling, G., Keogh, L., McInerney-Leo, A., Barlow-Stewart, K., Boughtwood, T., Gleeson, P., Delatycki, M. B., Winship, I., Otlowski, M., & Lacaze, P. (2024). Community concerns about genetic discrimination in life insurance persist in Australia: A survey of consumers offered genetic testing. European journal of human genetics: EJHG, 32(3), 286–294. https://doi.org/10.1038/s41431-023-01373-1
Lee, A., Mavaddat, N., Wilcox, A. N., Cunningham, A. P., Carver, T., Hartley, S., Babb de Villiers, C., Izquierdo, A., Simard, J., Schmidt, M. K., Walter, F. M., Chatterjee, N., Garcia-Closas, M., Tischkowitz, M., Pharoah, P., Easton, D. F., & Antoniou, A. C. (2019). BOADICEA: a comprehensive breast cancer risk prediction model incorporating genetic and nongenetic risk factors. Genetics in medicine : official journal of the American College of Medical Genetics, 21(8), 1708–1718. https://doi.org/10.1038/s41436-018-0406-9
Published
2025-12-31
How to Cite
Arych, M. (2025). INSURANCE RISK ASSESSMENT IN LIFE AND HEALTH INSURANCE: THE ROLE OF FAMILY MEDICAL HISTORY. Social Economics, (72). Retrieved from https://periodicals.karazin.ua/soceconom/article/view/28167
Section
FINANCE
This work is licensed under a Creative Commons Attribution 4.0 International License.
