Insurance, Personal Injury

BIID could raise LTD coverage questions

Although insurers have not likely considered unusual mental health conditions such as Body Integrity Identity Disorder (BIID) when drafting exclusions from coverage, the actions of insureds with BIID could already be leading to claims, Fredericton litigator Matthew Pearn writes in Lawyers Weekly.

As Pearn, a lawyer with Foster & Company explains, BIID creates a powerful compulsion in people to become physically disabled and in 2013, was listed as an “emerging condition” in the fifth edition of the diagnostic and statistical manual of mental disorders.

“People with BIID believe that a part or parts of their own body do not belong to them and must be removed or destroyed. These people may eventually choose to become disabled by severing a healthy limb or hurting themselves in other ways to achieve their desired disability. While the incidence rate of BIID is not known, medical researchers at universities are exploring the topic and now believe that hundreds of thousands of people worldwide have the condition,” writes Pearn.

For long-term disability (LTD) insurers who provide income replacement coverage for claims arising from illnesses, Pearn says the possible future recognition of BIID as a medical condition raises interesting coverage questions.

“Meanwhile, accidental death and disability policies have anticipated and excluded intentional acts as a basis for refusing a claim. Still, insurers may not be aware of the magnified consequences that arise from intentional acts of self-harm disguised as accidents,” he writes.

Pearn explains that if BIID becomes a recognized psychological illness, accepted treatments may range from cognitive therapy to elective surgery allowing a person to become disabled, with the progression in accepted treatment potentially following the history of gender reassignment surgery as a treatment for gender dysphoria.

In terms of a likely cause for the condition, researchers at the Centre for Brain and Cognition in San Diego, Calif. have found a connection between damage or defects in the right parietal lobe and errors in the brain’s ability to ‘map’ the dimensions of the human body, says Pearn. A person with defects in this part of the brain believes that a limb does not belong to his or her body and feels a compulsion to ‘self-harm’ in order to change their body shape.

“If elective amputation is ever recognized as an accepted treatment for BIID then LTD insurers could be called upon to provide coverage when surgical treatment puts their insureds out of work,” he writes.

Although many LTD insurers have varied their policies to allow for claims arising from elective cosmetic surgeries, some may want to consider whether their policy drafters should consider language to exclude these claims, says Pearn.

“On the other hand, creating exclusions for BIID treatment may motivate insureds to disguise their BIID and avoid cognitive therapy or other treatments, leading to manufactured accidents that harm them with worse outcomes than the elective surgery.

“Insurers may wish to follow research on BIID and other similar psychological disorders as the science and treatment options for these conditions develops,” Pearn suggests.

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