Insurance for differently abled is tough, but don’t give up hope yet

“He (the client, who did not want to be identified) was well-qualified and working with a multinational firm as a senior manager. His lower body was paralysed after an accident, but he would still drive to work. He had an automatic wheelchair and car. I reasoned with the underwriters that this disability is not a threat to his life. They reconsidered the proposal and issued the policy, albeit with higher mortality charges,” says Sharma.

His client thus got an unit-linked insurance policy (ULIP) and later also managed to get term insurance from a different insurer. But his troubles are still not over. Now, he is trying to get a health cover but insurers are rejecting the proposal due to his spinal problem.

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The missing gap

Anecdotal evidence suggests that insurance penetration among differently-abled people, who comprise more than 2% of the country’s population, is meagre. While insurance companies do issue them policies, the process takes a lot of time and rejections are higher.

“Insurance for differently-abled depends on the underwriting norms of different insurers. No insurance company has a specific product designed for this segment. There is lack of data and the underwriting is done mostly on qualitative inputs that we have,” says Nikhil Kamdar, appointed actuary, Digit Insurance.

Another challenge is the right advice and support that they need to communicate better with insurers. “Agents themselves are not that knowledgeable or do not want to put time and effort to strongly present the proposer’s case to the underwriters,” says Sharma.

Awareness is key

Financial underwriting holds supreme in the case of life insurance. In the case of differently-abled, there is the mortality risk as well. “First, the differently-abled person has to be gainfully employed and have a documented source of income. Second is the extent of disability. If a person is unable to move or requires help for daily tasks, we would obviously review those cases in a different manner. If someone’s disability is not worsening, not involving mental faculties or is stationary in nature such as an injury to the leg, we would insure them,” says Atri Chakraborty, chief operating officer, IndiaFirst Life Insurance.

If the disability is not going to worsen or hurt the individual’s earning potential, insurers may issue standard policies without rating up the premium. In cases where certain health parameters may cause a higher mortality risk, the premium can be levelled up. “In most cases, it is about providing life cover, not how much incremental premium we should charge,” points out Chakraborty.

On health insurance

There are no health insurance products that are specifically tailored for differently-abled people. In most cases, regular policies are issued after necessary medical underwriting.

“It is evaluated if the disability of the individual should be considered as a pre-existing disease (PED) or not. In the case of PED, the waiting period or exclusions may apply,” says Amit Chhabra, business head – health, PolicyBazaar.com.

“Policies for differently-abled are not very restrictive. In some cases, for example, if one has hearing disability, or is speech impaired or is an amputee, they can get comprehensive policies also,” he adds.

Getting health cover is difficult in cases where individuals suffer 100% physical disability. “There are also some chronic medical conditions that are often incurable or require long-term care and the chances of multiple medical complications arising out of this are higher in such cases. So, individuals in such circumstances may find it difficult to get a medical cover,” says Kamdar of Digit Insurance.

Essentially, the underwriters try to analyse different system abnormalities which may happen in combination with what the disability is. “The underwriting team studies the correlation with other organ systems and accordingly a proposal is accepted or denied,” says Dr S. Prakash, managing director, Star Health and Allied Insurance.

If somebody is planning a treatment for a specific disability in the near future, then they will not get the insurance cover. Prakash says “planned treatment cannot be covered obviously, but in cases where there is no requirement for a specific treatment, for example a person having polio with some limb weakness, then they can get the coverage.”

In the case of congenital diseases, while externally visible conditions are generally excluded, all internal conditions are usually covered. “Birth defects which are visible externally like spina bifida, additional digits, hydrocephalus, limb deficiency, etc are often excluded. Some Internal congenital anomalies like atrial septal defect (hole in the heart), transposition of blood vessels, atresia of the intestine, etc might be covered in the fresh retail policy after a specified waiting period,” says Kamdar.

To be sure, disabilities are covered in group insurance policies from day one, unless permanently excluded. Employees who get group insurance should enquire with their employers about the cover for their specific disability, if any.

Industry players accept there is a need to collect quantitative data on disabilities to ensure better penetration and wider coverage for differently-abled people.