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Perspective

Do Advances in Prosthetic Technology Prompt a Different Claims Approach?

January 04, 2017| Von Anna Dalton | Auto/Motor, General Liability | English

One of the benefits of being a global excess of loss reinsurer is the opportunity to spot trends and share insights with our clients. One notable change we are seeing is the rise in the value of amputation claims. This can be attributed to the increased cost of settling those claims due to advances in prosthetic technology, a market that has developed considerably and now offers a vast variety of prostheses, ranging from limbs with battery-powered joints to those specifically designed for certain sports or those designed to match exactly from a cosmetic point of view.

One case from 2014 in particular highlights the range of prostheses that can be claimed. The claimant was a 28-year-old male involved in a motorcycle accident in which he sustained an injury to his left foot that led to a below-knee amputation. The case is exceptional because the claimant was pursuing a sports degree while working as a tennis coach. He was also an avid and skilled skier, mountain biker, runner, swimmer and snowboarder. The court accepted that the claimant was an exceptionally fit individual who participated in different sports at a high level and ruled he should be provided 14 different prostheses. This resulted in an overall settlement of GBP 4,550,000.

Our experience at Gen Re confirms that our clients commonly see claims where four or five prostheses are claimed. In a typical claim, the claimant’s expert recommends five different prostheses for various uses, including water use, sport, jogging and skiing, at a total cost of GBP 165,852 every five years. The result can be expensive for insurers, depending on the claimant’s age and life expectancy.

As prosthetic technology continues to advance, this trend is set to increase even more because new products tend to have a high price when they are launched. We have seen claims for prosthetic limbs priced in excess of GBP 60,000 each, with a life span of just a few years. Insurers need to fully utilize all medical and care evidence to ensure the prostheses are appropriate for the claimant.

In amputation cases, introducing rehabilitation early can result in benefits for all parties. For insurers, earlier involvement in a case allows an insurer to identify not only the potential for a claim for multiple prostheses, but the merits of such a claim in relation to the claimant’s lifestyle and the need to reserve accordingly. Additionally, for claimants suffering in silence with badly fitting prostheses that severely limit their ability to maximize their independence, timely expert intervention can make an enormous difference.

A good working relationship between the insurer and the claimant’s solicitor and medical experts is key. Ensuring that the claimant receives the most suitable prostheses may result in that individual's ability to live more independently, thereby improving quality of life and potentially reducing future care costs - a positive outcome for all parties.

 

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