Critical illness payout for autistic child?

Hi,

I have recently discovered that I have critical illness (not terminal illness) insurance for my children and it has come to my attention that there is a case going through at the moment where a mother is fighting to claim a payout for her autistic son.  In my opinion she is more than entitled to it as autism is an incurable life long dibilitating illness and as a parent it is a life changing experience to have a child with this condition, I know that NAS are backing her.  Anyway, I am also looking into finding out about claiming on my policy and am just wondering if anyone has any experience with this?

Thanks

  • Any idea's how to lower the inflammation cycle ?

  • Then we can agree to disagree as to the the weightings given to (possible) autism factorsWink

     

  • @Hope, I don't particularly disagree with anything you said in your last post.  Your post also doesn't alter anything I have posted.

  • The causes of autism are complex and varied. All we can say with certainty is that nothing definite has been concluded, other than the strong association with genetic factors. It is premature to claim we have found the magic key.

    So IntenseWorld, you, and the Scientists you quote, may be right, but the jury is still out, and nothing conclusive has been identified. When that day comes, it will be all over the news!

    Even  if you are completely correct, it would still only apply to certain subgroups or types of autism, because the cause(s) will be different for individuals.

    Most academic books on the subject offer the disclaimer, after presenting possible causes, that these are still only hypotheses.

  • my family is riddled with inflammation diseases, including me, with episcleritis, IBD and fibromaylia..

    any idea's how to lower the inflammation

    I can understand the gene inflammation dna cross-over as cancer mutation and body repairs use inflammation as a carrier to work, my motabolism is very high,, so I can understand the over-drive cycle.

    http://en.wikipedia.org/wiki/Category:Inflammations

     

     

  • Firstly, there you go again falsely claiming I have made blanket claims.  Read what I said carefully:

    "There is a lot of research and evidence that autism is linked to the immune system"

    So I'm not going to belabour that point any longer.

    "Not all Scientists are good Scientists and not all Scientists speak the truth."

    This is true, but I don't see your point.  There is a lot of research and bone fide findings based on that research, out there.  Are you saying it's all bunkum!

    I have nowhere said that all autistic people are ill or have immune-system problems.

    I have nowhere said autism is an illness either.

    You have derailed this thread enough.  You clearly just like an argument.  I love a healthy debate, but this one is not based on logic or you correctly reading what I have said.  IntenseWorld is not playing.

  • In any event, we are all individuals, with different genes and different vulnerabilities.

    I think I have inherited my good immune system from my parents, who also rarely get ill. They don't have Aspergers.

    I eat a healthy diet, and exercise regularly. I experience stress and anxiety, but I still rarely get ill. I eat a vegetarian diet, full of pulses and fresh fruit and veg.

    As a child, my mother never had to give me medicine because I never had a bacterial infection, just the usual , short lived, childhood colds. I have not had a cold for 10 years.

  • Not all Scientists are good Scientists and not all Scientists speak the truth.

    I am aware of epigenetics - I have researched it in depth.

    You make blanket claims just by saying 'autistic individuals have'.. To avoid this, it is better to say 'many' or even 'some', to back up your opinion.

    I rarely get ill, and have never taken antibiotics. Other people with autism get ill a lot, but I know several people with Aspergers who are in normal, and even optimal, health. Maybe we don't really have Aspergers then because we are too healthy.

    Do you think Aspergers is a sickness? A toxic pathology? The problem with this view, regardless of its  merits, is that it suggests autism is an illness.

  • Hope said:
    Actually the consensus is that autism is a largely genetic condition, particularly Aspergers, although something could trigger it: premature birth, hormones in utero, maternal stress etc. No-one knows for sure what causes autism (other than a genetic basis), and there are likely to be different triggers for different people.

    It is wrong to make blanket claims about all cases, particularly when there is no actual Scientific agreement. In other words, claims about immunity etc are just opinions at the moment, and not necessarily objective fact.

    I'm not sure if you are referring to me Hope when you say "making blanket claims" but I did no such thing.  You do love to challenge people don't you!

    FYI:

    http://www.nytimes.com/2012/08/26/opinion/sunday/immune-disorders-and-autism.html?pagewanted=all&_r=0

    "It starts with what scientists call immune dysregulation. Ideally, your immune system should operate like an enlightened action hero, meting out inflammation precisely, accurately and with deadly force when necessary, but then quickly returning to a Zen-like calm. Doing so requires an optimal balance of pro- and anti-inflammatory muscle.

    In autistic individuals, the immune system fails at this balancing act. Inflammatory signals dominate. Anti-inflammatory ones are inadequate. A state of chronic activation prevails. And the more skewed toward inflammation, the more acute the autistic symptoms.

    Nowhere are the consequences of this dysregulation more evident than in the autistic brain. Spidery cells that help maintain neurons — called astroglia and microglia — are enlarged from chronic activation. Pro-inflammatory signaling molecules abound. Genes involved ininflammation are switched on."

    https://sfari.org/news-and-opinion/viewpoint/2013/brains-immune-cells-show-intriguing-links-to-autism

    Plenty more where that came from.  I would imagine the scientists who have discovered such medical evidence would refute your claim that it's not objective fact.  You should research epigenetics.

    http://www.nature.com/scitable/topicpage/environmental-influences-on-gene-expression-536

    "other than a genetic basis"

    I could say that this "ain't necessarily so" for all cases of autism either - touché madame.

    Bring it on. Cool

  • We all have eczema, which is an immune system thing, as well as hay fever.

    Anxiety and stress also incidentally lower your immunity and we have higher rates of those.

  • I have Aspergers and have a normal immune system. No allergies, nothing.

  • Actually the consensus is that autism is a largely genetic condition, particularly Aspergers, although something could trigger it: premature birth, hormones in utero, maternal stress etc. No-one knows for sure what causes autism (other than a genetic basis), and there are likely to be different triggers for different people.

    It is wrong to make blanket claims about all cases, particularly when there is no actual Scientific agreement. In other words, claims about immunity etc are just opinions at the moment, and not necessarily objective fact.

  • I agree inteseworld, I think the insurance company like many others do not count autism because it is invisible as you say. Discrimination once again.

  • stranger said:
    Autism isn't an illness. An illness is either a disease or a period of sickness. Autism doesn't fit with that definition. It's a learning / developmental disability.

    "Now aged four, he has autism-related digestive, bowel and respiratory conditions and a low immune system, which means he struggles with illness every four to six weeks."

    But how can anyone prove that his digestive, bowel, respitaory conditions and low immune system are Autism related? Not heard of a link between Autism and immune disorders. The only people I know of who have Autism and problems with their immune system, have other conditions which cause the immune system problems.[/quote]

    There is a lot of research and evidence that autism is linked to the immune system - where have you been!

    http://www.medicalnewstoday.com/articles/244320.php

    Having said that, they don't need to claim on his autism, they can claim on his co-morbid conditions alone, as I said above.

    I wonder OP, if the insurance company mean disability as in loss of limb or something physical.  As we know, autism (especially the higher functioning end) is considered the invisible disability. 

  • Thank you openheart and intenseworld for your response,  that is helpful. 

  • Yes however, part of the cover is permanent disability which autism is.

  • Autism isn't an illness. An illness is either a disease or a period of sickness. Autism doesn't fit with that definition. It's a learning / developmental disability.

    "Now aged four, he has autism-related digestive, bowel and respiratory conditions and a low immune system, which means he struggles with illness every four to six weeks."

    But how can anyone prove that his digestive, bowel, respitaory conditions and low immune system are Autism related? Not heard of a link between Autism and immune disorders. The only people I know of who have Autism and problems with their immune system, have other conditions which cause the immune system problems.

  • Definition of the word critical:

    http://www.thefreedictionary.com/critical

    4. Forming or having the nature of a turning point; crucial or decisive

    a. Of or relating to a medical crisis: an illness at the critical stage.
    b. Being or relating to a grave physical condition especially of a patient
     
    7. Being in or verging on a state of crisis or emergency
     
    8. Fraught with danger or risk; perilous

    http://en.wikipedia.org/wiki/Critical_illness_insurance

     

    "Critical illness insurance or critical illness cover is an insurance product, where the insurer is contracted to typically make a lump sum cash payment if the policyholder is diagnosed with one of the critical illnesses listed in the insurance policy.

    The policy may also be structured to pay out regular income and the payout may also be on the policyholder undergoing a surgical procedure, for example, having a heart bypass operation.

    The policy may require the policyholder to survive a minimum number of days (the survival period) from when the illness was first diagnosed. The survival period used varies from company to company, however, 14 days is the most typical survival period used. In the Australian market, survival periods are set between 8 – 14 days.

    The contract terms contain specific rules that define when a diagnosis of a critical illness is considered valid. It may state that the diagnosis need be made by a physician who specialises in that illness or condition, or it may name specific tests, e.g. EKG changes of a myocardial infarction, that confirm the diagnosis.

    In some markets, however, the definition of a claim for many of the diseases and conditions have become standardised, thus all insurers would use the same claims definition. The standardisation of the claims definitions may serve many purposes including increased clarity of cover for policyholders and greater comparability of policies from different life offices. For example, in the UK the Association of British Insurers (ABI) has issued a Statement of Best Practise which includes a number of standard definitions for common critical illnesses.

    Conditions covered

    The schedule of insured illnesses varies between insurance companies. In 1983, four conditions were covered by the policy, i.e. heart attack, cancer, stroke and coronary artery by-pass surgery.[2]

    Examples of other conditions that might be covered include:

    Due to the fact that the incidence of a condition may decrease over time and both the diagnosis and treatment may improve over time, the financial need to cover some illnesses deemed critical a decade ago are no longer deemed necessary today. Likewise, some of the conditions covered today may no longer be needed a decade or so in the future.

    The actual conditions covered depend on the market need for the cover, competition amongst insurers, as well as the policyholder's perceived value of the benefits offered. For these reasons conditions such as diabetes and rheumatoid arthritis, among others, may become the norm cover provided in the future."

    I think the issue here is that they are treating the claim in a blanket way.

    "Now aged four, he has autism-related digestive, bowel and respiratory conditions and a low immune system, which means he struggles with illness every four to six weeks."

    He is clearly unwell much more than would be normal, and this is co-morbid issues that he likely has because of autism, and they are referring to the autism when they should be referring to the co-morbid conditions.

    Also, they appear to treat critical illness in a survability way.  He may have very impaired quality of life, but his survivability (unless his respiratory issues are severe) are not likely to be much different than an average child.

    I think there is more going on here than would appear at first glance.  The insurers don't want to open the way to all autistic people having claims, don't forget we are 1% or more of the population.

    It may be that the parents should have claimed on a different aspect of his health than the autism itself, if that's what they did.

    I believe the NAS is right to challenge the Ombudsman, not on the basis of their decision in this individual case, but in their understanding of autism and their statement that autism improves with age.  This is very wrong.  I in fact, have regressed and I am not the only autistic person this has happened to.  (Look up "Aspie burnout").  It is akin to saying that someone with a severe heart problem who is on medication to keep it controlled has improved.  They haven't improved, external factors (i.e. medication) have kept it contained, so why should an autistic person's masking and coping skills be treated as an "improvement" in the condition?  In fact, being autistic without support, or without the right support can bring on all sorts of stress and mental health issues that negatively impact your physical health too.

  • Regardless of the autism, you will normally have other secondary conditions along side.. social anxiety, GAD, IBS, Depression, PSTD, OCD, those alone would make a good case for a claim.