…trends and changes in public policy and lessons for underwriting.
What is suicide?
Suicide means taking one owns life. It is simply a way for people to escape pain or suffering. When someone ends this own life, we say that they “died by suicide.” A “suicide attempt” means that someone tried to end this life, but ends up living or surviving the attempt.
Why will someone commit suicide?
Suicide is a mental health condition. A mental health condition, sometimes referred to as a mental illness, refers to health problems that can affect your well-being, emotions, thinking and behaviour. Symptoms of a mental health condition can include anxiety, stress, fear, anger, low mood, sadness and depression.
Examples of mental health conditions symptomatic of suicide may include the following:
- Depression
- Anxiety
- Paranoia
- Phobias
- Psychosis
- Obsessive Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD)
- Schizophrenia
- Bipolar Disorder
It’s important that if you are experiencing a mental health condition, you first get a diagnosis from your General Practitioner. You can use this information when applying for life insurance.
Official data on suicide are not routinely collected in Ghana, but where available, they are often fraught with reliability issues and poor scientific rigour. However, emerging evidence from self-report cross-sectional surveys and qualitative studies (Akotia et al., 2019; Asante et al., 2017; Osafo et al., 2015; Quarshie et al., 2020; Quarshie, Shuweihdi, et al., 2021; Quarshie & Andoh-Arthur, 2020; Simmons et al., 2021; Sweetland et al., 2019), analyses of media reports (Abdulai, 2020; Quarshie, Asante, et al., 2021; Quarshie et al., 2015), and medico-legal autopsy studies (Der et al., 2016) suggests that suicide and suicide-related behaviours remain a public health concern in Ghana. Recent crude estimates by the WHO suggest that 6.6 persons per 100,000 people (representing 177 females and 1816 males) within the general Ghanaian population died by suicide in the year 2019 (WHO, 2021b).
The position of the law on suicide in Ghana:
Attempted suicide remains criminalised in 20 countries – including Ghana, with additional 20 countries maintaining attempted suicide as punishable under the law of Sharia (Mishara & Weisstub, 2016; United GMH, 2021). Some countries have kept their anti-suicide laws – most of which were inherited through colonial rule – for more than half a century (Mishara & Weisstub, 2016; UnitedGMH, 2021).
Section 57:2 of the Ghana Criminal Code1960 ACT 29 (as amended) stipulates that: ‘a person who attempts to commit suicide commits a misdemeanour’ (Criminal Offences Act of Ghana, 1960). Indeed, evidence shows that individuals found guilty of this law have been given hefty fines, or jailed in some cases (Adinkrah, 2012; Osafo et al., 2017).
Amendment of the law on suicide in Ghana
Attempted suicide no longer a crime in Ghana, Parliament amends law.
Andreas Kamasah. March 29, 2023 3:53 PM
Henceforth, attempted suicide will no longer be treated as a criminal case in Ghana, but rather a mental health one in which the person who attempted to take his or her life would be considered a victim and provided mental health assistance.
Some Ghanaian health experts have been advocating for the law to be amended, arguing that suicide is a medical condition that needs health and medical support rather than imprisonment for anybody who attempted it.
Calls for an amendment to the old law have always been underscored by the fact that over 1,500 cases of suicide are reported nationwide every year.
Thankfully, after years of resistance, the long-anticipated amendment has seen the light of day. It happened on Tuesday, March 28, 2023.
Should the President give his assent, the bill would guarantee that individuals who survive attempted suicide are no longer in danger of being arrested, charged and punished, but rather would have access to medical and psychological assistance.
Approach in life assurance underwriting
Does life insurance pay for suicidal death?
Most life insurance policies exclude suicide as an insurable risk. Generally, self-inflicted injuries and the resultant consequence are specific exclusions. (Typically, two years). The policy may pay out for suicidal death if there’s no suicide clause or if the clause is no longer in effect and the insurer finds no other reasons to contest a claim. It’s meant to prevent someone from purchasing a policy immediately prior to taking their lives so their loved ones can receive financial benefits.
Group life insurance through an employer or organisation treats suicide differently. Same with military life insurance. Generally, these life insurance policies don’t include a suicide clauses, so the policy may pay out for suicidal death. But each plan can depend on the regulatory and legal framework in place.
What about the contestability period?
A contestability period is also generally two years after the policy activates, but it is separate from the suicide clause. The contestability period allows the insurer to deny a claim if the insured dies during the contestability period and the insurer finds undisclosed health conditions or other discrepancies in the policy’s application. Failing to disclose information in a life insurance application can be considered as a misrepresentation of material fact which could either be innocent or fraudulent. Contestability period lengths vary from one insurer to the other.
How does a mental health condition affect life insurance?
Current statistics from the Ghana Mental Health Authority (GMHA) and the World Health Organization (WHO) suggest an estimated 3.1 million of Ghana’s population as having one form of mental disorder or the other and about 16,000 of the cases are reported to be severe. Further, the WHO data reveals a more disturbing reality that 41 percent of Ghanaians are currently experiencing psychological disorders. So, life insurance providers will be concerned about assessing applications from people with history of mental illness.
The main way a mental health condition can affect life insurance is at the underwriting stage. One would need to give truthful information about their mental health when they apply for life insurance, otherwise, a claim would be repudiated.
Despite the afore-mentioned statistics, a person with a mental health condition can still get life insurance, but the decision is made based on the nature of the condition and their most recent medical history.
life insurance providers cannot discriminate against persons with mental health conditions. They are protected against disability discrimination by the Equality Act 2010, so no life insurance provider can lawfully treat them differently for having a mental health problem without good reason. For example, a provider is not obliged by law to offer them life insurance after learning of a mental health condition, but they will need to operate on the basis of information that’s reasonable, reliable and relevant. Furthermore, if you disclose a mental health condition and a life insurance provider wishes to contact your doctor for your medical records, they can only do so with your own written consent.
Unfortunately, there are circumstances where your mental health would affect your life insurance eligibility; for example, life insurers are unable to provide cover where there has been a recent increase in the severity of your condition.
The role of prudent underwriting
Unlike the Marine Insurance Act of 1906, the Consumer Insurance Disclosure and Representation Act (CIDRA)2012 made it compulsory for the insurer to ask the insured any question which is material to the subject matter of insurance. This places the onus on the insurer to request from the assured all relevant questions they deem material. Else they can’t repudiate on the basis of material misrepresentation.
Likely questions by insurers
- Have you been diagnosed by a physician of any of the following conditions for the past 5 years?
- Please Tick
| Anxiety | Schizophrenia | ||
| Depression | Eating Disorders | ||
| Psychosis | Disruptive Behaviour & Dissocial Disorder | ||
| Phobias | Neurodevelopmental Disorder | ||
| Dementia | Alcohol Disorder | ||
| Post Traumatic Stress Disorder (PTSD) | Substance use Disorder | ||
| Obsessive Compulsive Disorder (OCD) | Paranoia, etc. |
If yes provide details …
| Date | Hospital \ Treatment | Discharged Date |
- Have you ever attempted suicide in your life? YES \ NO
- Do you sometimes receive suicidal thought or self-harm? YES \ NO
- Have you been admitted at a psychiatric ward before? YES \ NO
- Has any of your family members suffered from a severe mental health condition before? YES / NO
The afore-mentined questions or more may be put forward for prudent underwriting. It must be noted that the underwriter may call for further details if the applicant answered YES to any of the close-ended questions stated.
The underwriter, after a careful analysis of the answer to the earlier questions, has a number of options as follows:
- Accept the risk at a standard rate: that is if everything were normal
- Accept the risk with a conditiong., with a high premium, mostly in a case where the condition is not severe and the patient is showing signs of recovery.
- Reject the risk: here the severity of the condition is high
- Postpone the risk: if the patient is undergoing treatment and will need time for the physician to confirm his\her status
Looking at the rate of mental health conditions in the country, it is appropriate that insurers become proactive in underwriting this condition, especially now that attempted suicide would be decriminalised in Ghana as soon as the President assents to the bill.
The law could exacerbate our underwriting loses if prudent measures are not put forward to mitigate the consequential enhancement of the associated risk.
Conclusion
The question that arises is whether attempted suicide is the same as suicide. Because the law is trying to decriminalise attempted suicide. Also, one key factor insurers consider before paying benefits of life insurance policy is Proximate Cause. Whether or not suicide can qualify as the proximate cause could, at best, be interpreted by the Supreme Court.
In any case and without prejudice, once suicide is considered as a mental health condition, it could be accepted as any of the natural or terminal illness recognised as an insured peril, thereby making it insurable.
Considering the alarming rate of suicidal death of about 1500 per year and about 46 percent of the population experiencing different levels of mental health conditions, it is important insurers proactively provide prudent underwriting measures to continue the wow customer service we envisage for our cherish customers and the general public.
There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds. Laurell K. Hamilton.
The author is part of the pioneer members of The Life & Health Chartered Insurers in Ghana. A Sales & Marketing Strategist, Trainer, Underwriter, Researcher and innovative in developing new channels of executing insurance business.
For feedback and inputs: Kindly reach the author via Phone: +233243978273 or Email: [email protected]
