ABSTRACT
The second of a series of lectures on inebriety was delivered on Tuesday last by Dr. Norman Kerr, chairman of the B.M.A. Inebriates’ Legislation Committee, in the rooms of the Medical Society of London, Chandos Street, Cavendish Square. The subject was “The Relations of Inebriety and Insurance.” Dealing first with the subject of insurance against accident, Dr. Kerr said that associations insuring against accident, or death by accident, usually had a proviso to the effect that no claim could be allowed if the insurer was intoxicated at the time when the accident occurred. Two special legal points were here involved. To successfully resist a claim on the ground of the insured’s drunkenness at the moment when the accident took place, it must be established that he was drunk at the time. It must also be proved that the accident was the cause of his inability to follow his occupation, or of his death. With reference to the first point, the lecturer pointed out that the contradictory testimony of witnesses was sometimes most perplexing, due to the fact that there were varying opinions as to what constituted drunkenness. Having quoted cases in the courts showing most remarkable conflict of evidence in this respect (including Mair v. Railway Passengers’ Insurance Company, 37 L.J., 356; “Daily Telegraph,” 19th April, 1877; a recent case, David Hadley’s Executors v the Crown Accident Insurance Company, reported in the Post Magazine 13th August 1892), Dr. Kerr referred to the practice of insurance offices as regarded taking in brewers and publicans. He said: “The Eagle, Kent, Metropolitan, Patriotic, Positive, Provident Clerks’ and Reliance do not necessarily charge any extra for occupation. The England, Clergy Mutual, General, Lancashire, Law Life, Legal and General, London Assurance, National, Rock, and Scottish Provident have no fixed rule, each case being judged on its merits, but usually some addition is made.” The National of Ireland charges 5s. per cent. extra; Yorkshire, “speaking generally, an extra charge of about 10s. per cent.”; Equitable, “eleven per cent. of the premium”; in the Royal, “extra charged is equivalent to an addition of five years to the proposer’s age”; Provident, “usual extra charged is thirty per cent. on the premiums”; Northern, “rate them for their occupation as if they were seven years older”; Caledonian charges 10s. per cent, extra; Pelican an extra of 10s. to £1 per cent., according to the circumstances of 266the case; Gresham, “can only be assured on Endowment Assurance tables, and at special rates of premiums”; while the following offices each charge £1 per cent. additional: Alliance, Atlas, City of Glasgow, Commercial Union, Economic, Edinburgh, English and Scottish Law, Equity and Law, Guardian, Imperial, Life Association of Scotland, Marine and General, North British, Norwich Union, Royal Exchange, Scottish Amicable, Scottish Equitable, Scottish Union and National, Standard, Star (“on endowment assurances the directors would not accept them on the whole life rates”), Union, Victoria, Westminster and General, and Whittington. The London and Lancashire, and Prudential each charge 21s. per cent. additional. The Hand-in- Hand states that “proposals are not accepted by us in the absence of specially favourable circumstances;” the Crown: “My directors decline owing to the extremely risky nature of publicans’ lives, to accept proposals on such lives.” The Clerical, Medical and General, Friends’ Provident, National Provident, Sceptre Life Association, Scottish Widows’ Fund, and United Kingdom Temperance and General Provident all refuse them. After quoting cases in which Companies had been successful in resisting claims, where proof had been forthcoming that death was due to alcoholic disease, the lecturer proceeded to deal with life assurance apart from accident and quoted cases to show that resistance to claims for payment, had been successful on the ground of concealment of intemperance. Among these cases were Wiggins v. Gresham Life Office, Bristol Summer Assizes, 1872, verdict for Office; Hutton v. Waterloo Life Association (1 F. & F. 735), verdict mainly for defendants; Wheelton v. Hurdisty (26 L.J., Q. B. 265, and 27 L.J., Q.B. 241), verdict for defendants; Denman v. Scottish Widows’ Life Assurance Society (“Times”, April 3–10, 1886), verdict for the Company; and Baker v. Whittington Life Assurance Company, tried before High Court, London, Feb. 18, 1892, verdict for the plaintiff. It should also be noted that a claim might be successfully resisted on the ground of the concealment of the remote and secondary effects of intemperance as well as of the immediate and primary intemperance itself, as in Wiggins v Gresham Life Office, where a verdict was returned in favour of the Office on the ground of suppression of material facts, namely, intemperance and consequent disease of the lungs. In all cases however the refusal of the payment of the amount for which the deceased’s life had been insured, on the ground of concealment of intemperance, had not been sustained. On the point of concealment of intemperance, it was not always easy to establish that the deceased was intemperate either before or after insurance had been effected. Having touched upon the question of opium, the lecturer said that in addition to the purely medico-legal relations of insurance actions to inebriety, there remained a wider and important field for research in the commercial relation of life insurance itself to narcomanical indulgence. Insurance companies were generally understood to be desirous of avoiding the risks of intemperate lives altogether, but there could be no doubt as to the fact 267that a considerable proportion of the many inebriates who abound in our midst were insured. What the exact proportion might be, it was difficult to estimate with even an approach to accuracy. Among the drunken poor, only a very small number of individuals had life policies, but as we ascended in the social scale the ratio increased. Of inebriate artisans and skilled workmen, probably more than one-half had their lives insured. Coming to the middle and upper classes, so called, in all probability at least one third of men had taken out policies on their lives. Inebriates who were insured might be divided into two groups – those who effected their insurance before and those who effected their insurance after becoming addicted to drinking. With regard to the first class of insurers, the lecturer said that no provision except the forfeiture of the policy on the substantiation of the fact of intoxication at any previous period in life could possibly meet the difficulty. Such an insurance revolution however would be too radical, such a procedure too drastic, to be practical. If enforced it would probably act as a strong deterrent from insurance altogether. Yet the loss to insurance associations from this source was undoubtedly grievous and amounted to a very much larger sum than almost any one could imagine. Some time ago a leading official to a well known Life Assurance Company in the United States estimated the annual loss arising on inebriate lives insured with his Office at several millions of dollars. With regard to the second class of inebriates, those who were addicted to intemperance for a longer or shorter period prior to / applying for a policy and who concealed their previous mode of life from the Office, that was a still more numerous class than the other, and the loss accruing therefrom was very grave indeed. As he had before pointed out, there was a remedy at law for the companies against this species of fraud – for fraud it often unquestionably was; although in many cases the concealment was not purposely designed. Of course the various Life Offices had to bear the brunt of the heavy financial loss arising from the insurance of both these classes of inebriate lives – or rather the burden of loss on these additional and uncertain risks had to be shared by the policy-holders, the Offices being compelled in self protection of themselves and their assured to weigh the scale of all premiums sufficiently to cover such risks. The result was that the rates of premiums were higher than they would be if the inebriate risks could be substantially reduced. Thus the abstaining life had to bear the loading necessitated by the abnormal risks of inebriate policyholders. Having pointed out that such a system acted unfairly against and was unjust to the abstaining policyholder, the lecturer commended the example of such offices as the United Kingdom Temperance and General Provident Institution, the British Empire Mutual, and the Sceptre, who had separate classes for abstainers and non-abstainers. It ought not to be forgotten that the acceptance of so called “moderate,” or “temperate” lives involved not a little risk of the Offices being saddled unawares with a considerable sprinkling of undesirable, because, doubt 268ful lives. That risk, however, was practically unavoidable for many reasons, for there were so many interpretations of intemperance, for a given quantity of alcohol had a different effect (i.e., in degree, not in kind, all intoxicants being of a poisonous character) on different individuals, and even on the same individual at different times. It remained, therefore, to locate the standard in the specific life, in the individual idiosyncracy, and make the standard itself the real (not the apparent) effect which any beyond an arbitrary physiological minimum might, from their modern knowledge of the action of alcohol and its narcotic allies, be reasonably believed to have on the life in question as compared with the known effect on an average life. The effects of such habits might not show themselves immediately; but the Insurance Office required to be informed of their existence or non-existence and not of the period when they were likely to affect health visibly, or to engender a fatal disease. To assert that a man could be addicted to excessive drinking without impairing his health was contrary to experience. There was no such compensation or balance of habits as was supposed to exist in such cases. Habit might accustom a man to intemperance, it might enable him to drink a large quantity of alcoholic liquor without apparently being injuriously influenced by it at the time. But a deranged state of the system would sooner or later follow, and delirium tremens 1 or dropsy 2 would probably intervene. A good constitution might enable a man to resist the pernicious effects for a certain time, but ultimately they would show themselves in some form of disease, and the result of his intemperance was made apparent by early death. As to what constituted intemperance, the lecturer quoted Dr. Tidy 3 who had said “it is difficult to say in words what constitutes intemperance. An occasional ‘drinking bout’ does not make a man, in strict phrase ‘intemperate.’ Again a habit of indulgence which would constitute intemperance in one man may not constitute intemperance in another. Hence, for insurance purposes, the true question is, not What constitutes intemperance generally? but Is there reason to believe that the applicant takes more alcohol than his constitution will bear? In this matter, the general circumstances of a man’s life must be considered. Much beer and much exercise is a totally different combination to much beer and sedentary habits. Hence it is evident that, in insurance cases, physicians and jury must consider the word ‘intemperate’ as a habit prejudicial to the life of the special individual and not in any broad and general sense.” Continuing, Dr. Kerr said that the most skilled and painstaking physical examination would fail to disclose the initial morbid states of gradually but surely advancing inebriety in many cases. Only when the disease had attained a certain height could any appreciable sign of its existence be so diagnosed. Hence the need for some more scientific method of dealing with proposals from inebriates who were not recognised to be inebriates by public estimation. Little as we know with certainty about this malady and the action of inebriants on the human frame, we knew enough to form an approxi 269mate idea of the comparative values of temperate and intemperate lives. By “temperate” lives they might mean insurable persons who, if they drank at all, drank too little and too seldom either appreciably to disturb normal functions, or to keep the system continuously under the influence of the intoxicant. There was a scale which might fairly be applied in the elucidation of this valuation. We knew that one prominent effect of alcoholic poisoning, whether spread over a longer or shorter series of years, was premature ageing. If there was one fact, concerning alcohol, better established than another, it was that it operated in antedating the day of our death. Based on an exhaustive comparison of a wide induction of insurance death returns and distribution of profits to abstainers and non-abstainers, the medical examiner ought to be able to load the premiums of any inebriate, whose life was not rejected, with additional years of premium corresponding to the increased risk. That scale might be extended in application to the lives of “moderate” drinkers. As the vital statistics of those companies which insured non-abstainers and abstainers in different sections showed a higher rate of mortality, with a smaller proportionate return of profits, among the non-abstainers than among the abstainers a thoroughly scientific revision of rates would take the abstaining life – free of course from organic disease, as the normal starting point. That would be a typically healthy life, calling for no loading of premium. Each non-abstaining life which might be deemed fit to be accepted (of course some of this class of lives would involve too heavy a risk and would have to be refused) would be weighted with an addition to the premium on abstaining first class lives, proportional to the extra risks involved. That would be fair to all parties. The non-alcoholic insurer would reap the full benefit of his healthful habits; the “moderate” or “immoderate” or “free” drinker would have to pay a premium commensurate with the actual risk on his life to the Office insuring him. Having given it as his opinion that regular “moderate” drinking tended to shorten life, he said that practical confirmation of the noxious influence of what was generally esteemed to be “moderate” drinking and of the accuracy of the scientific classification of alcohol as a poison, was afforded by the only available practical test – experience. The records of associations for insurance against sickness and death, with different sections for abstainers and non-abstainers, supplied the opportunity of applying that crucial test. Take a quarter of a century’s returns of the United Kingdom Temperance and General Provident Institution. The expected and actual claims for insurance against death during 25 years had been, in the General Section, 7,277 and 7,043; in the Temperance section 4,856 and 3,423. That was to say, there was a mortality in the General section of 96.66 per cent. and in the Temperance section of 71.49 per cent., a difference in favour of the latter of 26.17 per cent. In other words, reckoned by a common life table, there were 243 fewer deaths in the General Section against no less than 1,433 fewer among the abstainers. If all those insured 270had been non-abstainers, the total deaths would have been 11,727. If all had been abstainers, the deaths would have been 8,553, a difference of 3,174 deaths, which last total number gave the nearest approach to accuracy as to the preventable loss by death to a considerable group of selected lives. Any objection to the unmistakable meaning and force of those figures on the score of the General section including, some inebriates, was counter-balanced by the fact that the lives in that section had been below the expectancy, supplemented by the additional fact that some of the abstaining section had been reclaimed drunkards and had succumbed to cirrhovic 4 and other fatal lesions dating from their pre-abstinence days. The transfer of insurers from one section to the other, both ways, had not appreciably affected the comparative death rate. The only precise information which he had as to transfers had been with regard to the Sceptre Office, Mr. Bingham 5 having supplied him with the total number of deaths in the transferred during the seven years, which had amounted to seven. The fact was that the transfers had been found to occur from the omission of the insured to fill up and send the declaration of continued abstention which had to be done at stated times. The claims by death expected during 1891 in the Sceptre (calculated by the Institute of Actuaries’ Hm table) as compared with those which actually occurred were as follows: General Section.
Expected claims.
Actual claims.
Rate per cent.
115
93
80.86
Temperance Section.Expected claims.
Actual claims.
Rate per cent.
61
30
49.18
