While cardiovascular disease is the leading cause of death globally, more men and women are surviving heart attacks than ever before. As a result, insurance claims assessors may expect to see more living benefits claims for heart attack. Another potential contributing factor is the reported increase in heart attacks among those under 40 due to poor lifestyle choices, lack of exercise, unhealthy diets, smoking/vaping, and substance abuse.
Following a heart attack, an insured can make a claim on a variety of benefit types, including death, disability, and medical reimbursement, but the most common heart attack claim is for critical illness (CI). Understanding exactly what happens when an insured has suffered a heart attack is crucial for claims assessors managing CI claims.
What Happens During a Heart Attack
Payment of CI benefits is not dependent upon a heart attack diagnosis, but upon meeting a specified definition of “heart attack,” which is usually contingent on the size of the infarction suffered and the resulting myocardial damage. CI definitions of heart attack typically require a specific presentation, identifiable symptoms, and evidence of severity measured during cardiac investigations, which may be explicitly defined.
When assessing such a CI claim, it is important to be familiar with the typical series of events that occur during a heart attack. This information can help determine exactly what clinical evidence will be available and help the assessor appropriately direct claim enquiries.
Ten Phases of a Heart Attack
A heart attack occurs when the flow of oxygen-rich blood to the heart muscle is restricted or blocked. The heart muscle does not receive enough oxygen and begins to die. While the most common cause is coronary artery disease, many different factors can contribute to heart attack such as trauma to blood vessels, hypoxia, or even drug misuse.
Note: These steps are provided as an example. Not all heart attacks will follow this exact presentation. The infographic shows an overview of the typical presentation and treatment of a heart attack.