Heart-doctor

Cardiomyopathy and life insurance

Can you get life insurance if you have cardiomyopathy? Find out what personal insurance options are available to you.

Cardiomyopathy is a heart condition where the heart muscle (myocardium) becomes inflamed and is unable to supply blood around your body as fast as it normally would.

Many people will suffer mild cardiomyopathy in their lives. However, people with severe cardiomyopathy are susceptible to heart failure and may require a heart transplant in the future.

This article discusses what how to go about getting life insurance if you're suffering from cardiomyopathy, how it's recognised by insurers, other insurance options available and more.

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Life Insurance for people with cardiomyopathy

If you've been diagnosed with cardiomyopathy and are trying to take out life insurance, whether or not your application will be accepted will depend on the severity of your condition.

An insurer will generally require you to undertake a medical examination and may want to speak with your treating physician about your medical history, medications and other relevant information. Insurers will also assess if there are any other conditions present that could affect your cardiomyopathy.

An insurer will usually take one of three actions:

  • Apply a premium loading to the cover
  • Exclude the condition from cover under the policy
  • Reject the policy application

It's always worth speaking with an insurance consultant if you're applying insurance with a pre-existing medical condition. An adviser can provide you with invaluable insight, as they can use their knowledge of different providers to help you find the policy and insurance brand best suited to you.

How do Australian insurers define cardiomyopathy?

ProviderDefinition of event
AIAA condition of impaired ventricular aetiology whereby resulting physical impairment is recognised under Class III of the New York Heart Association classification of cardiomyopathy.
AMPHeart fails to function properly resulting in permanent physical impairment to at least Class III.
AsteronImpaired ventricular function of variable aetiology to at least Class III.
BTImpaired ventricular function to at least Class III or the equivalent.
ClearviewCondition of impaired ventricular function of variable aetiology resulting in significant permanent physical impairment to the degree of at least Class 3 of the New York Heart Association classification of cardiac impairment.
ComminsureClass III of the New York Heart Association classification of cardiac impairment.
MacquarieIrreversible left ventricular ejection fraction of 30% to 40% while on ongoing optimal therapy for a minimum period of 6 months and significant cardiac impairment to at least Class III of the New York Heart Association classification.
MetLife"Cardiomyopathy" means impaired ventricular function of variable aetiology resulting in permanent irreversible physical impairment to a degree of Class 3 of the New York Heart Association classification of Cardiac Impairment. This would not include Cardiomyopathy occurring as a result of alcohol or drug use.
MLCInability of heart to function properly resulting in cardiac impairment to at least Class III of the New York Heart Association classification.
One PathImpaired ventricular function of variable aetiology to resulting in significant physical impairment to Class III classification.
TALImpaired ventricular function of variable aetiology to at least Class III.
ZurichThere is marked limitation of physical activity and symptoms may occur with ordinary physical activity.

What is cardiomyopathy?

Cardiomyopathy is a heart condition that affects the function of the myocardium, which is the muscular wall of the heart. The weakening means that your heart is unable to supply your body with an adequate amount of blood.

What are the different types of cardiomyopathy?

Cardiomyopathy can be separated into two categories of cardiomyopathy: primary and secondary.

  1. Primary cardiomyopathy. Primary cardiomyopathy is a condition that affects the heart alone. It can be further broken down into smaller subgroups, in which several variants of the disease sit:

    Acquired

    • Ischemic cardiomyopathy
    • Myocarditis
    • Stress Cardiomyopathy

    Genetic

    • Arrhythmogenic right ventricular cardiomyopathy (ARVC)
    • Dilated cardiomyopathy (DCM)
    • Hypertrophic cardiomyopathy
    • Ion Channelopathies
    • LV non-compaction
    • Restrictive cardiomyopathy (RCM)
  2. Secondary cardiomyopathy. Secondary cardiomyopathy on the other hand is caused by something outside the myocardium itself.

    Cardiofacial

    • Noonan syndrome

    Endocrine

    • Acromegaly
    • Diabetes mellitus
    • Hyperthyroidism

    Endomyocardial

    • Endomyocardial fibrosis
    • Hypereosinophilic syndrome

    Metabolic/storage

    • Fabry’s disease
    • Hemochromatosis

    Neuromuscular

    • Friedreich’s ataxia
    • Muscular dystrophy

    Other

    • Obesity-associated cardiomyopathy

Different classifications of cardiomyopathy

Most life insurers in Australia recognise the New York Heart Associations classifications of cardiomyopathy when determining whether a benefit payment will be provided.

Classification ClassDefinition
Class IPerson does not experience any limitation on physical activity and there are no symptoms with normal physical activity
Class IIPerson experiences slight limitation of physical activity, symptoms may be evident with ordinary physical activity
Class IIIThere is marked limitation of physical activity and symptoms may occur with ordinary physical activity
Class IVSymptoms are evident with any physical activity and may also occur at rest, symptoms are increased in severity with any physical activity

Most insurers will recognise cardiomyopathy with class III or more for a benefit to be paid.

What causes cardiomyopathy?

There are four main causes of cardiomyopathy:

  • Alcohol. Moderate to heavy consumption of alcohol is believed to have a direct influence on heart problems. Drinking more than the daily recommendation can lead to a deterioration of the heart muscle. It can be worth checking with a medical practitioner to see if the level of alcohol you consume is having a negative impact on your heart and overall health.
  • Family medical history. The heightened chance on being diagnosed with cardiomyopathy if there is a family history.
  • Viral infection. Viral infection of the heart can have a direct impact on the development of cardiomyopathy.
  • Heart attacks. Experiencing one or more heart attacks can damage the heart muscle and result in primary cardiomyopathy. Heart attacks can cause scar tissue on the heart and result in the heart having to work harder to pump blood around your body.

Symptoms and treatment of cardiomyopathy

If you think that you may have cardiomyopathy then you should know about the symptoms and the treatment. The symptoms and treatment of cardiomyopathy are:

  • Symptoms of cardiomyopathy. The symptoms of cardiomyopathy can be wide ranging but they will generally be the similar to the symptoms of other heart diseases. Generally, people with cardiomyopathy will experience being out of breath, tiredness, swelling in the legs and abdomen due to build-up of fluid.
  • Treatment of cardiomyopathy. The treatment of cardiomyopathy will depend on the type of cardiomyopathy you have. Treatments include medication, implanted pacemakers, defibrillators, or ventricular assist devices (LVADs), or ablation.

What other personal insurance options are available?

  • Trauma insurance for cardiomyopathy. Most Australian life insurers provide cover for cardiomyopathy under trauma insurance. In the event that you suffer from cardiomyopathy, your insurer will pay you a lump sum benefit if you meet the claims conditions. You will need to provide your insurer with evidence from a certified medical practitioner verifying your condition. Most insurers will recognise the Class III on the New York Heart Association classification of cardiomyopathy.
  • Income protection and TPD for cardiomyopathy. Some insurers also allow you to claim crisis events under their income protection or TPD policy. However, you will need to satisfy the claim conditions. For example, BT Income Protection Insurance require:In the event that the insured suffers cardiomyopathy for the first time while covered under the policy, BT will pay a benefit equal to the monthly total permanent disability benefit or severe disability benefit for a period of six months from the date that the insured event occurred.If at the end of this six month period is suffering total disability or severe disability as a result of cardiomyopathy, they will receive the total permanent disablement or partial disablement benefit.The benefit will not be paid if condition becomes apparent within 90 days after the later of:
    • Commencement date
    • Insured monthly benefit is increased
    • Date policy was reinstated

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Richard Laycock

Richard is the senior insurance writer at finder.com.au and is on a mission to make insurance easier to understand.

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