past medical officers of life insurance companies – add the biased relative risks associated with these medical conditions (given by the underwriting manual of the life insurance company), assuming that these relative risks will remain constant with aging. Then they transform this final biased relative risk into a life expectancy using an actuarial table available to all of these life insurance companies. Again, this biased method should be banned in the litigation field. The only method to be used in the litigation filed to calculate a true life expectancy associated with several medical conditions has been proposed by Dr. Singer, and is recommended by the American Academy of Insurance Medicine. To employ this method, the expert must proceed in the following four steps sequentially: 1. Select the most recent publication reporting the long-term survival for each of the medical conditions reducing the life expectancy. 2. Calculate from each of these publications the excess mortality (measured by the excess death rate or EDR) associated with each of these medical conditions. 3. Add the EDRs for each medical condition to the expected mortality rate at the patient’s age. 4. Use these obtained new mortality rates to build a new life table to calculate the life expectancy of an individual of the same age who has these medical conditions. This method, which is evidenced-based and unbiased, is rarely used by experts, who are not familiar with these actuarial concepts. What other biases have you observed regarding these calculations? Some experts do not consider all the medical conditions altering survival. Some experts add considerations like 58 LAWYERMONTHLY JANUARY 2023 Contact Dr François Sestier, Medicolegal Expert Suite 901, 1851 Sherbrooke East, Montreal, QC, H2K 4L5, Canada Tel: +1 514-738-6476 | Fax: +1 514-738-2333 Email: drsestier@hotmail.com www.drsestier.org (Eng) | www.drsestier.net (Fra) www.lifeexpectancyexpertise.ca About Dr François Sestier Dr François Sestier is a leading cardiologist, a clinical professor of medicine, an expert in life expectancy calculation and a past president of the Canadian Life and Health Medical Officer Association. In terms of life expectancy calculation expertise, Dr Sestier has over 15 years’ worth of experience, during which he has reviewed more than 8,000 scientific publications reviewing mortality for more than 400 medical conditions. In 2020, he published ‘Expertise 101’, the first and only textbook on how to give an expert opinion in the province of Quebec. fortune, family support or absence of common medical conditions to alter the true life expectancy associated with medical conditions reducing survival. Some experts cite old references, often 20 or more years old, but do not use them and rather give an estimated life expectancy based only on their clinical experience. This is obviously an unreliable method when numerous medical conditions reduce survival. Their opinion is then no more than an educated guess (‘junk science’) and not a scientific, unbiased opinion to provide to the Court. Finally, what would be your recommendation to a lawyer who has to find an expert to calculate a person’s life expectancy? My main recommendation would be to only use experts who are adept in employing solid actuarial methodology based on the best recent publications, and who are able to provide to the Court a true estimate of the life expectancy of a person with several medical conditions reducing survival. Such opinions will prevail in Court.
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