Dr Francois Sestier is a life expectancy calculation expert. He is a licensed medicine practitioner in the Province of Québec, Canada, practicing as a certified cardiologist. After obtaining his PhD in cardiac physiology at McGill University, he participated in more than 100 randomized control studies in cardiology, over three decades. He is also certified in cardiology, respiratory medicine, occupational medicine, aerospace medicine in France, and in cardiology and insurance medicine in Canada.
In 1985, Dr Sestier started working as a medical officer for Life Insurance Companies. He is a diplomate of the American Academy of Insurance Medicine since 1995, having obtained a formal training and certification in mortality risk assessment by the American Academy of Insurance Medicine.Along with that, he is a US Certified Medical Examiner, having passed with success the American Board of Independent Medical Examiners examination, in February 2011.
With this background, he started spending more and more time on Independent Medicolegal Reports on life expectancy calculation, but with a precise, scientific and accepted actuarial methodology.
The CEO Views team has spoken with medicolegalexpert Dr Francois Sestier, an expert on lifeexpectancy calculation, to gain greater insight into his journey.
Medical Director For Different Insurance Companies
Dr Francois has been the program director for InsuranceMedicine and Medicolegal Expertise in Health Sciences at University ofMontreal (1999-2018). He is a past president (1994-1995 and 2017-2018) of the CanadianLife Insurance Medical Officers Association (CLIMOA), of the CanadianSociety of Medical Evaluators (2011-2013), and of AIDC (2010-2012), theworld association of medical experts.
Conducting Programs and Workshops
In 2000, Dr Sestier launched a unique University bilingual Insurance medicine program, with lectures on Life Expectancy calculation given by actuaries and well- known experts in the field. In addition to conducting research in life expectancy, Dr Sestier has supervised Master and PhD students who were conducting research in this area. He had published and gave lectures nationally and internationally on Life Expectancy in a variety of conditions. He had organized workshops on Life Expectancy Calculation for CLIMOA attendees in 2008 and 2018.
Areas Of Expertise
For more than 30 years, Dr Sestier served different Insurance Companies and reviewed multiple applications daily, giving advice on the mortality and life expectancy associated with the medical conditions of the applicant. He has performed life expectancy calculations, for lawyers, on topics as diverse as traumatology, morbid obesity, different cardiac pathologies, sudden death, stroke, cerebral palsy, epilepsy, asthma, chronic obstructive lung disease, pulmonary fibrosis, depression, anxiety disorder, liver cirrhosis, and all kinds of cancers.
Need For Life Expectancy Opinion
A lawyer may request the calculation of a life expectancy of an individual on several grounds. The need for such opinion arises mostly in medical liability lawsuits. Defence lawyers may seek an opinion suggesting low life expectancy, to reduce the lump sum for the damages, while plaintiff lawyers may look for an expert known to give opinions slanting towards long life expectancies, allowing the requested damages to be maximised.This opens the field for biased opinions.
Methodology For Life Expectancy Calculation
While Life Expectancy Calculation is based on scientific data and research, the conventional approach may lead to potentially biased estimations. The easiest method is to use the constant relative risk (RR) method. It relies on the assumption that the relative risk of dying with a medical condition stays constant with increasing age. This method overestimates the risk of dying with most chronic medical conditions, leading to calculated mortality rates that are generally too high at older ages, reducing the true-life expectancy associated with a medical condition. However, for most chronic medical conditions, such as diabetes or coronary artery disease, the risk of an early death is not constant, but decreases with older ages. The two methods that give unbiased and science-supported opinions on life expectancies are the log-linear declining relative risk (LDR) method and the proportional life expectancy (PLE) method.
The first challenge is to select all the medical conditions reducing life expectancy in the medical brief. Lengthy experience in the field of life underwriting is an advantage when it comes to identifying all of the medical conditions associated with a reduced survival
Multiple Medical Conditions And Life Expectancy
Multimorbidity has a direct impact on life expectancy. With each additional chronic condition, life expectancy decreases. It is a challenge to calculate the life expectancy of an individual having several medical conditions that are reducing their likelihood of survival. Dr Sestier shared, “The first challenge is to select all the medical conditions reducing life expectancy in the medical brief. Lengthy experience in the field of life underwriting is an advantage when it comes to identifying all of the medical conditions associated with a reduced survival.”
Keeping in account the relative risks of the biased methods, Dr Singer had suggested a method to calculate a true life expectancy associated with several medical conditions. This method is recommended by the American Academy of Insurance Medicine. The steps include:
Documentation: Search for the most recent medical literature and select the most pertinent publications concerning the long-term survival for each of the medical conditions reducing the life expectancy.
Mortality Analysis- Calculate from each of these publications the excess death rate or EDR associated with each of these medical conditions. Add the EDRs for each medical condition to the expected mortality rate at the patient’s age.
Estimation of Life Expectancy- Use these obtained rates to calculate the life expectancy of an individual of the same age having these medical conditions.
Conclusion
For his life expectancy calculations, Dr Sestier employs a solid actuarial methodology, based on the best recent publications, such as to provide to the Courts a true estimate of the life expectancy of a person with several medical conditions reducing survival.
