CASE: 66 y/o man who had applied for life insurance; was unhappy when he got a moderate rating for life insurance, as “there is nothing significantly wrong with me. I feel fine”. After you (as a consulting underwriter) review of the medical records you find that the medial problems are increased build, coronary artery disease (s/p mi and stent placement in 2008), hypertension, LVH, diabetes mellitus – type 2 (+ neuropathy) and sleep apnea / cpap and that the medical records often cite compliance issues. Assuming you had reviewed the records and felt that the underwriting decision was appropriate and even generous, what are some things you might do to get the case issued and why this path? As a producer whose underwriting staff reviewed the records and arrived at the same conclusion, what path might you take? Feedback please on how you would manage this case …..
Important Notice:
The opinions and examples contained in this article are those of Strategic Medical Consulting, Inc. (SMC). As each case is fact sensitive, it would be ill-advised to take action on any given case based on the conclusions from examples that are included in this communication. Whether or not they are appropriate for a specific medical underwriting situation must be determined by the producer who will assume all responsibility should the outcome not be favorable. The examples illustrated herein are what SMC provides on a case-by-case basis for and to its clients. In addition, the opinions are not medical advice and they do not establish any physician-patient relationship.
The absence of information often forces underwriters to assume a more conservative posture. Case in point is an underwriter’s question similar to the following: I have a 63F with a history of breast cancer. Out of 170 pages of medical records, I have no details about her breast cancer except it was in 1988 and that she had reconstruction surgery. Her other medical history is insignificant. In response to this referral, I would have liked to have be able to make a standard offer without delay. My problem with going standard is that the life insurance carrier has no way of knowing with enough assurance that there has not been a recent recurrence, which may be why life insurance is being sought. If on the life insurance application the applicant had stated an accurate account of the history, something like, “in 1988 I had a left-side mastectomy for breast cancer, I had no radiation therapy or chemotherapy and I have never had any recurrence of breast cancer”…. underwriting would be in a much better position to make assumptions as to the current status of the cancer history. 
ncrete medical underwriting problems that underwriters see. In order for the producer to have some idea of what a rating might be for the client, he or she can ask the underwriter by phone call or email. So what specifics does the underwriter need to know? They are the same ones that underwriters must discover in order to use their company’s reinsurance manual:
Conventional wisdom is that the process of selling life insurance involves only the interaction between producer and client; it is only the client who needs to be “sold” in making the transaction. This is not correct. Who is the other “decision maker” in the sales process? It is the carrier’s underwriter. Why? The answer lies in their job descriptions.
Here’s the scenario. You as the writing agent receive unexpected bad news from the life insurance carrier’s underwriter. The underwriter says that the insurance lab showed blood in the urine so another sample will be needed from your client or that a rating will be placed on the case. Is this an appropriate underwriting action? Well … maybe yes, but often no.
Problem: You or your underwriting adviser discovers an error in the medical records that will probably adversely impact the carrier’s underwriting assessment (rating). What might you do, prior to case submission or after the carrier informs you there is a problem? Example: The records state that your client has a permanent pacemaker and you do not think he or she does.
Effective client communication is one of the most overlooked ways to compete in today’s life insurance marketplace. Producers are not only interested in compensation and product, but they are also looking for a “home” where they can comfortably function. The differentiating factor among life insurance underwriting shops is communication. A carrier underwriter’s traditional approach to communication is vastly different compared to a more direct and informative method to which a carrier’s concierge team’s “hands-on” approach. A carrier who is looking for an underused solution to an old problem (case wastage) or a high-end producer who wants to know the questions to ask when he or she is being courted by insurance carriers, then take a look at the complete article: “
Question: You have a client who is applying for a large amount of life insurance coverage and he sees a therapist for anxiety. The “APS” or attending physician’s statement you receive from the therapist is a one-page document that cites a diagnostic code for “anxiety” or only a diagnosis and no other useful descriptive information. You are concerned that the carrier’s