Case 2

The proposed insured is a 54 y/o lady, nonsmoker. SMC review of the medical records and noted that the most recent office visit disclosed that she was anemic (her hemoglobin was 10.9) and that she was advised to schedule a colonoscopy. SMC advised the producer that the case, as it presently stands would likely be declined or postponed, and the case should not be submitted until these issues were resolved.

Learning this, the proposed insured called her physician and informed him that the anemia presented a life insurance issue. Because of this and because follow-up testing was deemed necessary, additional studies were done; these were normal. In addition, SMC discussed the case with the physician because the office notes were ambiguous. From this, the physician was able to clarify uncertainties and SMC learned that the colonoscopy was suggested as a screening test rather than for cause (the low hemoglobin had not come back yet), and that there was a technical problem with the initial blood count leading to an incorrect hemoglobin value. Once these facts had surfaced, the case synopsis was created that reflected the full set of circumstances. Its abbreviated form reads as follows:

The proposed insured is 54 years old whose only medication is Lipitor. Her primary care physician, Dr. XXX saw her in the office last on 2/4/08. Off to the side of this note is a hemoglobin value of 10.9. The note says “need to schedule colonoscopy and mammogram”. The other lab, chemistries and lipids were normal, as was her PAP smear. Realizing that the 2/4/08 hemoglobin was not normal and could be an underwriting issue, the producer, called his client who then called her physician, Dr. XXX about this (see the 7/8/08 APS #2 office note). On 7/10/08 Dr. XXX had the proposed insured do a complete blood count, reticulocyte count and iron studies at a commercial lab; these were all normal (including the CBC’s indices). Per his office note on 7/14/08, Dr. XXX addresses the indication for colonoscopy. He states that the colonoscopy was recommended as a screen due to patient’s age (rather than for symptoms). She was last seen by a physician on 3/3/08 when she was seen and treated for acute bronchitis at an urgent care center.

The Medical Underwriting Summary along with all of the supportive data was sent to the carrier. The case was issued standard, and there was no delay in obtaining additional APSs as all necessary medical information had been submitted initially.