Jack Cotlar, M.D.

Recent Posts

Your feedback on how you would manage this substandard case

Posted by Jack Cotlar, M.D. on Sun, Mar 09, 2014 @ 05:32 PM

Substandard case managementCASE: 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 …..

 
Dr. M. Jack Cotlar, President
Strategic Medical Consulting, Inc.®
Voice: 317.536.2603 (ET)
Email: jcotlar@strategicmedconsulting.com

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.


Topics: Life insurance medical underwriting, Dr. Jack Cotlar, case management, rating, communicate, Underwriting, substandard case, diabetes, underwriting assessment

Using the life insurance application to your advantage

Posted by Jack Cotlar, M.D. on Fri, Aug 30, 2013 @ 04:34 PM

Breast cancer underwritingThe 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. 

The take home message is that an applicant who has had a history of cancer may help himself or herself by providing as much accurate detail about the cancer as possible when he or she fills out the life insurance application. These details are explained in my earlier post, but at the very least, the information should include the type of cancer, the type of treatment(s), when the treatments ended and whether or not there has ever been any recurrence of the cancer. The applicant’s statements must be truthful and the applicant should be aware that providing this type of information is no guarantee that a favorable underwriting decision will be made. However, this simple step of providing the underwriters needed detail upfront can save a lot of time and aggravation for the applicant and the insurance agent. 

Free brief consultation on your cancer case
 
Dr. M. Jack Cotlar, President
Strategic Medical Consulting, Inc.®
Voice: 317.536.2603 (ET)
Email: jcotlar@strategicmedconsulting.com

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.


Topics: rating, Breast cancer, life insurance, application, carrier

How to anticipate a life insurance rating for cancer

Posted by Jack Cotlar, M.D. on Sat, Aug 17, 2013 @ 11:56 PM

Cancer is one of the more coshutterstock 142163296 resized 600ncrete 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:
1.    Type of cancer (breast, prostate, colon, etc)
2.    What the pathology report says about the cancer
   a.    Stage, for example, “T1N0M0”
   b.    Grade, for example “well-differentiated” or grade 2 or, for prostate cancer, “Gleason      3+3=6”
   c.    Margins of the specimen removed: free of cancer or not free of cancer
3.    How was the cancer treated? Generally it would be by radiation, chemotherapy, surgery or some combination of these.
4.    What was the date of the last form of therapy? For example: if radiation follows surgery, then it would be the date of the last dose of radiation.
5.    What type of surveillance testing is being done?
a.    Type of test (colonoscopy for colon cancer, PSA for prostate cancer or mammogram for breast cancer, etc)
b.    Date of most recent test and its result
6.    Has there been a recurrence of the cancer, if so, when?
7.    Is the client currently in remission (is free of cancer)?

This information can be found in the medical records, often included in the most recent pages of the physician following the client for cancer and from the client himself or herself. If you are able to relate as much of this information as possible to the underwriter, he or she will be able to give you an accurate rating for this condition from which you can plan your strategy with confidence.

Contact me if you have any questions or comments.

Dr. Jack Cotlar

Topics: medical underwriting, Cancer, communicating to the underwriter

The upside and downside of our digital society

Posted by Jack Cotlar, M.D. on Mon, Jul 09, 2012 @ 09:27 AM

With so much emphases given to social media and the like, sometimes it is helpful to step back and reassess. We may find that some of the “old fashion” methods allow us to live and work in a more healthy and successful fashion. 

Our new digitalized society enables individuals to communicate with others around the world from the comfort of his or her home. This is good. Using these same tools we may find ourselves communicating “remotely” even to our own family members who are in the same home! This is not so good. In this brief musical YouTube clip, I am reminded of the joy and benefits of real interpersonal interaction; how much each individual can add to the effort of others and how many people can benefit from what they accomplished. Enjoy this uplifting clip.


Topics: social media, communicate, music

Why Experienced Producers Sell Their Cases to the Underwriter

Posted by Jack Cotlar, M.D. on Thu, Apr 05, 2012 @ 06:20 PM

PartneringConventional 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.

The underwriter’s job is to determine whether or not the case makes financial sense and whether or not the premium is in sync with the applicant’s health status, i.e. they determine whether or not the carrier is able to make an offer, and if so, at what rating (price). So the producer needs to “sell” the underwriter the idea that the contract will be profitable for the carrier.  A forward thinking and experienced producer understands that he or she should interact with the underwriter as business partner and not as an adversary. So how is this done?

 

The experienced producer will …

The inexperienced producer might …

  • provide the carrier the necessary underwriting information in a timely manner,
  • fail to meet deadlines and will give push back for any requested information,
  • avoid errors that create work for the underwriter,
  • carelessly complete forms and create problems that cause the underwriter to do additional work, needlessly,
  • provide an accurate and informative cover letter that provides relevant financial and medical information, succinctly and …
  • not bother to create a cover letter, of if he or she does, it contains little more than “fluff”, and …
  • communicate in a fashion appropriate for a business partner relationship

 

  • interact with the underwriter in a non-professional manner, then he or she will wonder why there appears not to be a good working relationship

 My point? Building sound relationships with both your client and the carrier’s underwriter evaluating your client’s case and providing the underwriter with tangible reasons to prove that a case is worthy of consideration are critical to the success of your placing your cases.

How do you define the role between you and your carrier’s underwriter? What do you do to make this happen?

Topics: Insurance medical underwriting, medical underwriting, Underwriter, experienced producer

“Blood in the urine” as an insurance lab related underwriting error

Posted by Jack Cotlar, M.D. on Wed, Mar 28, 2012 @ 03:04 PM

describe the imageHere’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.

The initial test on the urine is a screening chemical analysis for blood. A positive result for blood is simply a color change due to oxidation of a test-strip reagent but it does not confirm that red blood cells are present. Confirmation that there are red blood cells present in the urine is made by using a microscope to look for them. If the microscopic evaluation does not show a significant number of red blood cells, then the urine would NOT be positive for urinary blood. In sum, the diagnosis of microhematuria (blood in the urine not visible with the naked eye) should not be made from the results of only a dipstick result. Unless red blood cells are seen microscopically, the term hematuria or microhematuria is inappropriate. Many individuals with a positive “dipstick” blood test are labeled as having dipstick urinary blood cells although microscopic analysis would show that red blood cells are absent.

Topics: microhematuria, rating, insurance labs, hematuria

How to manage an error in the medical records

Posted by Jack Cotlar, M.D. on Wed, Jan 04, 2012 @ 06:50 AM

dreamstimefree 164477 resized 600Problem: 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.

Example solution:

1. Verify with your client whether or not he or she currently has a pacemaker. If not, then ...

2. Find the page in the medical records that makes the statement that there is a permanent pacemaker in place.

3. Circle the statement that you believe is in error or ambiguous.

4. Have your client provide his physician a copy of this page (#3 above) along with a cover letter that addresses this issue.

5. If there is an error or a significant ambiguous statement in the medical record then your client can discuss with his or her physician the appropriate way to correct it or to clarify it.

6. Obtain a copy of the “corrected” statement and provide it to your carrier when the case is submitted.

In my opinion, explaining a potential underwriting issue and working with the client in order to solve the problem pays dividends, especially if problems are solved before the case is initially submitted. Addressing medical underwriting problems in this fashion may not only resolve the underwriting problem, but the client will appreciate your expertise that separates you from others. To see similar case examples, GO?HERE.

Topics: Dr. Cotlar, Strategic Medical Consulting, Life insurance medical underwriting, medical undewriting, medical records, Errors in medical records

Effective communication between underwriter and applicant

Posted by Jack Cotlar, M.D. on Tue, Sep 20, 2011 @ 11:18 AM

describe the imageEffective 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: “Bridging the Underwriter and the Applicant

Topics: life insurance marketplace

A Proactive Way to Avoid a Possible Medical Underwriting Glitch

Posted by Jack Cotlar, M.D. on Mon, Sep 05, 2011 @ 10:19 AM

dreamstimefree 168394 resized 600Question: 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 underwriter will want more information given the size of the case, and you cannot afford a time delay. How would you manage this situation?

The most simple and direct way is to go to the client explaining the underwriting dilemma and to do so before the case is submitted. Providing the carrier up front what he or she will need to do their work properly is likely to greatly expedite the case being issued. There will be occasions when providing answers to key questions in a cover letter will allow the underwriter to make a decision about this issue without needing another APS. To see a brief case example, go HERE.

Topics: Dr. Cotlar, Strategic Medical Consulting, Life insurance medical underwriting, medical underwriting, medical records, attending physician statement, underwriting glitch, underwriting dilemma