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

The Producer’s Participation in Medical Underwriting

Posted by Jack Cotlar on Tue, Jan 17, 2012 @ 04:57 AM

istockphoto 6131779 the main part of mechanismSuccessful entrepreneurs know that what separates them from the competition is doing a few things of value really well. Often, one of these is a task that others ignore. In the life insurance industry, some producers either ignore the field underwriting piece of the case development, i.e. they simply don’t do it, or they delegate this task to staff that are not trained in this area. Life insurance company carriers have well trained professionals, underwriters, who make a risk assessment based upon the financial and medical data they see and this determines how much your client will be asked to pay for the product you sell. This simple concept should provide incentive to apply some of the sales energy into case management. What do I mean “case management”? This in part means to gather the necessary financial and medical data, ask the questions and record the answers on the insurance application (to gain first-hand knowledge and to cement the producer-client relationship), anticipate what the underwriting issues are or might be and take necessary steps to preempt underwriting problems. Any underwriter would say, “the devil is in the details”. This characteristic as it relates to medical underwriting is often outside the producer’s comfort zone. Because it is, any producer has an opportunity do standout from the others and to provide the kind of expertise your clients expect.

Jack Cotlar, M.D.
Strategic Medical Consulting, Inc.
Phone: 317-536-2603

Topics: Dr. Cotlar, Life insurance medical underwriting, medical underwriting, Straegic Medical Consulting, case management