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

“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