Case 1

61 y/o non smoking male. SMC reviewed all of the medical records, and then discussed the case summary with the producer. Among the listed diagnoses in the medical records were “hypertension”, atrial fibrillation and congestive heart failure. The last two problems are significant underwriting issues. All three of these were not correct diagnoses!

The applicant saw a cardiologist in November 2008 for palpitations. Through testing, a minor cause was found, however the stated reasons (indications) for the tests were incorrectly listed as congestive heart failure (for a myocardial perfusion stress test), and atrial fibrillation (for an echocardiogram). In the initial cardiology note, hypertension was also mentioned incorrectly as a diagnosis. The proposed insured said he had no history of hypertension or treatment for it, and the clinical records cited no atrial fibrillation or congestive heart failure. Prior to case submission, the proposed insured discussed these inconsistencies with his physicians; they made the appropriate corrections in the medical record.