CASE: 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 …..
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.
The 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. 
Here’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.