Underwriting Hepatitis C Clients: What You Need To Know
Many clients who have Hepatitis C are not impossible to place for life insurance, provided you present the underwriter with a case showing a history of treatment and good follow-up.
One circumstance that makes this type of risk so difficult for many to evaluate is the lack of prior knowledge of the hepatitis C virus (HCV). Many times, it is discovered at time of underwriting.
As with any other impairment revealed at time of underwriting, this discovery means there has been no treatment and no histology behind that treatment. Such records are among the strongest assessments that underwriters rely upon to make a fair offer for coverage, so their absence is problematic.
Producers can help avoid the lack of prior knowledge situation by asking the right questions during the client interview.
Naturally, if the client mentions he or she had the disease, ask: How was the disease transmitted?
[Note: The most common ways are transmissions through intravenous drug use; blood transfusion prior to 1992 (before accurate drug screening was established); and inhaling cocaine through contaminated straws. Less commonly, the virus can be contracted through tattooing, body piercing and acupuncture.]
But the challenges come when the client doesnt mention the illness, or perhaps doesnt even know he or she has had it. (Such lack of personal knowledge is not uncommon today, because this virus is still relatively unknown and frequently, in the early stages, it displays no symptoms.)
This is where your careful questioning can be of critical assistance.
For instance, explore whether your client is harboring a hepatitis B co-infection. And check to see if the client has any other major health problems (cancer or diabetes, for example). These facts become an important part of what an underwriter looks for.
What about medicinal therapies? There are several to look for when you are interviewing a person who has hepatitis C.
The use of interferon is one of the most common treatments. Interferon is a drug that inhibits viral replication.
[Note: Up until recently, interferon has been the best weapon against HCV and is effective in about 20% of cases presented. Now, injections of interferon are combined with oral doses of ribavirin, a comprehensive antiviral agent. This treatment is successful in approximately 40% of people with HCV. A new treatment has recently been introduced as well, Pegylated (PEG) interferon. PEG is now known to be two times as effective as regular interferon.]
Look for current alcohol consumption. It tends to raise liver enzymes SGOT (AST) and SGPT (ALT), which become a serious problem in the HCV infected individual. Hence, inquiring as to whether your client partakes in any type of alcohol consumption would be in order. A more than minimal use of alcohol becomes an adverse factor in underwriting.
Other indicators to look for are type of testing that has been performed. Has your client undergone a liver biopsy, liver ultrasound or a CT scan? A biopsy doesnt necessarily confirm a diagnosis of HCV; rather it can determine the severity of the disease. It may also aid in ruling out other causes of liver problems such as alcoholic induced hepatitis or hemochromatosis (excess iron).
The best types of HCV cases, for life underwriting purposes, are those presenting strong follow-up, and normal or mild stable elevations in liver functions. Cases that have had a liver biopsy showing no or minimal inflammation or scar tissue are also more favorable, as are those who refrain from continual use of alcohol.
A showing of stable liver enzymes for a period of about three to six years generally can be a trade off for a liver biopsy, however, attending physician records must be available for a period of seven to 10 years so the case can be fully assessed properly for the best possible offer.
Finally, you should know that carefully selected cases can be acceptable for coverage. Generally, a standard rating will not be likely; however, such ratings are not impossible and, as treatment methods improve, this underwriting philosophy may change.
The best cases would be those showing normal or mildly elevated liver functions, those indicating eradication of the chronic HCV infection by use of interferon, PEG interferon or ribavirin, and those showing no portal bridging. These cases generally will fall in the low to mildly rated categories.
Remember its important to understand these basic facts. And be sure to ask the proper questions in order to adequately present the case for the best possible underwriting decision.
Elizabeth V. Cammarota is vice president at Brokerage Professionals, Inc., Phoenix, Ariz. Her email is firstname.lastname@example.org.
Reproduced from National Underwriter Life & Health/Financial Services Edition, November 12, 2001. Copyright 2001 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.