NU’s Issue On Underwriting Did Agents ‘A Great Service’
To The Editor:
Thank you for the focus on underwriting in the Nov. 12 issue of National Underwriter, and your lead stories on depression and Hepatitis C. As a former field underwriter (agent) and 30-year veteran of the life insurance business, you did a great service in helping agents understand these two diseases…both of which I know firsthand. I’d like to add a few facts and opinions.
First, depression. An estimated 10% of the U.S. population suffers from depression in one of its many forms. Agents and underwriters should be sensitive to the “stigma” the patient feels. Tipper Gore unwittingly became the Poster Child for it a few years ago, and thus, those of us on drugs for our depression feel somewhat less shame.
While trauma, such as a loss of a loved one, can cause or contribute significantly to short-term episodes, and viruses to long-term depression, the evidence is clear that all forms are characterized by chemical imbalances affecting the brain’s ability to send steady charges of electricity through the nerve ending synapses.
An easily managed form is Seasonal Affective Disorder (SAD), which I also suffer from and which is aggravated by where I choose to live: diminishing light during the winter causes depression and sadness, as too little serotonin is being produced. We all know someone who gets “sad around the Holidays” or gets a severe case of “cabin fever.” A simple management tool is a prescribed light box –a half-hour sitting near it each morning while reading the paper does wonders, as does, of course, a trip south.
An imperfect analogy may be a poorly functioning auto spark plug that misfires. Whether the depression is “episodic” and short-term, or “systemic,” e.g., caused by a chronic disease in another part of the body, is of course a mortality concern, but drugs, or pharmacological management, help considerably in allowing sufferers to lead productive lives. The trick is in controlling the side effects.
Field underwriters and home office underwriters should try to classify the manifestations further than some clinicians do to get a clearer understanding of the disease. The often-used physician term “clinical depression” (mostly to minimize patient anxiety and shame) includes many types, a number of which are relatively harmless, but also some which indicate the patients are at high risk, to themselves or others. Thus, they present a huge mortality risk.
Here are some questions to consider: Are there panic attacks? Is there a bipolar disorder, or manic-depressive behavior associated with the depression? Any hallucinations? Any violence or psychotic tendencies or episodes? Has the patient experienced any or recurring suicidal ideation? Does he have a history of suicide attempts? Has the patient sought and received counseling on how to better react to the external circumstances aggravating the depression? What drugs are being prescribed, for how long, and what is the prognosis for drug use termination?
Second, Hepatitis C (HCV), is, like depression, a “closet” type of disease in that contracting it causes a sense of shame, even if one contracted it by transfusions during surgery. And, it too is pervasive, with estimates of 4 million Americans unaware that they have HCV. Thus, the 20,000 cases per year estimate cited in NU may mislead slightly, as that is the number of those whose symptoms are strong enough to warrant the specific blood screening required for “discovery.” Any temporary breakdown in the immune system can trigger the virus from a dormant to active state.
Elizabeth Cammarota infers that a 5-to-7-year history be obtained for signaling a clean bill of health. However, the interferon-ribavirin combination treatment, which I underwent, has only been out of clinical trial studies and approved for 36 months, and since then has become the prescribed treatment.
As to “cure” rate, the National Institute of Health library on the subject would suggest an even lower rate of “cure” than cited for an interferon-only treatment course (20% cure). And, a major reason for the relatively low–40%–cure rate for the interferon-ribavirin antiviral treatment is that over half of those who start the treatments (three self-administered interferon shots per week and six ribavirin tablets per day for six months to a year) are unable to complete a course.
The cure is much worse than the disease: side effects are similar to those enduring various forms of chemotherapy, but at a minimum may be described as having the worst flu you can imagine for the first two to three months, and then it gets worse!
HCV “cures” are defined as “no longer active” or “no longer appearing” and if caught in the early stage, liver enzymes should all be in the normal range. No one really knows if there is a permanent cure.
Underwriters will want to evaluate liver damage, such as enlargement, sclerosis or cancer, and naturally evaluate alcohol use above a very moderate amount (which has demonstrable other benefits), but also the patient/applicant’s follow-up blood series regimen. Testing should be every six months at a minimum.
Depression and HCV are two insidious, hard-to-diagnose, hard-to-cure diseases we’ll likely hear a great deal more about, and thus, field and home office underwriters do have some challenges and opportunities.
For my part, I’d love to hear from those underwriters taking a fairly liberal stance, so I can buy more, lots more life insurance at a reasonable rate! You have no idea how wonderful our life insurance products are until they are unavailable!
Larry L. Cox, CLU
Insurance Company Consultant
Cox Insurance Marketing Solutions
Lake Park, Minn.
Reproduced from National Underwriter Life & Health/Financial Services Edition, December 3, 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.