Crohns Disease Is Serious, But Its Not An Automatic Turndown

When presenting any case to underwriting, its essential that the agent make clear if there has been a treatment history and good follow-up.

The same holds true when presenting to underwriting a client who has Crohns disease. Well look at some strategies for that here. First, though, lets review the basics of Crohns disease.

Also referred to as regional enteritis, Crohns disease can affect any part of the gastrointestinal system from the mouth to the lower colon, where it can cause chronic inflammation. Most frequently, it affects the colon and small intestine, causing intestinal swelling, obstruction and scarring of the intestines.

The disease inherited its name from Dr. Burrill Crohn in the early 1930s, and today, it is estimated that approximately 1 million people suffer from it. The affected age groups tend to be in 15- to 30-year-olds and also 50- to 65-year-olds.

Currently, there is no known cause. Some experts believe it occurs when the body responds to a bacterial infection or virus, which in turn causes the intestinal walls to become inflamed.

A common result of the disease is a deficiency in the bodys ability to absorb food properly, due to excessive diarrhea. As a result of this malabsorption, the body suffers from lack of protein, calories or vitamins. Other related complications include liver problems, sores or skin rashes, kidney or gallbladder disease, and arthritis.

It can be a very serious affliction. Crohns disease can lead to colon cancer, for instance. Cancer of the colon and small intestine are more common in patients with Crohns disease than in the general population. Unfortunately, this risk rises as the duration of the disease increases.

Treatment can be administered in several different ways. For instance, some use dietary planning, such as avoiding foods known to increase disease activity. Types of foods, such as carbohydrates, have a big influence on intestinal microbes (yeast and bacteria). Further, lactose-filled products, refined sugar and most grains should be avoided.

What about medicinal therapies? Many medications have been designed to decrease inflammation within the bowel. For instance, many people take steroid medications.

However, the steroid regimen can be a controversial issue with some underwriters. That is because some experts believe the toxicity of steroids outweighs the merits of the treatment. In addition, some are concerned that steroids may produce unpleasant and potentially troublesome side effects.

Another drug therapy includes Azulfadine, or sulfasalazine. These drugs work as anti-inflammatory agents.

On an optimistic note, research continues to make progress in treating this disease. There are new medications such as Remicade (infliximab), which the Food and Drug Administration approved for the treatment of Crohns, starting in 1998. Infliximab works with the bodys immune system in neutralizing the activity of “TNF alpha” (a pro-inflammatory chemical that the body produces; its considered to be a main cause of inflammation).

In fact, some researchers say their studies prove that people who were dependent on steroids to control moderately active Crohns disease were able to turn their control over to infliximab and maintain clinical remission.

Another common strategy for dealing with Crohns disease is surgery. This is done to relieve blockage, bleeding or other complications. Experts predict that, in due time, a vast majority of patients will require surgery, many having two or more operations during their lifetime.

Although there is no cure for Crohns disease, the future is bright. Prognosis is variable and some individuals experience only one or two attacks and may be completely asymptomatic after that.

The disease may also go into a sort of remission or become inactive, not showing up for months or even years. And, as medical progress continues, Crohns disease patients may some day benefit from the discovery of a cure.

Unfortunately today, some individuals who have this disease experience severe diarrhea, weight loss and the need for intravenous feeding. The condition in such cases may be uninsurable.

Therefore, when packaging your case for underwriting, be sure to understand the diagnosis, its severity and its duration. If the evidence shows the disease is progressing, this may suggest the severity is on the high side, and the client may require a higher underwriting rating.

If your clients history shows several operations have been performed, this may suggest an even more severe condition.

The message for you, then, is to develop complete information about the clients medical history, including symptoms and medications currently being taken and those administered in the past. For instance, since you know that the risk of cancer increases with the duration of the disease, look for adequate follow-up care, including colonoscopies and biopsies. Look for blood tests, as well, because underwriters will want to see if there are signs of anemia and intestinal bleeding. A high white blood cell count is a sign of inflammation.

Remember, its important to understand these basic facts about your Crohns client, so be sure to ask the proper questions. Good communication between you and the client will help you effectively organize the case for evaluation.

Crohns disease is not an automatic turndown. Some cases can and will be placed, if carefully selected and developed. Your goal should be to obtain the best possible underwriting decision by presenting the pertinent information accurately and in an organized format.

Elizabeth V. Cammarota is vice president at Brokerage Professionals Inc., Phoenix, Ariz. Her e-mail is beth@bpim.com.


Reproduced from National Underwriter Life & Health/Financial Services Edition, November 18, 2002. Copyright 2002 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.