“Tell me what he’s taking, and I’ll tell you what he’s got!”
How well I remember writing that phrase for the first time, on a flip chart during my first-ever agency visit to lecture about underwriting back in 1977.
And how little did I realize back then what a powerful statement this would come to be in 21st century risk management.
Considering current issues surrounding medical record procurement, in context with the ever-widening embrace of teleunderwriting, it is Rx details that now pave the road to faster, more accurate underwriting assessments.
This is equally true whether the case is highly substandard or eligible for super-preferred.
Imagine, as an example, three middle-aged females all disclosing a history of a “nervous breakdown.” Their understandable reluctance to delve into detail, coupled with the vicissitudes inherent in extracting details from an attending psychiatrist, do not bode well.
However, if one knows precisely what medication was prescribed to treat this ambiguous condition, the risk may come squarely into focus.
Let’s postulate that the women were given Prozac, lithium and olanzapine, respectively. What does this tell us?
o That the first woman is surely the best risk of the three, quite probably “standard” if not even better.
o That the second is likely bipolar–formidable, yes, but not outside insurable boundaries in many cases.
o That the third may have schizoaffective disorder, if not overt schizophrenia.
We can extend this last scenario further, asking: What dose was prescribed?
A short course of olanzapine at 2.5 mg makes a compelling case for a period of intense anxiety (which may have completely resolved and therefore have little or no influence on our assessment), whereas 15 mg reinforces a “worst case” assumption.
Back to the first lady.
A comprehensive list of conditions potentially treatable with Prozac–not to mention the other widely prescribed drugs in the selective serotonin reuptake inhibitor (SSRI) family (Zoloft, Paxil, etc.)–doesn’t quite match the Manhattan White Pages in length, but it comes closer than any other prescription drug in the world!
Given the sheer number of those conditions, one would be correct to intuit that some reasons for using Prozac are questionable insurance risks, while others have little or no mortality (even morbidity, come to think of it).
To work through this scenario, the insurance underwriter needs some meat on the bones, so to speak. That being, obtain as much disclosure from the client as possible to amplify the circumstances that lead to the use of the SSRI prescription. (This is the perfect scenario for teleunderwriting.)
Quite literally, the more the underwriter knows, the better the odds of securing approval “as applied for.”
One of the most prevalent impairments raising an underwriter’s eyebrow is chest pain. Most patients who experience this scary phenomenon will go to an emergency room, be evaluated and sent home, strongly admonished to see their personal physician.
Does this sequence of events inherently mean the risk is favorable?
Not at all!
Everything now hinges on how the doctor assessed the problem.
If, in the end, the physician wrote a script for rabeprazole (acid reflux), the risk implications are entirely different than if he chose one of the mononitrates (angina).
Indeed, coupled with a tele-interview, the underwriter will likely act favorably on the first drug without medical records, whereas a full attending physician’s statement will be the minimum evidence driving a decision in the face of a nitrate compound.
This analogy could be extended to virtually all major impairments in any underwriting manual.
In consideration of all the foregoing, producers are well advised to get as much detail as possible from their clients about any and all prescriptions: drug name, dosage, times taken each day, and why the proposed insured believes he was given the medication.
Studies have shown that by age 65, many readily insurable individuals will be taking three, four or even more medications. Therefore, be especially mindful to clarify that you have all the drug use details when working with older age clients.
Given the profound insurability implications of prescription drugs, it comes as no surprise that more and more insurers are making use of prescription drug profiling services as a routine screening resource. This testifies to the critical contribution that drug details make to the process of making accurate underwriting decisions as quickly and “painlessly” as possible, without compromising mortality and morbidity expectations.
Hank George, FALU, FLMI, CLU, is president of Hank George, Inc., Greendale, Wis. His e-mail address is email@example.com.