Many times, the Big 3 diseases–diabetes, cancer and coronary artery disease–are involved in impaired risk cases, either individually or in some combination. This is particularly so with older clients. Here are some pointers on placing such clients.
Fact-finding is where it all begins. In the initial appraisal, don’t be afraid to ask questions about medical history. Too often, that fear is a disservice to the client and yourself.
Explain the attending physician statement and process–the way the insurer requests copies of the client’s medical records and history from the doctor so it can make an informed decision about the client’s health. The APS includes all lab tests performed, the results, other recommended tests and an explanation of forms needing signature (for authorization and Health Insurance Portability and Accountability Act compliance).
Some clients are reticent to disclose medical history. They believe that lack of full disclosure will hide the facts from the insurer. But this is incorrect, since insurers will have access to the Medical Information Bureau, which contains relevant information such as whether the client has applied multiple times with various insurers and if those apps were declined or highly rated. It’s the broker’s job to encourage clients to be forthright and candid about their medical history. It’s also in the client’s best interest to be open, as this will help avoid problems when attempting to secure coverage.
Heart disease. Heart disease is the primary concern of underwriters, since cardiovascular disease is the number one killer of both women and men. When there is a history of coronary artery disease, ask the key questions shown in the chart.
Diabetes. Diabetes is characterized by a high glucose (sugar) level. Diabetes control is monitored by testing Glycohemoglobin in the blood, also known as Hemoglobin AIC. The AIC level is normal at 6.0 or less and acceptable at 7.0 to 9.0. A reading of 9.0 or greater shows very poor control.
One client may have a reading of 11 (poor control), while another may have a reading of 6.7 (good control). If there is good control, this will work in the client’s favor for underwriting purposes. If not, the underwriter will have concern, and this can be reflected in a rating (extra premium charge) for that client.
Additional questions to ask: What medications is the client taking and what is the dosage? Does the client exercise regularly? What is the client’s diet (fast foods or lots of vegetables)?
Cancer. When considering clients who have a history of cancer, review these 2 measures: grade and stage.
“Grade” refers to the “aggressiveness of the cancer.” The higher the grade, the more rapid the growth of the cancer. Most cancers are graded 1-5: Grade 1 is most favorable (a low-grade malignancy), while Grade 5 has a less favorable prognosis (high-grade malignancy).
“Staging” refers to the extent of the tumor/mass, size and/or spread. It, too, is graded from 1-5, according to how limited or invasive the cancer has been.
Prostate cancer is a cancer that brokers come across quite often with older male clients. With such cases, it helps to provide the Gleason Score, a specific measure only used for prostate cancer. It grades the tumor’s aggressiveness on a scale of 2-10.
These men would probably have had a PSA (Prostate Specific Antigen) test performed, too. This is a marker for prostate cancer. What is acceptable varies with age and PSA level. For example, a 4.5 PSA might be acceptable for a 75-year-old male, but it would be considered high and require further testing for a male aged 35-40. Note: In the past few years, company underwriters have differed in how they actually view prostate cancer. This could be reflected in a standard offer with a small flat extra, whereas before, the case might have been declined outright.
Breast cancer, much like prostate cancer, is also being aggressively underwritten by a number of major insurers. For example, a number of major companies today would consider making a standard offer to a female, age 40, with a small-localized Stage 1 cancer, good follow-up and no recurrence.
Having a history of cancer does not always mean the client will be declined or highly rated. So it’s important to gather the relevant information, such as: tissue of origin (i.e., colon, prostate gland or breast), grade, stage, time since diagnosis, type of treatment, time since treatment ended, and relapse or reoccurrence. Remember, even if the client asks the advisor’s opinion, the advisor’s role in this process is only to obtain factual data, not to interpret the meaning of the facts.
Careful, thorough fact-finding can and will benefit the client and the client-advisor relationship. It helps to avoid unnecessary issues that will certainly arise later in the process if not addressed up front, particularly concerning the Big 3: coronary artery disease, diabetes and cancer.