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Enough Is Enough: No More Chest X-Rays, Treadmills In Underwriting

By Hank George

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In a bygone millennium, when insurer priorities differed radically from today’s, chest x-rays and treadmill stress tests were widely used to screen life insurance applicants. Inexplicably, this practice continues today, despite overwhelming evidence of its incredible incompatibility with contemporary agendas.

Consider: In a 2007 survey, 63% of 132 insurance companies acknowledged that they continue to insist upon age/amount treadmills. Only 18% doggedly persist in deploying chest x-rays in the same capacity. (This is from the 2007 Life Underwriting Requirements Survey by Hank George Inc., Greendale, Wis.)

While this is down somewhat from a decade ago, the very fact that these baggage-ridden tools have not been completely discarded is a sad paradox when one reflects on their imposing drawbacks:

o Both are unspeakably expensive. For example, estimates of the fee for performing a treadmill test–as recently reported by service providers–range from $500 to $800. Mind you, this is 10-15 times the outlay required for a handful of readily-accessible, client-friendly blood tests which would more than replace any value purportedly derived from these antiquities.

o Both take far longer to acquire than even medical records. Remember, one key reason why 75% of life insurers now embrace tele-underwriting is to reduce ordering of attending physician statements–due to legendary slowness.

o Both are highly subjective when assessing whether risk-significant abnormalities are present and what, if anything, should be done about them. Also, post-underwriting dialogue with clients’ attending physicians is the rule, not the exception, whenever adverse action is taken.

o Both completely undermine the insurance industry’s commitment to customer-friendliness. Is exposing clients to carcinogenic radiation among company priorities? What about compelling clients to work up a sweat, performing like caged gerbils? Are these arcane undertakings consistent with how the financial services industry is, and wants to be, perceived?

What is most egregious with treadmills is that 64% of companies persist in demanding them of clients as old as age 75.

Is this is a risk the life insurance industry really wants to take?

According to a prominent South African medical officer, there have already been 3 avoidable deaths due to this practice in his country. Who shall be the first in North America to face such a catastrophic event? Would this make an “interesting” installment on televised investigative news shows?

It would be difficult, to say the least, to defend any adversities associated with either of these requirements now that clinical medicine has disavowed their use in equivalent contexts.

Fact is, chest x-rays are no longer deemed appropriate to screen patients being admitted to the hospital in the absence of a firm clinical indication (suspicion of lung disease, etc.). Similarly, treadmill stress testing has been shown to be cost-ineffective as a screening tool for undiagnosed coronary disease in the general population.

Is it, for want of a better word, quixotic that many who argue against embracing new and innovative screening options–because the approaches are not yet widely used in medical care–also clamor to retain tests which their clinical peers have abandoned in the context in which some companies still use them?

Let the record show that there is no credible evidence that either chest x-rays or treadmill tests confer anything remotely akin to sufficient protective value to overcome their staggering drawbacks in a screening context. Nevertheless, many insurers persist in using them to the detriment of clients, budgets, app-to-issue turnaround time and liability insurance premiums.

Far superior alternatives, devoid of such weighty baggage, not only exist but are being phased in at this writing by leading progressive companies. Chief among these are outstanding new diagnostic tools such as cardiac marker NT-proBNP and hemoglobin A1-c (which is already used in underwriting diabetes).

Why would an industry that has invested so much in state-of-the-art advances in all domains of doing business choose to move forward with a readily-detachable anchor chained to each ankle?

The time has come to challenge the ways of the past. Industry professionals must insist upon seeing overwhelming and indisputable evidence that these 2 tests should be retained in the face of these damning realities. If that evidence is not forthcoming–and affirmed after objective scrutiny–then the industry is obliged to bring this chapter in the history of risk appraisal to an end before fate intervenes … and hand-wringing ensues.

Hank George, FALU, CLU, FLMI, is president of Hank George, Inc., Greendale, Wisc. His email address is [email protected]