As mortality and morbidity underwriting undergoes a much-anticipated metamorphosis to accommodate the demands of the 21st century, the need for fast, reliable and cost-effective screening resources has come into clear focus. The purpose of this paper is to examine the extent to which Rx profiling is one of these resources.
Knowing which pharmaceuticals an insurable applicant is taking has always been a key goal of medical history-taking. It is axiomatic that if we know what Rx an individual is taking, we have keen insight into his medical history. It is an a priori assumption, therefore, that Rx profiling services will serve to enrich our ability to relate pharmaceuticals to medical histories.
While we underwriters do not get directly involved in the sales process for the most part, there are likely some advantages to accrue to us if we suggest some “angles,” if you will, that help our producers make the value of CI policy ownership clear to prospective customers.
This is one approach that I think has merit, especially in the USA.
Cardiovascular events are the #1 cause of mortality (and morbidity).
Our traditional screening approach to cardiovascular disease has elements that confer value. But there are also prevalent screening modalities that have considerable expense and delay baggage, and may also be overvalued when compared to more progressive alternatives.
To determine insurability of applicants age 65 and over on the same basis as we do at younger ages all but guarantees a botched job.
This is because factors that we know contribute to premature death in young and middle-aged adults differ dramatically from those linked to excess geriatric mortality. These examples give clear evidence of this too-often-overlooked reality.
“In the literature, there is still a pervasive lack of recognition between skeletal muscle injury and ALT elevation, which has led to the unsubstantiated conclusion that serum aminotransferase elevations are due to liver injury...”
Rahul A. Nathwani et al.
Division of Gastroenterology and Liver Diseases
University of Southern California School of Medicine Hepatology
In underwriting, we are seeing an increasing number of cases of chronic hepatitis C and nonalcoholic fatty liver disease (especially nonalcoholic steatohepatitis, NASH) wherein the proposed insured has not had a sufﬁcient clinical workup to determine if advanced liver pathology (signiﬁcant ﬁbrosis, cirrhosis) is present.
This is a key determination regarding insurability and the absence of this information has forced us to take uncertain actions…certainly insuring some who are bad risks while postponing others who are insurable.
This survey was undertaken by sending questionnaires to 55 North American life and health insurers.
Of that group, 45 responded. Not bad.
It is ﬁrmly against my policy to name companies in the context of any survey or to make them identiﬁable in any way based on their responses. Sufﬁce to say that the majority of the TOP TWENTY life carriers are here.
Teleunderwriting embraces multitudes. It is, at the same time, both a technical process that reconfigures day-to-day home office underwriting and a dynamic process that affects every aspect of how we select risks.
Let’s explore the technical aspect first. Teleunderwriting makes extensive use of the telephone as an information gathering resource. One day, the Internet should play an equivalent role…but, for now, the telephone is our focus.