Medical Underwriting

Have you ever heard of this condition? Is it in your underwriting manual? It should be!

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.

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 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.

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.