One of the first questions you’ll see on most life insurance applications is whether or not the applicant has Alzheimer’s disease, dementia or any form of cognitive impairment. In most cases, a “Yes” response is often the precursor to declining your policy. However, understanding these impairments will help get your client full consideration – and potentially a policy in hand.
The word dementia is really just a general term used in describing symptoms caused by disorders of the brain. Symptoms are things like memory loss, or difficulties with thinking, problem solving or language.1 The most common type of dementia is Alzheimer’s disease. Typically, if you have been diagnosed with end-stage dementia or Alzheimer’s disease, the condition has progressed enough that it interferes with activities of daily living. This decline in cognition is severe enough to generally exclude consideration for traditional life insurance plans.
Mild Cognitive impairment or MCI is a decline in memory and personality that could produce alterations in judgment, behavior and language. Mild cognitive impairment is a disorder that presents with measurable memory decline, but the client is able to independently perform all usual activities of daily living successfully. This is not to be confused with basic forgetfulness or not being able to recall a name on occasion. However, it’s important to understand the signs and symptoms. In fact, there are several causes of mild cognitive impairment that are actually reversible. To name just a few: thyroid dysfunction, vitamin deficiency, medication side effects, sleep disorders and even stress.
In general, a medical workup for cognitive impairment will include:
If the workup doesn't create a clear clinical picture, the doctor may recommend neuropsychological testing, which involves a series of written or computerized tests to evaluate specific thinking skills.2
To help best negotiate a life insurance offer, we must work together to determine the actual diagnosis and how it was made. We must understand the severity of the client’s symptoms or lack even lack thereof.
It’s important to highlight all of the favorable factors. This would include having regular preventative health care and immunizations, as well as compliance with any prescribed medications. You should also make note of a routine that involves gainful employment, regular exercise, hobbies, participation in social activities and the ability to travel or take vacations. It also helps to point out if there are any family members with longevity as well.
What does this all mean for your clients’ chances of securing life insurance? Carriers are continually re-evaluating their manuals when it comes to older age underwriting and cognitive impairment, giving more opportunity to secure affordable life insurance.
Clearly, many factors need to be taken into consideration for underwriting, and Ash Brokerage is here to help. To help assist you in gathering the needed information, we have developed a Cognitive Impairment Questionnaire. Give our experienced underwriting staff a call to discuss your case.
Dianne Leidigh has earned an unwavering reputation, among customers and constituents alike, as a respected partner and trusted resource. Through her personal commitment to continuous professional growth, she’s become an Associate of the Life Management Institute, Associate of Customer Service with LOMA, and an Associate of the Academy of Life Underwriting. As Dianne approaches her second decade in the brokerage life insurance industry, much of which dedicated to advocating risk, her passion for helping others, commitment to personal growth, and perseverance continues to yield truly winning solutions!
Ash Brokerage Cognitive Impairment Questionnaire: https://ashcmsstorage.blob.core.windows.net/media//Docs/uw/impairment/Mild_Cognitive_Impairment.pdf
1Alzheimer Society Canada, “What is dementia?”: http://www.alzheimer.ca/en/About-dementia/What-is-dementia
2Alzheimer’s Association, “Mild Cognitive Impairment”: https://www.alz.org/dementia/mild-cognitive-impairment-mci.asp
Do you know somebody with Breast Cancer? It’s highly likely that you or somebody you know has been diagnosed with breast cancer at some point.
In 2017 alone, it is estimated that more than 300,000 new cases of invasive/non-invasive breast cancer will be diagnosed in women in the United States; this does not include the more than 3.1 million women who are currently being treated or have completed treatment. And, it’s not just women who are affected. A man has a 1 in 1,000 risk of developing breast cancer; in 2017, nearly 2,500 men will be diagnosed with this disease.1
A diagnosis of breast cancer is not a death sentence. There continues to be a decline in deaths from breast cancer every year, thanks to early detection and improvements in treatment. Breast cancer cannot be prevented, but early detection is paramount. Mammography continues to improve and is the gold standard for breast cancer screening because it can detect breast cancer up to two years before a tumor can be felt by you or your doctor.
Genetic testing has played a huge role with early detection in those individuals with a family history of breast cancer. Abnormal BRCA1/2 genes accounted for 1 out of every 10 cases of breast cancer. If you have been found to have BRCA1/2 mutation, you have an 80 percent risk of developing breast cancer during your lifetime. These mutations are rare in the general public, but testing should be considered when there is a strong family history of breast cancer.2
What does this all mean for your clients’ chances of securing life insurance? The continued increase in survival with breast cancer has resulted in lower mortality rates. Carriers are continually re-evaluating their manuals when it comes to breast cancer, giving more survivors the opportunity to secure affordable life insurance.
Still, many factors need to be taken into consideration for underwriting. Ash Brokerage is here to help. To help assist you in gathering the needed information, Ash has developed a Breast Cancer Client Questionnaire. Give our experienced underwriting staff a call to discuss your case.
1BreastCancer.org, U.S. Breast Cancer Statistics: http://www.breastcancer.org/symptoms/understand_bc/statistics
2American Cancer Society, “Breast Cancer Risk Factors You Cannot Change”: https://www.cancer.org/cancer/breast-cancer/risk-and-prevention/breast-cancer-risk-factors-you-cannot-change.html
Breast Caner Underwriting Questionnaire: https://ashcmsstorage.blob.core.windows.net/media//Docs/uw/impairment/Cancer-Breast.pdf
With the majority of her 20-year brokerage insurance career spent as an underwriting advocate to a diverse customer base, Kim Schrass has built long-lasting partnerships throughout the industry. The depth of her knowledge coupled with her competitive spirit of winning have earned her significant credibility among her customers and peers alike.
Do you know the top two leading causes of death among men in the United States? If you answered heart disease and cancer, you are correct!1 What you may not know is that prostate cancer is the most prevalent type of cancer among men. Currently, nearly 2.9 million American men are living with the disease, and the American Cancer Society estimates that in 2017, 161,360 men will be told they have prostate cancer.2 With these statistics, there is a high probability you will encounter the opportunity to protect a prostate cancer survivor, if you haven’t already.
As a result of increased preventative screening to include Prostate Specific Antigen (PSA) – normal values between zero and four – digital rectal exam (DRE), and advancement in treatments, early detection is naturally higher.
When Prostate Cancer is diagnosed, usually through a biopsy procedure, a specific stage will be assigned. The staging refers to the extent of the cancer (how much cancer is present and how far it has spread), stage I-IV. Staging is a big piece of the puzzle in underwriting, along with a Gleason Score, which is based on the tumor pattern the pathologist sees.
All of these factors have improved many life insurance carriers’ underwriting guidelines, leading to decreased postponement periods and more favorable ratings. The key to successfully insuring your prostate cancer survivor is understanding what information is important to find the very best solution.
Two important pieces of information will be whether or not they are in full remission/cancer free and for how long (month/year the remission was established). The longer your client has been cancer free, with regular follow-up and testing, the more favorable their offer may be.
For most life insurance carriers to give consideration of someone who has a history of prostate cancer, the client must fully complete treatment (surgery, radiation, chemo) and often the carrier will require a waiting period, referred to as a postponement period. The extent of the rating and duration of postponement varies depending heavily on the stage of the prostate cancer, type of treatment, and date of last treatment. Risk philosophy also varies from carrier to carrier based on the reinsurance manual used or the carrier’s own proprietary guidelines.
With increased early detection, we are seeing more and more cases with these considerations. Active surveillance or watchful waiting means the client’s physician is treating them by regularly monitoring the client’s lab markers (PSA, CEA, etc.) on an interval basis and closely monitoring PSA velocity.
This treatment option may be elected with a first-time diagnosis or biochemical recurrence. A biochemical recurrence happens when the PSA levels transition from undetectable to detectable, generally increasing, and may occur among men treated with radical prostatectomy or radiation for localized prostate cancer. These clients require careful consideration on an individual basis with the most favorable being age 65 or older, initial diagnosis Gleason Score of six or less, availability of favorable PSA trending documented over several years, and being three or more years out if previously treated.
Let Ash Brokerage assist you with your next Prostate Cancer case. To simplify fact-finding, use our Prostate Cancer Questionnaire. We leverage our experience, carrier relationships and resources to identify viable solutions based on your client’s individual circumstances and insurance needs. Reach out to your underwriting team for information or assistance.
1Centers for Disease Control: https://www.cdc.gov/healthequity/lcod/men/2014/index.htm
Ash Brokerage Underwriting Questionnaire:http://go.ashbrokerage.com/rs/535-YRX-827/images/Cancer-Prostate.pdf
Julie’s unwavering passion and dedication for risk advocacy promotes lasting partnerships while driving impactful results for all stakeholders, from our agents to our carriers. She leverages her 20 years of industry experience with her relational approach to ensure you experience the Ash difference.
So your client is planning a trip outside of the United States. While their travel list may contain things like flip-flops, sunblock, beach towels, and toothbrushes, a life insurance underwriter’s travel list will often include things like political climate, crime rate, access to health care, participation in risky activities, and length of stay. These are just some of the many angles from which an underwriter is going to evaluate your client’s foreign travel risk.
When an underwriter talks about political climate, they are often referring to countries or regions where governments may be unstable or where governments have unfavorable opinions of the United States. Of the many lenses from which an underwriter evaluates a case, this is likely the most obvious, because oftentimes, these areas are the ones commonly seen on the news – the Middle East, Venezuela, the Philippines, and much of Africa.1 While travel to these countries/regions may not eliminate your client from potential coverage, the political climate in these areas raises some obvious red flags in consideration for your client’s safety.
So your client isn’t going to a politically unstable region, they should be good to go, right? Not so fast … The local violent crime rate is a major factor an underwriter takes into consideration when evaluating risk. A prime example of this is Acapulco, Mexico. When most people think Acapulco, they think beautiful beaches, a bustling nightlife, and wonderful golf courses, but when you look under the surface, another amazing characteristic jumps out … Acapulco, in 2016, had the second highest murder rate in the world, checking in at 113.24 murders per 100,000 residents, which is nearly twice as high as the most violent city in the United States.2 This, again, won’t automatically eliminate an individual from coverage, but does have potential to result in an adverse action depending on the client’s plans while there.
Another consideration while examining travel is access to health care. Should the client be injured or become ill during their trip, what is the quality of health care that they would receive? And, how far do they have to travel to receive care? There is a clear risk if health care is substandard or difficult to obtain.
While traveling, will your client be participating in any potentially hazardous activities, such as mountain climbing, SCUBA diving, sky diving, or any other avocations that could add to their potential risk? While many of these activities carry an innate risk in and of themselves, when compounded with possible language barriers and/or poor access to health care, an adverse underwriting action can occur.
Lastly, the length of your client’s stay abroad may affect their potential rating. If a client is planning a trip that is less than six months, then assuming they otherwise qualify based on the above criteria, there is generally no concern. But, if their expected stay crosses the threshold of six months, they become foreign residents and thus are evaluated differently. In some cases, a country can be OK for travel, but not OK for foreign residence, and an adverse action may be taken.
Overall, there are many considerations that go into foreign travel risk. If you have a client who has travel plans in which you suspect may result in an adverse underwriting action, consider that clarity is key and that a detailed cover letter can eliminate many concerns about your client’s upcoming trip. Check out our Foreign Nationals and Travel Questionnaire, a guide that can help you collect all the information you need for underwriting.
Should you have any questions about any of your potential clients, please don’t hesitate to reach out to an Ash Dedicated Underwriter, and we would be more than happy to answer any questions that you have.
Foreign Nationals and Travel Questionnaire: https://ashcmsstorage.blob.core.windows.net/media//Docs/uw/impairment/Foreign_Nationals_and_Travel.pdf
1U.S. Department of State, Travel Alerts and Warnings: https://travel.state.gov/content/passports/en/alertswarnings.html
2Business Insider, “The 50 most violent cities in the world,” April 8, 2017: http://www.businessinsider.com/most-violent-cities-in-the-world-2017-4/#50-durban-south-africa-had-3443-homicides-per-100000-residents-1
Joe Taulbee has been in the life insurance industry for nearly 11 years with more than five years as an underwriter, and he’s helped numerous families and individuals gain much needed financial security and peace of mind through the procuration of life insurance. He has an Associate designation (AALU) through the Academy of Life Underwriting and is currently pursuing an underwriting fellow designation with ongoing LOMA coursework.
Hepatitis C is a blood-borne virus. Today, most people become infected with the Hepatitis C Virus (HCV) by sharing needles or other equipment to inject drugs. But, according to the Centers for Disease Control, baby boomers seem to be at higher risk – your clients could be infected and not even know it!
The CDC explains people born from 1945-1965 are five times more likely to have HCV than other adults. The reason is not completely understood. “Baby boomers could have gotten infected from medical equipment or procedures before universal precautions and infection control procedures were adopted. Others could have gotten infected from contaminated blood and blood products before widespread screening virtually eliminated the virus from the blood supply by 1992,” the CDC says. 1
The Hepatitis C virus is a common, infectious virus that targets the liver; still this illness can appear in many other body systems and organs. Studies have found that between 70 and 74 percent of those with Hepatitis C experience extrahepatic (outside the liver) manifestations which could affect the brain, eyes, thyroid, joints and muscles, digestion, glucose control and the hands and feet.2
For some people, hepatitis C is a short-term illness, but for 70-85 percent of people who have HCV, it becomes a long-term, chronic infection.3 Chronic HCV is a serious disease than can result in long-term health problems, even death. Unfortunately, the majority of infected persons may not even be aware that they are infected as they do not feel ill nor do they experience chronic symptoms.
There is no vaccine for Hepatitis C. The best way to prevent it is to avoid behaviors that can spread the disease, especially injecting drugs.
Harvoni (ledipasvir/sofosbuvir) is currently one of the most advertised prescription treatments for HCV and has shown tremendous results. In clinical studies, most patients with HCV genotype 1 who had no prior treatment were cured with just 12 weeks of therapy. Most infected patients are experiencing little side effects and are able to tolerate the medication.
Unfortunately, the cure rates are not as high for people with cirrhosis who were previously treated unsuccessfully with interferon-based hep C regimens, people with decompensated cirrhosis and those with genotype 3 of hep C.
The typical treatment window is 8-12 weeks, with many patients clearing the virus (negative HCV RNA) as early as eight weeks. Once the HCV RNA has been negative for greater than six months after treatment, a person is considered to have sustained viral response (SVR) and is essentially cured.
Underwriters will consider multiple factors and test results when assessing the risk for an applicant with a history of HCV.
Aside from factors such as date and age of onset, symptoms, and prior treatments, they will also review serology, imaging (US/MRI/CT), biopsy results and scans. Today, there are more sophisticated blood tests (FibroSURE) and scans (FibroScan), which will measure liver damage (fibrosis and cirrhosis); these advances have significantly reduced the need for invasive, costly and riskier needle biopsies.
Applicants who have successfully cleared the virus (sustained neg HCV RNA more than six months) with no liver damage may be approved at preferred rate classes! (Depending on the carrier)
Applicants unable to clear the virus are considered chronic hepatitis C applicants and will be rated and possibly declined, depending on the individual’s overall factors and test results.
At Ash Brokerage, you have a dedicated staff of seasoned underwriters available to answer your questions regarding your clients with Hepatitis C. We’d welcome the opportunity to talk with you about your client’s specific needs. Also, be sure to check out our helpful questionnaire to use with your clients.
Ash Brokerage Hepatitis Questionnaire: http://go.ashbrokerage.com/WC2017-07-UW-Hepatitis_LP-Content.html?utm_source=blog&utm_medium=landing_page&utm_campaign=uw_questionnaire
1Centers for Disease Control and Prevention, “Know More Hepatitis”: https://www.cdc.gov/knowmorehepatitis/media/pdfs/factsheet-boomers.pdf
2HCV Advocate, “HCSP Fact Sheet, Extrahepatic Manifestation of HCV” July 2015: http://hcvadvocate.org/hepatitis/factsheets_pdf/extrahepatic.pdf
3CDC, Viral Hepatitis, Hepatitis C: https://www.cdc.gov/hepatitis/hcv/index.htm
4Centers for Disease Control and Prevention, “Testing Recommendations for Hepatitis C Virus Infection”: https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm
For more than 35 years, Charlie Kuhn has taken a personal interest in every case. To her, it’s more than a file – it’s a person trying to protect the people they care about, or a business trying to protect its future and the future of their employees. Charlie can think of no better vocation than to help provide financial and emotional security for others. Through her personal commitment to continuous professional growth, Charlie is one test away from becoming an Associate of the Life Management Institute. She is already an Associate of Customer Service with LOMA, has passed all three of the Academy of Life Underwriting exams, and is certified in EKG interpretation.
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