But My Doctor Says I’m Fine

Sometimes, medical tests done for underwriting purposes point to a potential health or mortality concern, even when the client has received a clean bill of health from their attending physician. This can result in the client being offered a ‘rated’ life insurance policy or being categorically declined coverage altogether even though the client reports, “But my doctor says I’m fine!”

For example, gamma-glutamyl transferase (GGT) is a marker for liver function and alcohol abuse and is a well-established insurance screening test. Marked elevation of GGT is associated with adverse health outcomes and higher mortality, with high-to-normal findings associated with excess risk. High GGT raises serious concerns for the insurance company underwriter and can warrant a rating or declination.

There is a conundrum between clinical medicine and insurance underwriting which the PPI Advisory Advanced Underwriting team aims to bridge. The team’s challenge is to work with the insurer’s underwriter to explain the use of insurance testing to medical clinicians and encourage them to provide client-specific insight, investigation, and intervention where appropriate. In best case scenarios, the team and/or underwriter will forward insurance test results to the attending physician to investigate and rule out serious medical causes, which can result in a more favourable outcome from the insurer.

In one case, an insurance test for a female non-smoker showed abnormal ECG findings which caused the case to be rated. The attending physician, who had deemed her to be low-risk with an impeccable medical history, was surprised by this outcome. But upon further discussion with the physician, which centred on the ECG findings and risk stratification norms, the doctor had a better understanding and initiated some further investigation which came back as normal – so the rating was removed, leaving the client happy.

The conundrum between clinical medicine and insurance underwriting remains, but education helps. As an advisor, you can learn more about how to analyze risk level and potential underwriting implications to position your client’s case for the best possible underwriting outcome. Log in to Know the Risk* and complete the education modules or view rating guides.

*Know the Risk is available exclusively to advisors affiliated with PPI.

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