We received an informal file for a 70-year-old male who turned out to be quite an underwriting
challenge once we reviewed the medical records. With the help of our internal medical consultant, we were able to push through barriers to obtain coverage for the client.
In 2012, the client was diagnosed with refractory anemia, a form of myelodysplastic syndrome (MDS), formerly known as pre-leukemia. Patients with MDS often develop severe anemia and require frequent blood transfusions. In most cases, the disease worsens and the patient can develop low blood counts caused by progressive bone marrow failure.
The outlook for people with MDS is poor, and most patients will progress within a few months to refractory acute myeloid leukemia (a type of blood cancer
). The median survival varies from months to years.
Luckily, the client was diagnosed with the mildest form of MDS. However, based on underwriting guidelines, carriers postpone for two years from the time of diagnosis — and the client unfortunately was not even a year out. We shopped the case to several carriers and received offers ranging from table four to decline/postpone.
After reviewing the client’s history with our medical consultant, we were able to determine that the disease had been present since at least 2008 and was not new when finally diagnosed more recently. Furthermore, the client’s blood counts had been stable for years. Because of these factors, our medical consultant felt that the insured did not fit the full MDS profile, which has a one- to two-year life expectancy.
Our medical consultant’s review was further corroborated by feedback from the client’s hematologist (a medical professional who studies and treats blood conditions and disorders). According to the hematologist the client had a good prognosis based on the evidence of the case: blood counts have been only slightly low historically; the labs have been stable; and there has been no evidence of progression.
With our review in hand, we were able to negotiate a standard offer from one carrier and the case was placed
, resulting in $30,000 of premium.