A formal case was recently submitted that the carrier rated at table eight due to a history of melanoma, diabetes, and asthma. Our underwriter
’s first impression was that the rate seemed excessive for the following reasons:
- The melanoma was over a decade old.
- The diabetes was well controlled.
- The asthma was mild to moderate at worst.
The carrier underwriter noted most of the rating was due to a history of stage four melanoma (which denotes melanoma with distant metastases to other organ systems).
Our underwriter reviewed the case carefully. The original records related to the melanoma were not available for review and, unfortunately, there was no pathology report. It is often difficult to track down an old pathology report especially when the surgery was performed over 10 years ago.
The APS we received mentioned the melanoma as "stage four " on one page and "level four " on another page. Our underwriter noticed the mention of stage four was by the proposed insured, not the doctor
. The proposed insured reported the staging to his new doctor as stage four.
Our underwriter felt that the notation of level four seemed more likely a reference to Clark’s Level (Clark’s Level is an outdated method of staging that refers to the pathology assessment within layers of the skin) – Clark’s level four is not the same as stage four.
Feeling that the staging reported may be incorrect, our team ordered an additional APS. Although this new APS did not have the original pathology report, it did have unambiguous staging information. It reported the stage as stage two, not stage four. With this evidence in hand, we had a persuasive argument and the carrier reduced the rating by five tables to a final offer of table three.