Blogs (8)

Sometimes, medical records alone may not tell the entire story about a client. Extra effort and knowledge can go a long way in helping to place a case. Our underwriting team recently received a case on a 68-year-old male applying formally for $5 million of indexed universal life (IUL) with an annual premium of over $320,000.

Initial carrier decision

After reviewing the formal application and associated medical evidence, the carrier declined the case due to cardiac testing that they felt was indicative of dilated cardiomyopathy (heart failure).

Review

Looking at the medical records, our underwriter recognized that the client’s physical activity level was significant and felt there was cardiac remodeling consistent with an athletic heart rather than heart failure. While heart changes are associated with an athletic heart, they are benign and there is no associated excess mortality.

Investigation

Medical records often do not tell the entire story about a client — when this is suspected and when there is more information needed beyond medical records, it is very useful to conduct telephone conversations with the client and his or her physician. Our underwriter called the client to better understand his activity level as his records provided several hints that he engaged in strenuous sports. The client enthusiastically confirmed what we had suspected, so we asked the client for permission to call his cardiologist to gather additional information. The cardiologist concurred that the client had an athletic heart and no indication of cardiomyopathy. Noting how helpful the cardiologist was, we asked if the cardiologist would participate in a conference call with the carrier medical director and our underwriter — the cardiologist agreed.

Negotiation

A conference call with the carrier medical director and the client’s cardiologist was conducted. The carrier medical director was noticeably swayed by the additional information we provided and strong comments made by the client’s cardiologist. The discussion included performing a non-invasive test called a Multiple Gated Acquisition (MUGA) scan, a test to assess heart function. The group concurred that this test would provide definitive information concerning the client’s actual heart function. The client’s cardiologist agreed with our underwriter that the client should have a completely normal MUGA scan — the carrier medical director agreed to offer standard rates if the test results were normal. The client was more than happy to proceed with this non-invasive testing. As anticipated, the MUGA scan results were completely normal and the carrier approved this case at standard rates.

Summary

The end result was a standard placement of a case that was initially declined. Our underwriter recognized there was more to the story and extra efforts to prove this salvaged the case for the producer to provide the client with the coverage he needed.