We received a request for $42,345 of universal life (UL)
coverage on a 79-year-old female in November 2012. The application only indicated a past history of a heart murmur, bronchitis and some mild arthritis in her knuckles. The client was illustrated at standard rates.
The medical records arrived and the history indicated on the application was confirmed and acceptable for a standard offer. However, lab
results from 2009 showed a concern for abnormal kidney function with a GFR at 46. Repeat labs done by the doctor in December 2011 still seemed to indicate some level of abnormal kidney function with a GFR of 48.
The carrier reviewed and assessed her at table D rates. The file was referred to our underwriter
The National Kidney Foundation defines chronic kidney disease (CKD) as either kidney damage or GFR <60 for at least three months. Interestingly, The National Kidney Foundation definition and classification of stages of CKD would judge this client to be stage III, considering only the GFR result. According to the Foundation, GFR 30-59 is considered a moderate reduction in GFR and stage III CKD, not stage II. Stage II would be a GFR from 60-89. In the business of underwriting, however, we find that GFRs are often noted as directional values rather than point statistics, and anything noted as “>60” would be acceptable as long as all else appears normal.
Per the medical records, the client’s GFR values remained stable since 2009 and her doctor noted the kidney disease was mild. Estimating GFR and kidney health should take into account many factors such as age, gender, build and race.
When our underwriter accounted for all of the above factors and plugged them into the GFR calculator, it showed her GFR was actually normal for her age.
Our underwriter also noted several clinical studies showing that it is not uncommon to find a deterioration in renal function in older clients due to age-related changes in organ function and tissue structure.
Additionally, the client had normal blood pressure. High blood pressure
can damage kidneys and can also be the result of poorly functioning kidneys. However, the client’s blood pressure was fine.
Lastly, the client had a normal microalbumin level. Microalbumin occurs when the kidney leaks small amounts of albumin (a type of protein) into the urine due to kidney damage. The microalbumin value is a good marker for kidney damage and is often used in differentiating between different stages of disease. Her lab results were fine.
Our underwriter argued that notwithstanding the reduction in GFR, it appeared more likely this was age-appropriate reduction
and not a pathological process. In spite of a reduced GFR, there appeared to be no other signs of kidney damage. Our underwriter argued any deterioration of kidney function was mild and the rating should be reduced.
Given her age and the stability of her GFR, as well as her normal blood pressure readings and microalbumin level, our underwriter was able to negotiate a reduction in rating from table D to table B. The carrier would not consider a standard rating due to the GFR value.