When the waters have already been muddiedArticle added by Tracy Hemmerle on May 3, 2012

Tracy Hemmerle

riverside, CA

Joined: August 28, 2008

Cleaning up a mess, especially one that you did not make, is never fun. But it is an opportunity to show your client that you can truly handle the tough cases.

Often, an agent is presented with a case which was previously shopped by another agent and IMO without success. Typically, the application was either declined or a rate class was given that was not believed to be competitive.

While successfully obtaining coverage for these individuals is often possible, there are some things which the agent can do that will ultimately simplify the process and help us to have a successful outcome.
  • Tell us where the case has already been submitted (formally and informally). Which carrier(s) has already reviewed it (formally and informally), and what was the outcome of these applications?

  • Please provide us with the details of the decision/offer which was received from each carrier. If the case was declined, what were the specific reasons stated? A copy of the declination will have all of this information. We may ultimately take the case back to the same carrier, but we will want to further develop any underwriting issues in order to avoid a repeat of the prior decision.

  • If the case was declined due to lab results obtained during the application process, ask the client to request a copy of the results from the carrier and to provide us with a copy of the results so we may determine the issue, look to place it elsewhere and formulate a plan, etc.

  • Realize that due to the prior submission, codes have likely been added to the MIB and that all markets will now be made aware of any medical history again as soon as an application is submitted. For this reason, we’ll need to have a full understanding of the client’s medical history and be prepared to demonstrate why we feel that the client is truly insurable or entitled to a more competitive offer.

    We’ll need to gather facts and details that demonstrate that things have essentially changed or that the initial decision given was actually incorrect.

  • Accept that positioning the case for approval may take a bit of additional legwork and that it may not be a quick process, even if the client truly is in good health.

    Often, we will ask for medical questionnaires to be completed, we’ll want to see medical records and we may have to ask the client to obtain additional information and/or results from their attending physician.
Cleaning up a mess, especially one that you did not make, is never fun. But it is an opportunity to show your client that you can truly handle the tough cases! It can be rewarding, both emotionally and financially, to obtain an excellent offer on a case which previously couldn’t be placed.

In order to find the most competitive offer for your client, it is important to know not only the details of the client’s medical history, but also the history of application process which has been completed to date in regard to the applicant, so that we can present it correctly and demonstrate why we feel the applicant is actually insurable.
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