Advisors constantly tell me that asking their clients about their medical histories are some of the most uncomfortable conversations they have. Many advisors’ customers are close or extended family, life-long friends, or friends of friends, and asking them detailed questions about their medications, surgeries they’ve had, how much alcohol they drink, or if they use tobacco, are all delicate subjects. This is a skill that even doctors spend years trying to perfect.
But the most successful advisors that we work with have become experts at explaining to their customers how this information will help to get them the most competitive offer possible. In no particular order, I’ve put together what I consider to be some of the least intrusive and most important questions that will get you the best bang for your buck when pre-underwriting your clients.
1. Family History
Asking about family history is one of the easiest and least intrusive questions that can be asked and one that many advisors don’t realize can dramatically affect the rate class that will ultimately be offered. When asking your client about their family history, you should ask about both parents and siblings; about ages of diagnosis of both cancer and heart disease, and the age at death if a parent or sibling did pass away from either cancer or heart disease.
Almost all carriers exclude their best three rate classes if either parent of the proposed insured has passed away prior to age 60 from heart disease. Note, however, that the rules vary between carriers if there’s only been a diagnosis of heart disease (no death), so always ask for the age at the time of diagnosis; and if there has been a death, it’s important to know their age at death as well.
The rules for cancer are more nuanced. Over the past several years the type of cancer that a parent or sibling was diagnosed with has become very important to many carriers. Many carriers are now only concerned with cancers that have a strong familial/genetic component. Some of these include, but aren’t limited to, breast, colon, prostate and ovarian cancer. Some carriers will also disregard a family history of cancer if the parent or sibling had a gender-specific cancer. For example, if an applicant is female and her father had prostate cancer, many carriers will ignore this when making their underwriting decision.
One last item regarding family history. There are a handful of medical conditions where only a family history of the condition can sometimes cause a decline. These include, but aren’t limited to, Polycystic Kidney Disease, Familial Adenomatous Polyposis, and an extremely strong family history of breast cancer with multiple first-degree relatives who have been diagnosed with breast cancer.
2. Patient Portal Lab and Test Results
One of the newest and best tools for pre-underwriting is also one of the best tools that consumers can use to take charge of their own healthcare. The online patient portal that most large healthcare systems now offer is a revolutionary way for your client to obtain invaluable medical information to help us pre-underwrite them for life insurance. Obtaining their last few sets of blood and urine test results and copies of any other test reports like colonoscopies, EKGs, MRIs, or echocardiograms can give us a huge jump on determining a best-case rating and which insurance companies will be the most likely to make the best offer. Even obtaining just the most recent blood test results that include blood glucose, cholesterol, kidney functions and liver functions can give us an inordinate amount of useful information.
3. List of Medications
Sometimes getting a list of your client’s medications can be awkward, especially if the proposed insured is taking an antidepressant or anti-anxiety medication or a medication for a condition that they feel is embarrassing. Most people have no problem providing a list of medications if you explain to them that the insurance company will eventually obtain a report via the Prescription Database that is ordered on every client. And if we have a list beforehand, we can again determine if there will be any underwriting challenges at any particular insurance carrier.
A list of medications also gives us a lot of information that the client might purposely withhold about their medical history or withhold through ignorance of their own health history. Some people take medications without knowing why and, as a result, don’t mention a condition that they have. Some tell us that they have a particular medical condition that they don’t actually have. Part of the reason for this is many doctors use euphemisms with their patients, such as “high sugars” for “diabetes.” The medications that have been prescribed help us investigate and determine what actual diagnoses have been made and sometimes we can even estimate the severity of the condition.
We can also avoid unnecessary declines if we know the medications prior to applying. A good example of this is the medication Naltrexone. If you google this medication, it says, “[Naltrexone] can help prevent relapses into alcohol or drug abuse.” This is absolutely correct and, until recently, this is exclusively what this medication was used for. Any note in medical records mentioning it, or if it came up on the Prescription Database report, would have caused an automatic decline. Some doctors however have started to use Naltrexone to assist in weight-loss, and there are now some carriers that will dig a little deeper and determine the exact reason that this medication is being used, and if there is no indication of alcohol or drug abuse offers are now possible.
Knowing if someone uses or has used a medication that might be used for multiple purposes can save weeks or even months in underwriting by applying with a carrier that will take the extra step and not issue an automatic decline.
4. List of Surgeries
This one may sound self-evident, but I worked on a case recently where the medical records stated that the proposed insured had his prostate removed several years earlier due to cancer. Strangely enough, this was the first indication we received that he had a history of cancer. The proposed insured wasn’t purposely misleading us…he truly didn’t understand that he had had cancer. We’ve found that doctors will many times use euphemisms with patients, and patients many times innocently hear what they want to hear.
But if, for example, we do discover prior to applying that someone had their prostate removed, the next obvious question that we can ask is, “Why?” The client still might not admit to a history of cancer, but at least we have a clue that they might have had a very low stage tumor and give alternative quotes. One quote would assume that they did have cancer and the second quote would assume they didn’t.
5. Cigarettes vs. Chewing Tobacco vs Cigars vs Marijuana
Tobacco rates with most carriers are two to three times the cost of non-tobacco rates. The price can quadruple if the best non-tobacco rate class was originally quoted. Therefore, obtaining the most accurate and detailed tobacco-use history up front can keep you from applying with the wrong carrier and spending weeks in underwriting before ultimately re-applying with the carrier that makes the most sense.
Determining the delivery system of the nicotine, the frequency of use, and the date of last use are the primary pieces of information that should be collected. This will help ensure that we quote the appropriate and most competitive premiums.
The rule with most carriers is that a single cigarette smoked within the past 12 months will cause an offer at tobacco rates. As of the date of this article, I’m aware of only one company that can offer non-tobacco rates if somebody smokes fewer than 24 cigarettes per year.
Chewing tobacco is treated identically to cigarettes at most carriers, but not all. A few carriers will offer non-tobacco rates, even with a urine specimen that’s positive for nicotine.
Most carriers will offer non-tobacco rates to occasional cigar smokers, but every carrier has slightly different rules about how many cigars per month or year are allowed, and whether the urine specimen can be positive for nicotine.
Finally, marijuana, which of course is not tobacco, but the rules are similar. The date marijuana was last used and the frequency of use will not only determine what rate-class each carrier can offer, but whether the client will be rated at tobacco or non-tobacco rates.
One of the most important pieces of information that advisors forget to ask are dates. Dates of diagnosis, dates of last treatment, dates of surgery, dates of medication use, etc. The ratings for many medical conditions are based on how long the proposed insured has had a particular condition or the date of last treatment. Therefore, it’s important to always try to pin down the most accurate dates for all information that you receive. If the client can’t give an exact date, an estimate is better than nothing. Knowing that someone was last treated for cancer around 2014-2015 is better than not having any information about the date of last treatment.
7. Driving History
An unexpected rating due to your client’s driving history is one of the easiest pitfalls to avoid by asking only a few simple questions. Many advisors think that only DUIs can cause extra ratings, but multiple non-DUI violations can be just as problematic. By obtaining details about every driving violation over the past five years, we’re able to choose the right carrier with which to apply. Remember, just like with medical underwriting, not every carrier has the same underwriting rules for driving history.
If your client has had any speeding tickets, then one additional question you should ask them is how much over the posted speed limit were they traveling? Carriers do rate differently if the violation was only five mph over the limit versus if the violation was 20 mph over. As noted in the previous section, it’s just as important to get dates of each driving violation that your client has had over the past five years to the best of their recollection.
8. A List of Doctors and Why They Were Seen
One more way to assist your client’s memory is to ask them for a list of doctors that they’ve seen over the past five years. Of course, many people won’t remember every doctor’s name or when exactly they saw them. If, for example, they tell you that they saw a dermatologist but they didn’t mention any dermatological medical history, this is an excellent way to collect additional medical history.
Getting this information can also help expedite the application process. If, for example, the insurance company finds a doctor on the Prescription Database report who prescribed a single fill of a narcotic pain medication a year ago and the client has already told us that they were prescribed pain medication for a broken foot a year ago, this could save time during the underwriting process that would otherwise be spent trying to clear up this information.
9. Results of Prior Applications
Obtaining information about offers on recent applications is helpful for two reasons. If, for example, we have what we believe to be all of the pertinent medical information on a client and we assess them as being Standard N/S, but they applied with another insurance company recently and were rated Table 6, then we can be relatively certain that we don’t have all of the pertinent medical information. And vice versa…if we have information that leads us to quote Table 6, but the client was recently offered Standard elsewhere, then we have to ask ourselves, “Are we missing additional information that would change our assessment; are we interpreting something incorrectly; or did the other carrier interpret something incorrectly?”
If another carrier recently offered your client Table 2 or Table 3 and we’re assessing them at Standard (or vice versa) then that’s very likely a difference in underwriting philosophies between the two carriers. Large discrepancies, however, can be used as a guide to let us know something isn’t right.
Another important reason to have details about recent offers is to use this information to negotiate with the second carrier to get a better offer for the client. Remember, insurance companies are competing with each other. They’ll never make unwise or irrational underwriting decisions, but if we can make a case for why your client should be offered a better rate class than what their competitor offered they’re more than happy to do so.
10. Use your IMO’s In-house Underwriter
The in-house underwriter at your IMO or BGA can be your best resource to obtain the best questions to ask your clients to ultimately get the most accurate quote. There’s nothing worse than having the underwriting offer come back other than applied for and having to ask for more premium than expected when you deliver the policy. Getting all of the important information, or at least all of the information that’s possible to get, up front can alleviate many headaches later on, especially if your client’s premium tolerance is inflexible.
If your client has a history of cancer, diabetes, heart disease, epilepsy, or any other specific medical condition, the in-house underwriter at your IMO or BGA should be able to get you the appropriate questions to ask in order to quote the case the right way the first time.
Those unhappy surprises during the underwriting process that can cause a delay, or even worse an extra rating or decline, should drop significantly if you follow the 10 steps I’ve outlined. As a result, the need to re-write an application with a second carrier should be a problem you no longer have and your business will continue to grow as a result.