Laboratory findings are a usual part of the insurance application and, hopefully, complete the picture of a healthy applicant issued as applied for.
Sometimes, lab abnormalities are expected and go along with already known disease entities, such as diabetes and abnormal (even when mostly controlled) blood sugar measurements. Sometimes they may show entities that have to be declined or further investigated, such as with kidney failure or newly found elevated PSA levels. However, out of the clear blue, lab tests can come back abnormal and provide an unexpected surprise. They may be run again to make sure the results are matching to the initial ones, this is where drying tools can be useful. By preserving biological products tightly so that no cells are destroyed or tampered with, this gives the chance for the technician to run tests again without external interference.
At times when an insurer declines or rates a case for abnormal laboratory values, the first step is to find out more about the problem by asking, “Does it make sense?” given the applicant’s history and medical condition.
For example, a very high hemoglobin A1C for an applicant with diabetes will show that the disease is not controlled properly and must be taken into consideration when underwriting. Sometimes such a finding indicates newly found diabetes-before the applicant has been diagnosed by his physician.
Sometimes, though, the handling of samples, the conditions in which they were processed, and even the background of an applicant make the results less drastic than they initially appear.
Kidney function tests are a good example. Creatinine and BUN are two tests used from the blood profile (besides the additive help of a urine specimen). When both are highly elevated, they are most often indicative of kidney function compromise. However, BUN can be elevated with a normal creatinine when a person is simply dehydrated-either from water deprivation or even from a diuretic given to control blood pressure. Certainly, this is an explainable rather than a declinable circumstance. Other times, creatinine will come back very elevated and the case will be declined as renal failure even though BUN is normal.
Samples that are run many days after being drawn or manhandled in the mail are likely suspect, especially when an applicant’s previous health has been normal. Asking for a repeat test generally solves this dilemma.
Elevated PSA (prostate specific antigen) is a result that can cause adverse action on an application but does not always mean a policy won’t be issued. An elevated value shows an increased likelihood of prostatic cancer, but sometimes a value that has been previously investigated and is within the norm for that individual is as good as normal. Pointing that out to an insurer keeps the case moving along successfully.
In some circumstances, though, a normal PSA value may result in an adverse action. For example, a change in a short period from the low end of the normal range to the high end may show a disease process in evolution. In such circumstances, a doctor visit may either find a transient cause (infection, irritation) or one that requires further investigation to rule out a malignancy.
One other commonly found quandary is with liver function tests. Even in the absence of occult hepatitis, most individuals feel absolutely fine even though they have significant liver function test abnormalities. Liver disease can occur in conditions such as increased alcohol intake, which make them a serious finding. Yet liver function test abnormalities can also be found when an applicant has a reaction to medication taken for something else.
Common medications given to decrease cholesterol often elevate liver tests and the findings are completely reversible when the medicine is stopped. Other examples can be a severe viral infection or even a mild form of infectious hepatitis, when tests rise to significantly high values during the acute illness and return to normal a short time later. Repeating the test after an illness has passed or medication is stopped often normalizes the situation without permanent harm-to either the applicant or the application for coverage.
Always find out exactly what the problem is when an abnormal blood value causes an adverse action, even if there is an underlying disease entity. At worst it will be something an applicant must take to his doctor for further examination and treatment; at best, it is a finding that turns out to be only a moment in time without any consequence whatsoever.
