Successful business transactions require a high degree of satisfaction on the part of the client. The results don’t always have to be perfect, but they have to meet the anticipated outcome. A dissatisfied client for whatever reason might not be just a one-time outcome but a continuous loss of business from both the individual, his or her continued needs, and to referrals to family and friends. It might not even stop there, as the internet is now the great perpetuator of personal experiences, both good and bad, to those doing their homework on where to purchase. This is a somewhat melodramatic way of saying that managing client expectations is now more critical than ever and has extended quite firmly into medical underwriting.
In the past there was a great degree of variability in medical offers one could receive from individual insurers. Those who remember the days of Wild West substandard underwriting and the Term Wars can bear direct witness to the same case getting standard to decline arrays of results. With less insurers and an increased involvement of large reinsurers in the process, the individual outcomes have become more streamlined. Involvement of multiple insurers on the same case now lean to more consistent guidelines and policies. The old adage of “show me the impairments your company is good at” rarely exists anymore, since if you are too good at something you are probably wrong. Reinsurers now have thousands and thousands of additional lives they have tracked over the years and are closer to having seen it all than ever before. You are likely to get more similar outcomes wherever you go out with a policy.
Perhaps this is nowhere better illustrated not in the substandard array of underwriting but in the numerous amounts of preferred, select and standard issues where outcomes are tight and price improvements are finite. Many brokers and agents will illustrate a best-case scenario with the lowest pricing in most any event. When there are what the client feels are minor or controlled impairments, they are still looking toward optimal pricing. At one time, the medical director or chief underwriter had a good deal of discretion in adjusting the policy and hoping that investment or volume results would help negate any mortality giveaways. Now, most underwriting is automated, and the results are strict “kick-outs” where blood pressure or cholesterol values or glucose measurement and even build parameters will assign a class well before an underwriter gets to a case, if he gets to it all before a tentative offer is made. These parameters are generally made known to most agents and brokers from the start, so an exaggeration into a better class may meet with preventable failure just with a little due diligence to start.
Sadly, there is less of an appetite for substandard cases than ever before. In the search for predictable results, clean cases provide fewer poor outcomes and variability in mortality. Many companies will set a limit as to the amount of tables they will assess on a case, and sadly decline ones that require too much discovery or expense or even acquisition costs. In these cases, steering clients away from the disappointment of an unexpected decline and into products they can more easily qualify for will meet their needs and may be the better part of valor.
There are other things that can be done to maximize meeting client expectations while still maintaining control of a case and getting the expected outcome. If clients know what kickout rules apply and that their cholesterol measurement or blood pressure measurements and treatment for example are going to fall outside the line of best possible rate, illustrating the expected rate provides a mutually beneficial result. It’s not that you have to under-promise and overdeliver as the saying goes—under-promising may lose the case to another firm who correctly anticipated what would be offered. But more exactly promising and meeting that goal generally does get the job done. It requires a little research which is readily available or provided by the insurer to make this more easily attainable.
Letting a client know that there is a difference between clinical medicine and insurance medicine is another key. Individuals may have multiple impairments all of which are “controlled” and as such are expecting the same rate as those who have none of these conditions. You may have hypertension that is controlled, diabetes which meets treatment guidelines, and sleep apnea which by itself might not cause problems, or coronary atherosclerosis that may not merit a rating in and of itself. But the combination of all of these in a single individual does increase the risk and makes for pricing above the most favorable level. Doctors in clinical practice often tell their patients they are doing as well as can be expected, and patients take that literally as meaning they are in great health. When confronted by one of their patients that their insurance policy was priced higher than they expected, doctors may become patient advocates against the big bad insurance company and feel this is a criticism of their more than adequate care. When explained how risk assessment works and that the client is indeed doing well considering what the impairments are, doctors then become friends rather than enemies in helping the patient/insured understand what the actual problems and assessments really are.
Lastly, candor is probably the most important thing that influences the result of any policy, including providing for loved ones or businesses as was the original intention. In the initial phases, the agent, broker and client must be upfront about any problems or health abnormalities. An initial opinion or tentative quote will not hold if the underwriting process or underwriting results don’t bear that out—in the same way a driving record will flush out previous infractions or DUIs, each application generally will provide a list of every medication a client takes or prescription he or she has ever filled—and leads to more suspicious and detailed underwriting when it doesn’t bear out what the application has represented. In addition, particularly in the contestable period but throughout the life of the policy, if fraud is suspected, answering “No” to all medical questions or omitting significant parts of the medical history that is asked about will result in the policy being rescinded and the expected proceeds not being paid. This results in the ultimate bad will of beneficiaries who are blindsided by what the deceased did or did not say to have the policy issued in the first place.
Expectations that are met result in positive outcomes for all. We all as members of the insurance team must realize that. We are all on the same side trying to issue profitable business for ourselves and those we represent. The better we deliver, the more our industry will thrive.
