The Need For A Follow-Up

Many applications have APS trails that read like a suspense novel. There is a medical condition, oftentimes a serious one, that has an intervention, and the trail ends. Perhaps it is a chronic condition, with unknown degree of control or stability that leaves no clue as to the present status. Maybe even a serious cancer condition that is treated with surgery, chemotherapy or radiation that does well at first, but no clue exists over what is happening in the present. The case will need closure, and that closure is best off anticipated by obtaining a follow-up or current status report with the application.

Underwriters get one chance at obtaining all the information they need in order to make a binding decision on risk. If a material fact is discovered after a policy is issued, unless it was fraud or a lack of disclosure, there is not a second chance to make a different decision. As long as all sources are disclosed, the underwriter has the responsibility of following up on the information that may be available. As such, it is not a good idea to leave a company guessing as to what might be happening. It generally will not be in a client’s favor unless current information is involved.

Gastrointestinal bleeding is one such example. The threshold for screening colonoscopy has been dropped in age to 45, and with good reason. Many cancers and pre-cancers are found early enough to be successfully treated with the newer guidelines. Therefore, if there is a complaint of blood in the stool, or a positive guaiac or Cologuard test for occult blood, the story does not end if the insured feels well, or the bleeding “stops” without a follow-up. It is necessary to know if there is an underlying pathology or the problem had a temporary reason that successfully resolved. Which often requires a doctor follow-up for the case to proceed.

A recent case that presented with a small “non-malignant” tumor in the heart that was successfully treated when a stent was used to approach the tumor without having to surgically open the chest to take the growth out. It was a delicate procedure as the tumor invaded one of the valves in the heart. At that point the surgery was deemed “successful” but the information available ended there. Was the tumor completely removed? Was the stent taken out of the heart or left in permanently? Was the valve functioning properly post-operatively, and was the valve and the rest of the heart intact and disease free? All this was information that was needed to go further, but no notes as to follow-up were available.

Neurologic disease pretty much always needs a current status available to the underwriter. Diseases like Parkinson’s can be stable or progress relentlessly. If the underwriter does not know the course of the disease and how stable (or unstable) it has been, no decision he or she makes can be a favorable one. Diseases like multiple sclerosis can have long periods of stabilization, or may have plateaus and periods of degeneration that can have serious disability. Demonstrating stability not only in the past but in the current can lead to a placeable offer on a case. The continuous follow-up information is crucial to the assessment of risk here.

Oncology cases are particularly sensitive to current follow-up. Cancer treatments can be successful or subject to long periods of remission. However for someone who has had cancer but provides no follow-up on the current results of treatment, it is impossible to be sure a recurrence hasn’t preceded the current application for insurance. Many cancers such as breast and hematological malignancies have rates of recurrence that persist long after initial treatment. Whether it is the oncologist or regular internist that provides current follow-up, it is still necessary for the case to proceed.

Finally, all the information that has succeeded any acute event must be followed up on. If there is a dangerous sign or symptom that an insured has sought treatment for but there is no current status or details of resolution, you’re leaving an underwriter the necessity of guessing what the worst possible outcome could be. Since underwriters have uniformly been exposed to the worst possible outcomes, their imagination may not be pretty. An underwriter will often have to postpone or delay a decision to wait on a proper follow-up, and the delays never help case placement. Anticipate and provide what is needed in advance, as accompanying information on follow-up submitted with the underwriting medical information leads to a smoother and very often more successful process.

MD, FACE, FLMI, board certified internist and endocrinologist, is medical director for SBLI of Massachusetts. He has extensive brokerage and life insurance experience over 30 years with Pacific Life, MetLife Brokerage and Transamerica Occidental Life.

Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World from 1991 to September, 2021.

Goldstone can be reached by ­telephone at 949-943-2310. Emaill: