The Underwriting Risk Assessment
John, age 45, applies for a $500,000 individual life insurance policy. He discloses that he has a history of hypertension controlled with medication, and a BMI of 32. He also mentions that his father died of a heart attack at age 55. The underwriter obtains an Attending Physician Statement (APS) that shows his blood pressure is 140/90 on medication, and his cholesterol is 220 mg/dL. The underwriter also orders a paramedical exam that reveals an irregular heartbeat (possible atrial fibrillation). The underwriter considers the following classifications: Preferred Plus, Preferred, Standard Plus, Standard, Table Rated, and Decline. The company's underwriting guidelines state that Preferred Plus requires BMI < 28, blood pressure < 120/80, cholesterol < 200, and no family history of heart disease before age 60. Preferred requires BMI < 30, blood pressure < 130/85, cholesterol < 220, and no family history of heart disease before age 60. Standard Plus allows BMI up to 32, blood pressure up to 140/90, cholesterol up to 240, and family history of heart disease after age 50. Standard allows BMI up to 35, blood pressure up to 150/95, cholesterol up to 260, and any family history. The irregular heartbeat is not addressed in the guidelines but may require a higher rating.
1. Based on the information, what underwriting classification is most appropriate and why?
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John's BMI is 32, which exceeds Preferred Plus (BMI <28), Preferred (BMI <30), but meets Standard Plus (BMI up to 32). His blood pressure is 140/90 on medication, which meets Standard Plus (up to 140/90) but exceeds Preferred (130/85) and Preferred Plus (120/80). His cholesterol is 220, which meets Standard Plus (up to 240) but exceeds Preferred (220) and Preferred Plus (200). His family history: father died of heart attack at 55, which is before age 60, so it disqualifies Preferred Plus and Preferred, but Standard Plus allows family history after age 50 (55 is after 50), so it meets Standard Plus. However, the irregular heartbeat (possible atrial fibrillation) is not addressed in guidelines and may require a higher rating. Therefore, the underwriter may assign a Table Rating (e.g., Table 2 or 3) due to the irregular heartbeat, or possibly Standard if the arrhythmia is benign. But based on the given guidelines, the best fit is Standard Plus, but with the irregular heartbeat, it might be Table Rated. The answer should note that the irregular heartbeat requires further evaluation and could lead to a Table Rating or decline depending on severity.
2. What additional information should the underwriter obtain before making a final decision?
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The underwriter should obtain a copy of the ECG or Holter monitor results to evaluate the irregular heartbeat, and possibly a cardiologist's evaluation. Also, an APS from John's treating physician for hypertension and any history of atrial fibrillation. A current blood pressure reading and cholesterol profile might be needed. Additionally, a family history questionnaire and possibly genetic testing if available. The underwriter should also consider the MIB (Medical Information Bureau) report for any undisclosed conditions. The underwriter may request a stress test if indicated. The goal is to assess the severity and control of the atrial fibrillation and overall cardiovascular risk.