Unlike drug taking, drinking alcohol is generally perceived as an acceptable and sociable method of relaxing in our society. Moderate use is condoned and alcohol is freely available at society events, parties and in the work context.

Milliman was engaged by the Society of Actuaries (SOA) to conduct research identifying laboratory tests that are not widely used in the life insurance industry but could have potential benefits for use in the life insurance underwriting process. This report presents the results of the research.

Over the last few years, ExamOne has developed a mortality risk assessment model capable of accurately determining the relative likelihood of premature death in the insurance applicant population. The model determines a percentile ranking of comparative mortality risk, normalized by age, gender and smoking status. We call the ranking a “risk IQ.”

A Point/Counterpoint article debating the value of screening with treadmill exercise ECGs was published in the December issue of OTR and it is posted here with the permission of On the Risk, Journal o

The above title could appear a little misleading – “Lifestyle Underwriting” may mean something quite different to some readers so here is a brief synopsis: this article is about predictive, preferred, profile, biopsychosocial and pre-selection underwriting. Confused? So was I - hence a brief 101 lesson in an attempt to get us all on the same page.

Life insurers are cautious about integrating medical and technological advances into their underwriting procedures in order to avoid unintended consequences to decision accuracy. Still, some recent advances are intriguing, and companies are starting to incorporate these innovations into their processes.

The November 2011 issue of Gen Re Risk Matters Oceania includes the two articles "When Is a Heart Attack a Heart Attack?" and "Financially Verifying Occupational Duties."

The latest edition of RGA's Reflections includes the articles "Advances in Cancer" and "Insights on Heart Failure."

Greg Brandner (Munich Re) presented on this topic at the Actuaries Club of the Southwest Spring Meeting in Corpus Christi, TX - June 23 & 24, 2011.

Occasionally, even the most seasoned agent is surprised by an adverse underwriting decision and must engage a prospect with disappointing news. Sometimes, when an agent explains that a substandard rating is being assessed due to information uncovered during the underwriting process, the prospect isn’t surprised and may even admit that they “forgot” to mention a particular element of health history or avocation.

Diabetes still remains one of the most prevalent diseases in the United States—an estimated 24 million Americans have insulin dependent type 1 diabetes mellitus, and there are many more with type 2 disease.

Chronic kidney disease (CKD) is an important claimable medical condition of which the underwriter should be aware. Chronic kidney disease increases risk for premature mortality and can result in claims for total disability and critical illness.

An Introspective View of Retrospective Underwriting

This Automation Solutions whitepaper from Munich Re examines one of the greatest threats facing life insurers today: anti-selection (also called adverse selection or negative selection).

It’s been a long time since most insurance made any kind of fuss over being treated for cholesterol. As long as it was well controlled you could count on best rate class approvals.

BestDay Podcast interview with Hank George on Underwriting Tobacco Use

New report examines how insurers can employ data from social media sites in claims and underwriting.

Everyone is familiar with the use of family history, especially early death before the age of 60 or 65, as a marker for potential genetic syndromes associated with premature onset of cancer or coro

Emphasis was added here to make certain everyone appreciates why underwriters pay such close attention to applicants’ blood pressure readings.

There are a host of things brokers need to know about blood pressure. In some cases, the truth is in stark contrast to what many of us have always believed.

Midwestern Underwriting Conference - September 14-16, 2011 in Chicago. Slides are posted from the following presentations:

- The Other Side of Underwriting
by Daniel T. Marsano, CIFI, CFE

- Sleep Apnea
by Gina C. Guzman, M.D., DBIM, ALMI, AALU

- Preferred Underwriting of the Elderly
by Charlotte A. Lee, M.D., FLMI, DBIM

- E-underwriting is Underwriting
by David Doss, FLMI, FALU

- Predictive Modeling
by Jim Rozar, FSA, CERA, MAAA

- Solitary Pulmonary Nodule
by RK. Illango, MBBS, MBA

- Actuaries are from Mars, Underwriters are from Venus
by Christopher Noyes, FSA, MAAA and Jeff Marks, FSA

- Echocardiogram Conundrums
by Sharon Belongia, RN, FALU, FLMI, Kace Kaiser, RN, FLMI, and Kathy Hubing, RN, FLMI

Cases covered:

Case 1: Long QT Syndrome
Case 2: Well Muscled Male
Case 3: Vertebral Artery Dissection

Kevin Quinn, CFP, RHU -- Disability Income Regional Vice President -- Principal Financial Group, dispels the myths around individual disability insurance underwriting. During this presentation, you'll learn the three main factors that impact the underwriting process and how to make the underwriting process work for you.

When underwriting life insurance policies, the types of evidence usually requested by insurance companies include medical evidence such as collection of fluids, attending physician’s statement, electrocardiograms, prescription histories, and non-medical evidence such as motor vehicle reports, inspection reports, and possibly several other items. The type of underwriting exam requested will also vary, as underwriting requirements for life insurance policies typically vary by age of the applicant and amount of coverage requested.

These are the slides presented by Marge Beckman of RGA at the 2011 Wisconsin Association of Health and Life Underwriters Spring Seminar.

Not a disease you might choose as a common underwriting impairment, malaria, a parasitic disease in humans, is far more common than anticipated and potentially deadly when contracted—causing hundreds of millions of illnesses and probably more than a million deaths a year worldwide. While much of the insurance buying population may not live in endemic areas for malaria, it is quite common in travelers from non-endemic areas who have visited the tropics.

An executive at Unum Group Corp. says the company is glad it has tried to take a disciplined approach to selling group disability insurance in the past few years.

Prostate cancer is the most common cancer diagnosed in males (29% of all cancers), the fourth leading cancer killer in Australians (after cancer of the lung, bowel and unknown primary site) and curable if detected early.

Ownership of insurance may influence the patient to choose the active treatment option for maximum financial gain when active surveillance may be just as viable a clinical option. Insurance policies which provide for a partial claim benefit (as much as 20% of the sum insured) for “early stage prostate cancer” often also pay a full benefit when “major interventionist” therapy is performed with curative intent. Early stage prostate cancer is usually defined in these contracts to mean severity up to stage T1 and Gleason Score less than or equal to 5 (See boxes
for explanation).

When this underwriter began his career in 1970, this impairment was not recognized as a distinct clinical entity. Four decades later, it is affirmed as the leading cause of liver disease in (at least) the Western world.

NAFLD is much more than “just” a liver disorder. Indeed, its ubiquitous nature leaves underwriters at risk for understating the extent of its potential insurability implications.

A new report published in the June 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, suggests that diastolic dysfunction maybe an independent risk factor for increased risk of death.

Article appearing in the newsletter of the Australian Life Underwriters and Claims Association. Other articles of interest include:

• What’s going on in Underwriting in the US of A?
• Update on the HIV Working Group
• Chronic (idiopathic) Benign Neutropenia: Not so Benign?
• and Hank's Recent Findings in Laboratory Testings: The Underwriting Perspective

Obesity could throw off mortality projections for members of Generation X, researchers warn.

Eric Reither, a sociologist at Utah State University in Logan, Utah, and two colleagues have published an analysis of the possible effects of obesity on mortality in Health Affairs, a health policy academic journal.

This article from the May 2011 issue discusses options available, including Cardiovascular Magnetic Resonance, Cardiac Computerized Tomography and 3D Echo, and the various advantages and limitations of less invasive cardiac tests.

Chronic obstructive pulmonary disease (COPD) is a disease that requires lifelong adherence to complicated drug therapy regimens. This claims-based analysis of COPD patients, published in Current Medical Research and Opinion, suggests less than optimal compliance with recommended drug therapy treatment for COPD patients based on Chronic Obstructive Lung Disease (GOLD) guidelines. This study further suggests that claims-data analyses provide reasonable aggregate distributions of COPD severity, which can be used by health plans and disease management programs to improve drug therapy management. Link to abstract of article from Informa Health Care.

There is already well established evidence that individuals with functional impairments and dementia face a higher risk of mortality than those who are not impaired.1,2,3,4,5,6,7,8 What is less well-known, however, is the association between the very earliest stages of cognitive decline—having mild cognitive impairment— and subsequent mortality experience.

The purpose of this research is to analyze the relationship between being classified as cognitively impaired by two alternative cognitive screens and mortality rates among long-term care (LTC) insurance applicants.

If ramping up the stress causes otherwise capable leaders to crack, it's a risk that needs to be identified and managed.

Dr. Himanshu Bhatia, OTR Asia Editor, Swiss Re Asia, Mumbai, India reviews this acute disease that affects the cardiovascular system, and is one of the causes of heart disease in children in Japan and the USA. The article discusses the epidemiology, pathophysiology and history of Kawasaki disease, provides a guide to current treatment, and concludes with underwriting considerations.

Few would argue that the last three years have been easy on life insurance companies as the financial crisis devastated their balance sheet and the soft economy dampened demand for their products.

A new report from Boston-based Celent, "Trends in Life Insurance New Business and Underwriting Systems Usage," examines how insurers are reinvesting in technology to counter these economic headwinds and ready themselves for a more competitive marketplace.

In 2003, the author wrote that reinsurers were conducting more client audits due to a “new reality” aimed at improving transparency and oversight. Although this shift had its growing pains, it appears that improved communications and diligence on the part of both reinsurers and direct writers have paid off; in many instances the audit results for our clients have improved significantly.

Today, underwriting audits are still about verifying appropriate risk assessments. That’s never going to change, because overly aggressive underwriting will show up at claim time. However, there should be more to an audit than that.

Nicotine appears to be the main culprit responsible for high blood sugar levels in smokers with diabetes, according to new research presented here at the annual meeting of the American Chemical Society.

The damning evidence against sugar and its relationship to obesity arrived decades ago, with studies in which rats fed sugar along with their standard diet gained more weight, consumed more calories and got fatter than rats fed standard rodent chow.

Every producer knows getting from illustration to application to issued to commission can be a long, agonizing process. The underwriter usually has been considered the culprit in causing many perfectly healthy prospects to be rated or declined.

The "pre-dementia" state has been conceptualized in a number of different ways usually described as Mild Cognitive Impairment (MCI) with subjective memory complaints (SMC) a consistent part of the criteria along with measurable impairment, preservation of functional ability and not meeting the criteria for dementia. This edition of Gen Re's LTC Quarterly explores the question of SMCs and the value of obtaining information of this type at underwriting stage.

In annual shareholder letter, Berkshire Hathaway Chairman says “testosterone-driven” decisions have led insurers astray.

This edition of Gen Re's LTC Quarterly considers whether the generation known as the Baby Boomers is likely to enter later life with better or worse age-specific rates of morbidity and disability than earlier cohorts.

A UK-based protection insurer assesses the nation's most perilous professions to cover.

Massachusetts Mutual Life Insurance Company (MassMutual) today announced it has broadened life insurance eligibility for persons with cardiovascular conditions, such as valvular and congenital heart diseases. The measure builds on MassMutual’s long-standing commitment to continually evaluating and updating its underwriting guidelines to reflect the benefits of the most up-to-date diagnostic and treatment advances.

Hank's new article on Pharmacy (Rx) Profiles was just published in the January/February issue of Perspectives, published by NAILBA (the life brokerage association). This article addresses recent insights regarding the use and impact of these profiles in the US market. The article begins on page 36.

A microfluidics chip designed to capture cancer cells circulating in the blood is taking a step closer to clinical use, thanks to a new partnership between Massachusetts General Hospital (MGH) and Veridex, a diagnostics company owned by Johnson and Johnson. According to a release from the company, the technology "will enable [circulating tumor cells] to be used both by oncologists as a diagnostic tool for personalizing patient care, as well as by researchers to accelerate and improve the process of drug discovery and development."

Hank's latest Best's Review article tackles the problem of "clean" applications from elderly insure-seekers.

Privacy concerns linger, but there's a case to be made for allowing the use of genetic information in insurance underwriting, says this piece in the January/February 2011 issue of Contingencies.

Changes in diet and lifestyle have combined with genetics to form a perfect storm condition for rising obesity rates in adults and children. Life insurers need to watch these trends closely. Many of today’s children will face severe co-morbidities related to obesity for the rest of their lives. As they age, mortality assumptions and underwriting rules that have served the industry well for many years may no longer apply.

40% of study patients with skin disorder had factors such as diabetes, obesity.

In this video, the second in a series for producers, Hank George discusses the importance of preparing clients before paramedical exams in order to prevent unnecessary complications during the underwriting process.

Hank has written an in-depth analysis of the current status of the pharmacy (Rx) profile as an underwriting asset, based in part on revelations from a major 2010 survey.

Chronic Obstructive Pulmonary Disease (COPD) has become the preferred name (rather than emphysema or chronic bronchitis) for a lung disease that is a significant public health problem. It is estimated that there are over three million people in the UK with significant airway obstruction but only about 900,000 have received the diagnosis and therefore appropriate treatment. The European Respiratory Society (ERS) predicts that by 2020 COPD will account for over six million deaths annually making it the third leading cause of death worldwide.

In this video, Hank George discusses passive smoking and nicotine "cotinine" testing.

Dr Julian Parmegiani, a forensic psychiatrist, writing in the July issue of Risk eBusiness, the newsletter of the Australian Life Underwriters and Claims Association.

The staid world of underwriting and new business processing has been shaken up by the development of tele-interviewing and the concepts can also be applied at the claims end of the business. However, there is no ‘one size fits all solution’ and how each company applies tele-interviewing will fundamentally influence whether it is successful.

Of more than 40 different types of Congenital Heart Diseases (CHD), Atrial Septal Defects (ASD) account for about 6-10% of CHD cases. Article starting on p. 15 of the October 2010 newsletter of the Australian Life Underwriting and Claims Association (ALUCA).

Anemia is the condition in which there  is a decrease in red blood cells and volume. As a result, oxygen-rich cells carry less and less of that essential element through the bloodstream. People are fatigued and tired and their organs don’t function optimally. It would stand to reason that an excess of red cells in the circulating blood, called polycythemia, might actually be favorable to health and well being, but alas, it is not. Polycythemia carries a series of problems and complications that make it a serious disorder to underwrite.

We all have a basic idea of what it means for experience data to be credible; that is, it must be reliable and predictive, but what makes one set of data more predictive than another? Or "how can we quantify our confidence in the ability of the experience to predict future claims?" Pricing actuaries use credibility formulas to determine the reliability of the data, but how do they settle on which formula to use? The answer is that there really is not just one right answer. Based on our observations of the Group Life industry and our own experience and research, this article will describe the most common approaches used today.

Is your company considering implementing an automated system for underwriting life insurance? Don't miss the recently completed study sponsored by the Marketing and Distribution, Product Development and Reinsurance Sections, along with the Committee on Life Insurance Research, examining the role of automated underwriting systems in a number of companies.

The report, authored by Deloitte Consulting, addresses: How and why companies are using automation to make underwriting decisions; the impact of utilizing these systems on operational efficiency, sales and retention; the quality of risk selection produced by automated systems; cultural acceptance of increased automation in systems; and challenges insurers overcome to implement and maintain these systems.

If you do not have time to read the report, you can sign-up for the Nov. 3 webcast,in which research results will be presented.

Topics include:

• Cancer Screening - Developments and Implications for Critical Illness
• Biometrical Trends and Their Effects on Long Term Care Insurance
• LTC Premium Increases - Survey Results
• Improvements in Traffic Accident Mortality - Spain

This issue looks at cognitive problems which have proved the most difficult risk to assess and manage.

Older men may be at risk of developing mild cognitive impairment (MCI), often a precursor to Alzheimer’s disease, earlier in life than older women, according to a study appearing today in Neurology.

Primarily funded by the National Institute on Aging (NIA), part of the National Institutes of Health, the study raises the question of whether there may be a gender difference in the development and progression of MCI.

Off-label prescribing and marketing of prescription drugs has come under fire recently, but the extent of off-label use of high-utilization drugs illustrates some of the shortcomings of clinical trials for pharmaceutical products. In this paper published in Pharmaceutical Commerce, Jill Van Den Bos and Daniel Perlman look for evidence of how often high-cost drugs are prescribed for off-label uses. They conclude that apparent off-label use should be examined carefully, as the analysis may give pharmaceutical companies important clues as to whether it may be worthwhile to seek FDA approval for a currently non-approved indication for use of a drug.

Articles reaching back to 2007 by Hank George.

Gen Re Risk Matters considers why research supports a cautious approach to underwriting those who use cannabis.

The objective of this report is to compare the prevalence of diagnosed and undiagnosed hypertension, hypercholesterolemia, and diabetes among three racial/ethnic groups and the prevalence of co-morbidity of these conditions for U.S. adults.

A study published in Archives of Neurology reports that a new spinal fluid test can predict with 100 percent accuracy those patients suffering memory loss who will eventually develop Alzheimer’s disease.

This breakthrough offers new hope to victims of the disease and their families, who heretofore could only know for sure that Alzheimer’s was the cause of their suffering after an autopsy was performed.

Risk Matters examines a potentially recognizable and modifiable factor in LTC risk.

As people seek ever more exotic locations for their holidays, the risk of contracting malaria, or indeed other infections that are not commonly found at home, poses a risk to the insurance industry. This edition of Risk Matters looks at the risks malaria poses.

Smoking, as most of us know, carries quite measurable health risks. The Surgeon General warning on every pack of cigarettes is virtually self-explanatory. The increased mortality risk of heart attack, stroke, worsening of diabetes, lung cancer, chronic pulmonary disease, and vascular disease is well studied, and even smokers without complications pay an increased premium for their policies.

Needless to say, there is a lot at stake for both the insurer and applicant in smoker and non-smoker classification.

Have you had a case declined because of a lack of insurable interest or insufficient financial justification? If you answered yes, you have experienced the other hurdle to getting your case issued—namely, meeting the financial underwriting factors established by the life insurance carrier.

Benign prostatic hypertrophy (BPH) is an inevitable result of aging in men. An overgrowth of the prostate gland with either benign enlarged tissue or small nodules, the prevalence of this condition goes from about 20 percent in men 40 years old to almost 90 percent when they reach their 70s.

BPH, while not cancer, can cause problems with both obtrusive symptoms for men as well as possibly even urinary blockage and chronic kidney disease in more extreme cases. It is a very common condition that is encountered while underwriting male lives.

Presentation from the SOA '10 Health Meeting, held on June 28–30, in Orlando, FL.

A large international study has found that 10 risk factors account for 90 percent of all the risk of stroke, with high blood pressure playing the most potent role.

Of that list, five risk factors usually related to lifestyle -- high blood pressure, smoking, abdominal obesity, diet and physical activity -- are responsible for a full 80 percent of all stroke risk, according to the researchers.

Members of some demographic groups in California can expect to live about 20 years longer than members of other demographic groups in that state.

The Cancer Prevention Institute of California (CPIC), Fremont, Calif., discovered the wide variations in average life expectancies while conducting a block-by-block study of the population of California to examine cancer survival rates across the state.

A ground-breaking medical-based approach to quantifying longevity risk that takes account of changing mortality phases was unveiled by Risk Management Solutions (RMS) today. The RMS® Longevity Risk Model examines expected future waves of mortality improvement that depend on changing social patterns, healthcare expenditure, and the development of new medical treatments, as well as historical phases of change. Exploring how transitions occur between the different phases provides companies with a better assessment of longevity risk than conventional models that use forward projections of past statistical trends.

Includes feature stories on “An Underwriting Solution For Chromosome 6P Duplication” and “Mental Health Claims, the GP and the Claims Professional.”

The slides from Comminsure CMO Dr. Bill Monday’s presentation on May 26, 2010.

The slides from a recent paper given by Dr Detloff Rump entitled "30 years of HIV/AIDS: lessons for the life insurance industry" posted at the ALUCA NSW website.

Applicants are expected to be classified as a “preferred” risk instead of a “standard” risk, saving some policyholders more than a $1,000 a year.

Metabolic syndrome is a group of obesity-related risk factors that increases your risk of heart disease, diabetes and stroke. A person with at least three of these five risk factors is considered to have metabolic syndrome: excess abdominal fat, high triglycerides, low HDL cholesterol, high blood pressure and high blood sugar according to the American Association for Long-Term Care Insurance which tracks health conditions impacting the aging American public.

Researchers report that seniors have six times the risk of developing dementia if they live with a spouse who has been diagnosed with the condition, according to the study.

Falls and fall prevention are a concern for the elderly and people with osteoporosis, according to data from trhe American Association for Long-Term Care Insurance. Osteoporosis is an increasingly common chronic disease that causes weak and fragile bones.

Since the Wright Brothers invented the first airplane, people have been jumping out of them in search of an adrenaline rush. Thrill-seeking, it seems, is an in-borne desire among humans, and it is universal across all age groups, ethnicities and genders, says this article appearing in NAILBA's Perspectives.

Life insurers looking to reach the elusive middle market must limit costs and deliver products efficiently. Generations X and Y will demand access to insurance on their own schedule, and won't tolerate the slow, invasive underwriting process of yesterday. Or so the advocates of automated underwriting would tell you. In fact, for these and other reasons, many life insurance companies continuously seek to streamline the underwriting process while preserving its protective value. Automated underwriting systems are often touted as the solution. Although these systems have been around for some time, not much is known about the industry's experience with them. (Article from the SOA's Marketing and Distribution Section January 2010 newsletter.

Nearly 1 in 5 survivors risks another attack when doctors fail to prescribe the meds, the study shows.

Hannover Life Re's In Focus considers the changing needs of the UK’s ageing population and what protection products we can sell to this rapidly expanding potential market. As a market leader in enhanced and impaired (immediate needs) annuities, Hannover Life Re has plenty experience of the “somewhat different” underwriting approach required.

Analyzing insured mortality by cause of death (COD) often provides insights that a typical actual-to-expected study may not reveal. In Part 1 of this series we utilized COD statistics from the proprietary Transamerica Experience Database (TED) to gain insight into mortality trends. This article continues our analysis and compares the TED insured population experience against the National Center for Health Statistics U.S. population experience. (The second in a 2-part series. For Part 1, see Causes of Death Study.)

Further research is needed to determine if treatments that improve sleep duration may help stabilize glucose levels in people with diabetes. The study will be published in the June issue of the Journal of Clinical Endocrinology & Metabolism.

A new study suggests they may have poorer long-term survival odds than their thinner counterparts if they do develop the disease. The findings are reported in the journal Clinical Cancer Research. The report suggests that excess weight may particularly affect male survivors' long-term prognosis. The study of nearly 4,400 US adults treated for colon cancer conducted by researchers at the Mayo Clinic found that obese patients were one-quarter to one-third more likely to die over the next eight years than their normal-weight counterparts.

We’ve all seen it—basic group life rates that look more like AD&D rates; rate guarantees periods that resemble a mortgage contract; liberal guarantee issue maximums; and plan maximums that are so high that no person in the group even comes close to qualifying for, and on and on.

In many situations insurance benefits are subject to complex tax treatments. Insurance underwriters in Australia should have an appreciation of the taxation issues for they are relevant to managing the expectations of and relationship with the policy owner. This article from Gen Re's April 2010 Oceania newsletter provides a guide to understanding the tax implications in relation to Key Person insurance.

New life underwriting technologies have gained ground during the last decade. Recent surveys sponsored by the Society of Actuaries and other industry groups show strong inroads and increased confidence in these new tools. More significantly, the focus of underwriting technology is moving beyond speed, ease of case submission and sales support to strategic business benefits, including product design, pricing and capital considerations. As we enter a new decade, the goal will be to take advantage of what’s available to improve efficiencies without losing sight of the big picture – risk management – and the analysis and understanding that is required to manage risk.

The secret to finding small business owners who are good disability insurance risks even in the middle of the Great Recession is that there is no secret, according to Ernest Smith in a breakout session on “financial underwriting” in turbulent times at a disability insurance conference organized by JHA, Portland, Maine, a unit of General Re Life Corp., Stamford, Conn.

An estimated 1.7 million deaths, hospitalizations, and emergency department visits related to traumatic brain injury (TBI) occur in the United States each year, according to a report released by the Centers for Disease Control and Prevention.

The report, “Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Death,” is based on data from 2002-2006 and identifies the leading causes of TBI and incidence by age, race, and gender.

What are the characteristics of a good underwriter? A few of the more important traits are: one must be analytical, flexible and creative, a decision maker, and a good communicator. Let’s examine each of these qualities in more detail.

This paper concentrates on both the non-motor symptoms whose management can reduce the likelihood of claim and the length of claim and the recent research suggesting changing patterns of PD mortality.

This is the 12th and final article discussing the benefits of using the Laser Underwriting Approach for Trial Applications. We have addressed 10 of the top questions that can help make the approach effective, utilizing an agency-based staff underwriter.

(This is a hot subject getting global scrutiny in a teleunderwriting context. The article is well worth reading!)

Life underwriters may be missing the forest for the trees when they ignore the broader implications of lifestyle and economic status, says Tia Sawhney writing in the March issue of Contingencies.

Dr. J. Carl Holowaty MD, DBIM revists his September 2005 piece looking at the epidemiological trends relating to obesity, Weighing-In On Obesity, and explores three other important topics: Prostate Cancer and PSA, Viral Hepatitis B and C, and MRSA.

The Individual Life Experience Committee has completed their latest report on intercompany mortality experience by amount of insurance under standard individually underwritten issues. This study includes policy years 2005-07. Read the report and associated documents.

A proposal in the House and Senate healthcare reform bills, the CLASS Act, establishes a federal long-term care (LTC) program financed from participant premiums without any federal subsidy. The new LTC program is subject to guaranteed issue, and that, combined with its voluntary nature, subjects the CLASS Act to considerable adverse selection risk. This paper by Al Schmitz examines this risk while considering other likely consequences.

From Bob Pedigo's series discussing the benefits of using the Laser Underwriting Approach, which utilizes an agency-based staff underwriter.

Catch Hank's article on Rx Underwriting, a look at the genetics of Huntington's Disease, a piece on medical advances that affect the industry, and more.

With the need for quicker turnaround time and swifter issue of policies, the life insurance industry was faced with a dilemma. How could the industry achieve this target to satisfy its customers’ needs without compromising its strict underwriting practices and its risk profile? The answer was simplified underwriting.

The Marketing and Distribution and Product Development Sections along with the Committee on Life Insurance Research, are pleased to make the following report available. Authored by a Mike Batty and Alice Kroll of Deloitte Consulting, the report summarizes the results of a company survey on the utilization of life insurance automated underwriting systems.

Americans, at least as a group, may have reached their peak of obesity, according to data the Centers for Disease Control and Prevention released recently.

Lifestyle Based Analytics can be used for a variety of decision-making behaviors and events in healthcare.

The 10 leading causes of death were the same in 2006 and 2007. The rankings also remained the same, with one exception. In 2007, Alzheimer's disease was the sixth leading cause of death, and diabetes the seventh; the ranks were reversed in 2006. Age-adjusted death rates for six of the 10 leading causes of death declined from 2006 to 2007 (from a decline of 1.8% for malignant neoplasms to a decline of 8.4% for influenza and pneumonia). Only the rate for chronic lower respiratory diseases increased (up by 1.7%). No changes were observed in the rates for Alzheimer's disease; nephritis, nephrotic syndrome, and nephrosis; and septicemia.

This Gen Re Risk Matters issues describes the changes to the HbA1c measurement and how underwriters should interpret them.

The Foreign Travel Survey Subcommittee of the Society's Committee on Life Insurance Mortality & Underwriting Surveys has completed their report on the results of a survey on foreign travel underwriting practices of reinsurance companies.

The Society of Actuaries International Experience Study (IES) initiative is in its seventh year. During that period, considerable progress has been made expanding experience studies into less developed parts of the world. This article (from the SOA International Section's August newsletter) presents the most recent preliminary results from Argentina, the Caribbean, the Philippines, Poland and Vietnam.

This is the eighth article in a series of 12 discussing the benefits of using the Laser Underwriting Approach, which utilizes an agency-based staff underwriter. Each story in the series addresses one of the 10 preliminary questions that make this approach effective. (Earlier articles in the series can be accessed here.)

The September 2009 issue looks at:

• Life Reinsurance Data from The Munich American Survey By David M. Bruggeman
• What Reinsurers and Cedants Can Learn from Uncle Rex and the Bulls By Rick Flaspöhler
• Reinsurance Modernization – A New World ViewBy Daniel W. Krane and Elizabeth A. Diffley
• Life Reinsurance: Capacity and Concentration of Risk Survey Analysis By William J. Briggs, Gaetano Geretto and Robert B. Lau
• Enhancing the Benefit: How quality successful limited-benefit health plans answered the demand for a more robust product By Curt A. Wieden
• American Academy of Actuaries Stop Loss Risk-Based Capital Work Group is Reviewing the Potential Need for Changes in the RBC FactorsBy Michael L. Frank

When an underwriting historian looks at the subject of financial underwriting, they quickly come to the realization that the conflict/confusion/befuddlement in the different perspectives between underwriter and advisor has existed since days we could not agree on the value of the inventor of the wheel as key man.

Heritage Labs' newsletter eEnvoy discusses the mortality associated with albumin and globulin. Using our database of insurance applicants and the Social Security Death Master File, we can measure increases in mortality at levels of albumin and globulin that may surprise many of our readers. The risk rises even before the lowest 2.5th percentile which is the traditional level chosen for a “lower limit of normal”.. We also propose a unique formula to help discern the relationship between albumin and globulin better than the current A/G ratio.

Underwriters are seeing requests from clients to modify policy provisions in advance of anticipated layoffs. By Eric Swanson, Senior Marketing Underwriter, ING Reinsurance. Reprinted from May 2009 Best's Review.

Topics covered include:

• Arterial Hypertension - A Major Risk Factor
• Hypertension Management through Physical Exercise
• Blood Pressure and Stress
• A Look across the Fence - Underwriting in France
• An Exceptional Sport: Canoe Polo - A Mixture of Various Sports
• An Exceptional Profession: No False Movement - Sign Language Interpreting
• Hypertension - Case Examples
• Seminar Dates

The latest issue looks at:

• Underwriting the Elderly - Findings From a U.S. Survey
• Beyond Containment but Well Into the Guessing Game - The Novel A/H1N1 Influenza Pandemic
• Evidence-based Underwriting - Rheumatoid Arthritis

Obesity is associated with increased health-care costs, reduced quality of life, and increased risk for premature death. Common morbidities associated with obesity include coronary heart disease, hypertension and stroke, type 2 diabetes, and certain types of cancer. As of 2007, no state had met the Healthy People 2010 objective to reduce to 15% the prevalence of obesity among U.S. adults. An overarching goal of Healthy People 2010 is to eliminate health disparities among racial/ethnic populations. To assess differences in prevalence of obesity among non-Hispanic blacks, non-Hispanic whites, and Hispanics, CDC analyzed data from Behavioral Risk Factor Surveillance System (BRFSS) surveys conducted during 2006-2008.

Improving its private-label market for term life insurance gave Transamerica Reinsurance an entirely new perspective on automated underwriting.

This is the second part of a series on the uses and misuses of mortality metrics. Life table construction is beyond the scope of this article, but the reader will need some familiarity with life tables in order to understand the issues. See this related document which illustrates life table construction and the calculation of life expectancy.

To examine the relationship between alcohol and suicide among racial/ethnic populations, CDC analyzed data from the National Violent Death Reporting System (NVDRS) for the 2-year period 2005--2006 (the most recent data available).

In this special section, three insurance suppliers (ImageRight, MajescoMastek and PlanetSoft), discuss some current issues in underwriting.

U.S., Bermuda and large international reinsurance companies lost about 15% of their capacity in 2008 as measured by shareholders’ equity. But A.M. Best Co. believes that two excellent operating years preceding 2008, sizable capital increases after Hurricane Katrina and significantly improved loss reserves have enabled the reinsurance industry to withstand the barrage of investment charges and catastrophe losses.

The current economic crisis is challenging life insurers to look closely at all of the products in their portfolio and make adjustments as necessary. While much of the focus is on variable annuities and universal life with secondary guarantees, the performance of term life is also affected by market upheaval.

In this issue of The Forecaster, Jim McArdle, Senior Vice President of Sales and Marketing at Transamerica Rinsurance, discusses the impact of current market conditions on term life insurance with Keith Dall, Principal at Milliman, Inc. Keith sees companies responding in a variety of ways – looking for new financing solutions, tightening underwriting guidelines, monitoring products and rates more closely and more.

This article is the first of a two-part series by Transamerica Reinsurance Vice President, Medical Research and Development, David Wesley, on relative survival, life expectancy and expected mortality, with this section discussing relative survival and how it is misused. For tips on using SEER*Stat and examples of alternatives, please see the article's supplement.

In developing mortality rates, actuaries smoothly increase rates by age and duration. We accept that some anomalies appear in the early adult years; however, for the majority of issue ages, we have a rather strong notion of the shape of the mortality curve. As a result we build experience studies using smooth expected mortality rates that consequently reduce volatility.

This result is intuitive and may be correct. However, it may not be the best basis on which to set expected mortality.

With the difficulties in 2008's credit market providing the background, 2009 promises to be a challenging year for insurance underwriters. Interestingly, while the market will certainly be volatile, the work done in the last few years by some insurers will position them to leverage the current market conditions into significant market opportunity.

The 2008 Fact Book provides statistics and information on trends in the life insurance industry. Specific topics covered include assets, liabilities, income, expenditures, reinsurance, life insurance, and annuities.

Presentation by Transamerica Reinsurance's David Wylde at the 2009 MUD Group meeting.

From the Morbidity and Mortality Weekly Review.

Hannover Life Re believes that we should all be looking to offer cover to as many individuals as we can and that as far as possible insurance should strive to be inclusive. The company also feels it is right to challenge ourselves to continue to change cultural attitudes and encourage inclusive behaviour.

From Gen Re's Risk Insights publication.

Presentation at ReFocus 2009.

Heritage Labs recently had an inquiry concerning the hepatitis B tests offered as part of their reflex panel and the apparent discrepancy with the requirements of certain reinsurers. The case involves a female applicant, age 27, with normal transaminases, and a positive result for hepatitis B surface antigen. Before getting into detail on this case, this technical bulletin recaps the nomenclature for several of the common hepatitis B markers.

This new article by Hank George lays waste to the so-called "advantages" of treadmill stress tests and shows why their use should end NOW. They welcome all comments!

Best's Review essay by Hank George argues that underwriting poses no obstacle to life insurance sold by banks, and that with today's rapid underwriting tools, banks should be using this opportunity to sell to the under-served middle market BECAUSE of the rapid, efficient underwriting.

Presentation at ReFocus 2009.

A small chunk of DNA linked to schizophrenia, mental retardation, and autism may change the way we think about disease.

'Risk' is a term that comes up frequently when people discuss medicine and health: What's my risk of heart attack? Breast cancer? What's my risk of dying from a complication of surgery? Or having a dangerous reaction to a drug?

But according to Mark V. Pauly, Wharton professor of health care systems, consumers don't necessarily use that term in the same way that medical and insurance experts do -- which is a potential pitfall that can lead to less than optimal health care decisions and faulty policymaking.

Life insurance underwriters are frequently faced with assessing the mortality of an impaired risk. There are two primary ways by which this increased mortality can manifest itself: as a multiple of standard mortality or as a constant addition to standard mortality.

When working with an older client in the planning process, the individual’s health may be a critical component of the underwriting equation. Right from the start, there are certain issues that should be taken into consideration.

Heart disease continues to be the leading cause of death for Americans, according to the Centers for Disease Control.1 Fair, inexpensive, and accurate assessment of health risk presents a challenge to all insurance companies. Research in clinical medicine is impacting insurance medicine in new and exciting ways and is transforming how companies assess the cardiac risk of a proposed insured. New laboratory testing evaluating insurance risk profiles will assist in more accurately classifying cardiac risk. It is important, therefore, to review the new and existing laboratory markers that are available in your clients’ cardiac mortality risk.

In this issue, Munich Re´s Centre of Competence for Biosciences (CoCB) focuses on the development of genetic testing for common diseases and talks to renowned geneticist Prof. Dr. Jens Reich about the predictability and prevention of common diseases. Our doctors also take critical look at other current developments such as the threat of an influenza pandemic. And finally they report on a common neurological disorder that Munich Re has now included in MIRA.

http://www.towersperrin.com/tp/showdctmdoc.jsp?country=global&url=Tillin...

From the CDC's Morbidity and Mortality Weekly Report.

Homeostasis is either the equilibrium itself or the process through which equilibrium is maintained between various chemical compositions and/or physiologic function in the body. Homeostasis is achieved by what engineers call “negative feedback loops” – sensors detect deviation and trigger corrective forces to bring the system back into equilibrium. There are thousands of such equilibria in the body, and the condition known as frailty in the elderly is thought to result from impaired homeostatic processes. (David Wesley, Vice President, Medical Research and Development)

Building a bona fide mortality management solution is not easy, but the value-creating potential is too big to ignore. In the short run, a mortality management solution improves operational efficiencies and mortality results. In the long run, it captures data that provide essential insights for building competitive products and meeting evolving regulatory demands, according to Joanne Collins, Lead Consultant, Product Consulting & Development.

The October website article by Hank reviews patient noncompliance with routine medical screening and how this is a major risk-taking behavior. It is fully documented from the worldwide medical literature. In this article, Hank argues that both risk-taking behaviors and findings consistent with the "healthy adherer" effect should be included in teleinterviews and used in risk assessments.

Presentation by Hank George at the SOA Individual and Small Group Health Insurance Underwriting Seminar, September 2008.

Kip May, Sue Nelson, FLMI, HIA, Mindy Stadel, J.P. Wieske panel at the SOA Individual and Small Group Health Insurance Underwriting Seminar, September 2008.

This paper presents a model for analyzing the impact of underwriting cycles on an insurer’s surplus. The model allows the insurer to vary its security loading in response to the cycles, with a strategy parameter that indicates the extent to which the insurer follows the loading which prevails in the market. The insurer’s claim rate is also allowed to vary to reflect exposure changes that result from the insurer’s strategy.

Presentation by Tia Sawhney at the September 2008 SOA Individual and Small Group Health Insurance Underwriting Seminar.

Presentation from SOA Annual Meeting in Orlando, October 2008.

• Underwriting and the Financial Services Concept, Presenter: Hank George, Hank George, Inc

• Canada Life's Teleunderwriting Operation, Presenter: Helga Hryb, Canada Life Assurance

• Emerging Value of New Underwriting Resources, Presenters: David Redpath, Hartford Life and Eric Hjerpe, Allstate

• Insights into Outsourced Teleinterviewing, Moderator: Hank George, Hank George, Inc., Presenters: Andrew Gething, MorganAshe, Carol Dineen, MRS Inc., and Rocco Salviola, RSA Medical

• Report of a Teleunderwriting Survey, Presenter: Hank George, Hank George, Inc.

• Beneficial Life's Teleunderwriting Operation, Presenter: Wally Taylor, Beneficial Financial Group

• American Enterprise's Teleunderwriting Operation, Presenter: Meg Brown, American Enterprise Group Insurance Company

A follow-up to the article originally published in the May 2006 edition of Product Matters!, the newsletter of the SOA Product Development Section.

• Life Reinsurance Data From The Munich American Survey
• Longevity: Mortality Improvement
• Solvency II—What It Means For Reinsurers
• Limited Medical Benefit Plans—What Insurance Companies, Employers And Reinsurers Need To Know
• Update In The Employer Stop Loss Medical Insurance Market
• Reinsurance Execs Predict Capital Channels Will Blur
• STOLI Poses Danger To Industry, Reinsurers Warned

...and more.

Daniel Perkins, JD, FALU writing in Heritage Labs' eNews, August 2008. Part II is at this link: http://www.hooperholmes.com/Skins/Image/HL_Cocaine_UnderwritingII.pdf.

Published in January, this issue covers:

• Measuring GFR
• A1c
• 21st Century Geriatric Medical Underwriting
• New Tools for Older Age Underwriting

...and more.

Presentation at the MUD Group meeting in January 2008 by Charles Levy, MD, Chief Medical Director, AIG American General Domestic Life Companies.

Presentation at the MUD Group meeting in January 2008 by Charlotte A. Lee, M.D., FLMI, 21st Services, LLC.

Presentation at the MUD Group meeting in New York, January, 2008 by Steve Bloom, Vice President & Chief Underwriter, New York Life Insurance Company and Joe Manczuk, Vice President & Chief Underwriter, RGA Reinsurance Company.

November 2008 GenRe Underwriting Focus looks at:
Gastrointestinal System - Stomach Disorders: Gastric and Duodenal Ulcer Disease / The ABC of Gastritis / Functional (Nonulcer) Dyspepsia / A Look Across the Fence - Underwriting in Singapore / An Exceptional Sport: Speedflying / An Exceptional Occupational Profile: Freefall Photography / Certified Medical Underwriting Specialist (CII) - Graduation 2008 / Seminar Dates / Stomach Disorders - Case Examples.

This article series continues to explore the evolving landscape of underwriting in the 21st century. In this installment we explore the impact of informal, or preliminary, applications on both the workfl ow of an underwriting department and on relationships with producers. We spoke with four leading carriers in this market about innovations they have implemented to improve these dynamics, and we also spoke with a reinsurer to gain additional perspective on this marketplace.

In the following article Hannover Life Re highlights results from one recent large medical study and outline their implications for coronary heart disease treatment options. In particular, the article considers how this type of medical information can inform decision-making on definitions and scope of cover for critical illness benefits.

Article on p. 19 of the newsletter of the Australian Life Underwriters and Claims Association.

Without underwriting, individual coverage applicants on average cost 40% more than applicants for small group coverage. While the individual market provides insurers more opportunities to take rating actions and to improve their competitive positions, it also presents more risks than group insurance since individual health insurance applicants are collectively less healthy and have greater variance in their claim costs than applicants in other markets. For these reasons, the individual market is especially susceptible to adverse selection.

http://www.genre.com/sharedfile/pdf/Topics16_FischerH-en.pdf

Looks at a possible tool for better differentiating prostate cancer.

Recaps some key findings from evidence based underwriting research Gen Re has completed into multiple sclerosis.

Hank George reviews patient noncompliance with routine medical screening and how this is a major risk-taking behavior. It is fully documented from the worldwide medical literature. In this article, Hank argues that both risk-taking behaviors and findings consistent with the "healthy adherer" effect should be included in teleinterviews and used in risk assessments.

An actuary uses his skills and develops some new tones to put a face on racial disparities in his hometown.

Presentation by Robert L. Stout, Ph D.

Presentation by F. Sestier, MD, PhD and A. Naslafkih, MD, PhD.

Some researchers now believe that certain diseases can be postponed simply by slowing down the aging process, says this piece in Contingencies.

"Rules-based" has become something of a cause célèbre in risk appraisal these days, just as "evidence-based" has in clinical medicine (and rightly so around some underwriting
campfires as well).

Assuming it comes to more than vacuous labeling, "evidence-based" anything should exert a reassuring effect on those accountable for whatever such evidence is brought to bear thereupon. Can the same be said of "rules based"?

This is the first of a Transamerica Reinsurance series of articles on the laboratory and examination components of age and amount requirements. Topics will be chosen on the basis of current interest, whether new tests or simply old tests that are being reconsidered. Sidebars will introduce the mathematical tools that are commonly used to evaluate tests and testing programs.

http://www.genre.com/sharedfile/pdf/RiskInsights200805-en.pdf

...from the Long Term Care International Forum.

Handouts from various sessions at the 4th Annual Teleunderwriting Seminar, held on February 21–22, 2008 in Tampa, FL including such topics as:

1. Underwriting and the Financial Services Concept - Presenter: Hank George, Hank George, Inc
2. Canada Life's Teleunderwriting Operation - Presenter: Helga Hryb, Canada Life Assurance
3. Emerging Value of New Underwriting Resources - Presenters: David Redpath, Hartford Life and Eric Hjerpe, Allstate

A state-of-the-art underwriting system, including a rules engine, is a must in today’s life insurance environment. What’s more, underwriting systems aren’t just for assessing risks. The newest and best underwriting systems can actually aid in the management process.

Hannover Life Re on relative mortality ratio and reasons for differences based on marital status.

http://www.genre.com/sharedfile/pdf/ClaimsFocus20081-en.pdf