Medical Underwriting
Preparation
Avoid the hurdles.
Get straight to the finish line!
Accredited by The Institute for 1.0 CE credits as ‘Successfully Avoiding the
Pitfalls of Paramedicals’ (#IAS13046601)
CONGRATULATIONS!
YOU’VE MADE A SALE.
NOW WHAT?
pre·pare
/priˈpe(ə)r/
Verb
Make (something) ready for use or consideration.
Synonyms
make - get ready - make ready
From dictionary.com
Prepare
yourself
Prepare
your clients
You will
get paid
sooner!
Prepare the
Underwriter
5
Prepare
yourself
Work smarter, not harder
• What are your issues around training for
paramedical services?
– Completing application medical information
– How to order paramedical exams and services
– Managing client expectations through the
paramedical process
• Client service experience with the QUS Health
Professional
Insurance Contracts
• Uberrimae Fides
• Each party required to make FULL
disclosure
• Advisors and paramedical companies act
as the ‘eyes and ears’ of the Insurance
companies
Fill in the blanks
• It all starts with the application…
• Missing information may result in an
amendment, a delay or even a decline!
Avoid the unknown
•
•
•
•
•
Take your time
Read the entire question
Don’t rephrase or skip questions
Be accurate in your response
Obtain additional details
•
•
Ask the ‘5 Ws’
Applicants have information on their own condition(s)
• Don’t be shy!
Just the facts
Confirm medical and other requirements
Company, face amount
Applicant’s name, address, phone #s and email
address
• Which telephone # should we try?
• May we leave a message?
Where and when do they want to be seen?
• Home? Office?
Special language or cultural considerations
Quality’s Top Paperwork
Prep Tips
• Ask your client to:
– Have government ID (with picture) at the start
of the appointment for verification
– Prepare a list of all doctors consulted past 5
years
• Who has complete medical records?
• Why were they seen? What was the result?
– Have a list of all medications (prescriptions &
homeopathic), including dosages
Place the order with QUS…
Your client wants and needs the coverage, so make sure they get it!
KEEP TRACK!
Prepare your
clients
Clients’ FAQ
How long will it take?
• Paramedical services required determine length of
appointment.
• Leave approximately 45 minutes.
What is involved?
• HP will visit your home to collect specimens and ask health
history questions.
What tests will be
performed?
• Determined by the insurance company.
• Usually, health history questionnaire, blood and/or urine
tests.
Who is doing the
examination / testing?
• Quality Paramedical Services is contracted by the
insurance company to perform the medical tests.
• An insurance medical lab does the testing, and results are
disclosed only to the insurance company.
Is disrobing is
required?
• You will be required to remove your shirt only if an ECG
test will be performed.
The Paramedical
Examination
Preparation is Key
• Quality Underwriting can
help!
• Your client needs to know what
to expect
• Client brochures in 16 languages
• Convenient locations with
customized health professionals
- cultural and language diversity
R.N.s’ Top 10 Tips
1.
2.
3.
4.
5.
6.
7.
No strenuous exercise for at least 24 hours prior to exam
Be well rested
If applicant has a cold or flu – reschedule!
Limit alcohol for 24 to 48 hours prior to exam
Limit caffeine
Reduce smoking
Ideally, fast for 12 hours before the exam
– Water is OK. Drink a large glass 1 hour before exam
8. Avoid vitamins and supplements for 24 hours
9. Continue all prescribed medications
10. RELAX!
Why limit exercise?
Vigorous
Exercise
• Before the exam:
• High-impact
aerobics, contact
sports, weightlifting, distance
running, etc.)
causes red blood
cell platelets to
leech into the urine
stream.
• After the exam:
exercise may cause
bruising at the
blood draw site
Lab test
shows blood
in the urine
Underwriter
worries it
may be
indicative of:
• Kidney
Disease
• Infection
• Cancer
Result:
• Repeat Testing
• APS
requirement
Why rest?
Applicant not well rested
• Possible increase in blood pressure
• Possible irregular heartbeat
“A single night of inadequate
sleep in people with existing
hypertension can cause elevated
blood pressure throughout the
following day”*
*Source AMA
Why reschedule?
Underwriter sees:
If applicant is sick
(cold, flu, etc…) or
if female client has
menses
• elevated temperature
• irregular heartbeat
• blood / protein in
urine
• etc…
Reschedule
Smoking
Let’s talk:
•
•
•
•
Spousal secrets
Cigars and the golf game
Betel nut – comes from Areca Palm tree
Chewing tobacco, nicotine gum or
patch
• Marijuana
• ‘Used to smoke in high school’
• What is the next question to ask?
• When did you last smoke?
Be honest
• Underwriter wants to see fully disclosed
smoking habit.
• State when they last smoked.
• Meet individually to maintain privacy
and “honesty” when answering
questions.
Why reduce alcohol?
ALCOHOL
• Even one drink causes the heart
rate to increase and small blood
vessels to dilate
• Excess consumption increases
blood pressure and causes
dehydration
• Carbohydrate rich drinks impact
blood sugar levels
Result:
• Applicant won’t receive
best decision
• Re-testing may be required
Why limit caffeine?
Caffeine
• Increases Blood
Pressure
• Increased heart rate
• Irregular heart rate
Sources of
caffeine:
• Coffee
• Chocolate
• Sports drinks
Result
• Adverse decision
• Re-testing may be
required
Why fast?
Blood Test
• Eating prior to a blood test will affect
the results, including cholesterol and
glucose
• Do not drink Milk before test; it
includes both sugar and fat
• Avoid vitamins and other
supplements
• Avoid chewing gum – even sugarfree versions can affect test results
Result:
• Retesting may be required
Managing the Applicant’s
Expectations
Your client needs to know what to
expect in their paramedical
examination
PREPARATION IS
KEY
Informed consent
Before ANY Specimens are
collected the applicant MUST
sign a release form that
authorizes the examiner to
draw the samples and permits
the lab to test & forward the
results to the insurance
company
Urinalysis
• Reagent Strips aka
common DIPSTICK Tests
test for:
• Blood
• Ketones
• Glucose
• Protein
• pH level
Timing: about 5 minutes
Blood Profile Exam
• Complete Blood Profile
– 2 or 3 test tubes filled
• Mini Blood Profile
• Urine Specimen
• Two attempts only
• May require fasting
• Other Specimen Collection
TIMING: about 15 Minutes
Electrocardiograms
• Resting
– Taken on a mobile basis in home
– Spot to lay down required
• Stress
– Doctor’s office or clinic
• Other Tests
– Ultrasound
TIMING: 15 – 20 Minutes
Prepare the
Underwriter
A reasonable and prudent Underwriter will want
to know:
a. the amount and purpose of the proposed
coverage;
b. the Financial Status of the life insured;
c. the amount of coverage in existence and
pending.
Armstrong v. North West Life Ins. Co. (1987) 28 C.C.L.I.(B.C.S.C.);
and on appeal (1990) 46 C.C.L.I. 18 (B.C.S.C.)
The Underwriter’s Perspective
• They never meet your client
• They only see:
• Health History on application and paramedical
form
• Lab Test Results
• APS, Financial Statements, MVRs or other reports
Underwriters are skeptical
• They are trained to look for the
inconsistencies
– What’s missing?
– Different answers from application to
paramedical form
– Incomplete information
– Gaps in the details
Dear Underwriter…
• Cover Letter
• How long have you
known the applicant?
• Purpose of Insurance
• Business
• Personal / family
• How was the Face
Amount determined?
Full disclosure
Disclosure
• Complete disclosure of all
medical and financial details,
along with avocations and
other information are vital.
• The Underwriter relies on the
declarations made by the
applicant both on the
application as well as the
medical to make a decision.
Result
• Coverage may be denied or
rescinded
• Policy declined
• Claim denied at time of
death
Prepare yourself
for the
extras…just in
case!
Additional Factors
• Attending Physician’s Statements (APS)
– Which Doctors have complete records?
• Inspection Reports
• Advise client
• Financial Statements and Financial Reports may
be requested (business insurance)
• Motor Vehicle Report (MVR)
Be thorough
Even some ‘harmless’
activities, such as
flying away on
frequent vacations,
using small aircraft, or
scuba diving can alter
the Underwriting risk
assessment!
Over the last hundred years in
paramedicals, things haven’t
changed much..
In 1848
Today
The future is now at QUS
Electronic Paramedical
Advantages to Advisor
100% in good order paramedicals means
underwriting proceeds faster
Applicant is contacted by one Health Professional to
complete an interview and subsequent specimen
collection
Faster turnaround as there is no delay in getting
documents to the underwriters
Perfect Output
is for Quality
Underwriting
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