As we’ve reviewed the underwriting criteria for life insurance when it involves diabetes over the years, I’ve beat the need to know your hbA1c to death. I would guess that more than 50% of diabetics I have spoken with don’t even know what I’m talking about, which in my mind heaps shame on their doctors for not educating their patients properly.
The hbA1c is a lab test that the doctor that is managing your diabetes will typically run every three months. This test is extremely relevant to them as it is the most accurate indicator of how your treatment is working. It tells them if you have achieved control and average glucose levels are low enough that no collateral issues should occur.
Life insurance underwriters are very interested in the same information. They take with a grain of salt what your fasting glucose level is. The proof comes when all the highs and lows are averaged. Control isn’t measured by your ability to fast and artificially lower your glucose, but rather by averaging those fasting periods with the more frequent real life periods when you aren’t minding the shop and your glucose rises.
Another relevant issue to underwriters when it comes to diabetes is the age of onset. Diabetes has potential impacts on other health issues such as heart disease and kidney health. The longer a person has diabetes, the greater the chances of complications and the greater possibility of a negative impact on mortality. From an underwriting standpoint, onset prior to age 40 is substantially different than after age 50.
Also important to underwriters are those health issues that, in combination with diabetes, make it harder for a person to avoid complications. Probably the two most important are obesity and high blood pressure. With obesity being one of the primary causes on diabetes onset, trying to control diabetes with unchecked obesity is problematic at best.
The good news is that for many with onset after age 50 and well controlled diabetes, standard or better rates are available.
Bottom line. Make sure you educate yourself on what diabetes means in your life. Don’t expect that your doctor will provide answers to questions you don’t ask. Seek out a knowledgeable independent agent to help you seek out the best rates and be ahead of the curve when you do by having your most recent set of labs available.
July 30th, 2008
Early on in my work with cardiac patients needing life insurance I learned to ignore what they remembered their cardiologist telling them about their prognosis, and just dig for facts. The most important fact that we needed uncovered and on the table was the amount of damage the heart muscle incurred.
Cardiologists, as near as I can tell, are taught in school to tell their patients that, having survived a heart attack or angioplasty or bypass surgery, “that they now had the heart of a much younger person”. That would be nice if it was true. A brush with the leading cause of death in men somehow does not equate to you somehow, suddenly, having the heart of a much younger person unless you happened to have a transplant in the mix and literally did have the heart of a younger person.
The measure of strength of the heart and therefore the measure of how much damage has occurred is generally drawn from one of the results of an imaged stress test, the left ventricular ejection fraction (LVEF). It is literally a measure of how effectively the heart is able to move blood out of the left ventricle, the heart’s primary pumping chamber. The heart’s function is to pump blood and if that ability is impaired, the rest of the body that is dependent on that flow suffers to some extent.
Clients often get weary of my need for the facts, but it is those facts that lead to accurate life insurance quotes and ultimately a successful search for the best possible life insurance rates. When I don’t take the cardiologist’s rosy synopsis without seeing a copy of the last stress test I am often perceived as “asking too many questions”. I am told more often than I can count that “other agents will give me quotes without all of that”. What life insurance seekers don’t understand is that ultimately the underwriters at the insurance companies will be looking for the very information I asked about and, if they deferred to an agent who wasn’t so bothersome up front, the chances of the end result, the approval, being the same as the beginning, the quote, is very slim indeed.
Underwriters evaluating risk in cardiac cases want to know your age when the condition was first diagnosed. They want to know what happened and what was done. They want to know how many vessels were affected. They want to know how often you see your cardiologist and when your last stress test was. (I just had one client who told me it was two years ago, which is kind of a hinge time for underwriters. Less than two years is good, more isn’t. So I asked him to check and he came back and said it was actually 5 years ago. My how time flies when you are ignoring your health and your cardiologist’s recommendations). They want to know your LVEF. If it is more than 50% you are still in the game. If it is less than 50% you had better hope that some offsetting factor will lead an underwriter to make a highly rated offer. That would be good news as most often less than 50% is an automatic decline.
Bottom line. Most doctors aren’t going to do it for you, so educate yourself. If you can’t answer the question, “how much damage was done”, get copies of your tests and Google the results and find out what they mean. Make a list of questions and demand answers. If a run at life insurance is in your future, seek out the independent agent that asks the most questions, not the least.
July 30th, 2008
