Posts filed under 'heart attack'
I know I’ve beat this drum before, but there is a real propensity in the life insurance business for agents to be so protective of a potential sale that they will actually tell a customer they are uninsurable, rather than admit they are the wrong agent for the job. They have a skewed view of their job. They think it is their job to sell only the products offered by their company. If a client doesn’t fit their company then they believe their job is done.
There isn’t a week that goes by without hearing from people who are desperate to find affordable life insurance. They have been told they are uninsurable because they had a heart attack. They’ve been told they will never get insurance because they’ve had breast cancer or because they have diabetes. I’ve had clients who are never called back by another agent because they admit they have been through alcohol treatment.
Agents actually tell these people “you will never get life insurance”. I wish I could be put in touch with every one of these clients, but in the whole scheme of things I get to talk to only a handful of them. I can only imagine how many just give up and leave their family without protection because some lame excuse for a life insurance agent didn’t have the guts to just tell their client to seek out a more experienced independent agent. Or better yet, do the legwork for their client and find them the right agent who represents a company that can do the job.
If you talk to an agent and they declare you uninsurable without running your information informally through several underwriters, they are either captive or incompetent. If they say they’ve shopped it and you are simply uninsurable and they don’t talk to you about what has to happen to reach insurability, they are captive or incompetent.
Bottom line. Agents very often declare you uninsurable because they aren’t knowledgeable in your impairment or are too lazy to work an impaired risk case. No one said it’s easy. Never, never take uninsurable as an answer without doing an internet search for an agent with the expertise you need.
May 18th, 2010
Long gone are the days of US Financial Life Insurance and their clinical underwriting that gave so many clients competitive rates, rates they really deserved, within 6 months of an angioplasty or bypass surgery.
While those are tough shoes to fill, other companies have managed to fill the void and, within certain parameters are able to offer reasonable rates for those needing to purchase new insurance or perhaps extend the term of their present coverage.
A discussion of those criteria may help you to understand better where you might fit into the rate structure.
1. Age of onset is a big deal in underwriting. In general if coronary artery disease is diagnosed prior to age 50, either because you have a heart attack or because you have arteries with enough blockage to require surgical intervention, rates will be higher. I learned early on in the life insurance business that dying of natural causes prior to age 50 is an oxymoron. There isn’t anything natural about dying prior to age 50 period, and there isn’t anything natural about having coronary artery disease in your 40′s. Even if you are genetically predisposed to CAD, with today’s testing and medical treatment, no one should be having bypasses at that age.
2. Was there a heart attack (an MI, or myocardial infarction)? Once you have a heart attack, the heart muscle has been damaged. Those that catch it before the MI and get treatment, 1. don’t die and 2. don’t have a damaged heart that will likely never recover completely.
3. How many vessels were involved? Simply put, a single blocked artery would indicate mild or early CAD. Multiple vessels would indicate chronic or late detection of CAD. Better underwriting goes to the least involvement.
4. Post incident left ventricular ejection fraction, LVEF. This is a measurement taken from either a nuclear or echocardiogram stress test. It is simply a measure of how effectively your heart empties the left ventricle with each beat. Normal is 65% to 75%. With heart damage that goes down. With most companies a LVEF under 50% is cause for an immediate decline. Because this is a critical component of underwriting, virtually all companies require completion of a stress test before they will approve a policy. If you are applying several years after the cardiac event most companies will want to see a stress test within the past two years.
5. No recurrence. If you have to go back in for a tune up, in an underwriter’s eyes that is called chronic CAD. Simply put, you should have applied for life insurance after the first incident. You aren’t going to like the price with chronic CAD.
Bottom line. There are some very good “clinical underwriting” companies out there and good rates are not out of the question even though you now have a cardiologist.
March 19th, 2010
I know for me that I consider daylight savings time to be a personal attack on my well being, and now there are studies to back it up.
There has always been an acknowledged link between sleep deprivation and heart attacks, so it really wasn’t rocket science when someone figured out that the onset of daylight savings time each spring caused a several day spike in heart attack incidents.
I suspect if I suffered a heart attack around the onset of daylight savings it would be more out of pent up anger than sleep deprivation, but that’s just my personal whine over the whole subject.
But buried in this whole idea is a life insurance underwriting issue, and a health issue worthy of discussion. Sleep deprivation is obviously caused by more things than daylight savings time. Stress and anxiety are huge players in sleep deprivation as is sleep apnea which interrupts sleep frequently on a nightly basis. While there is no question on a life insurance application about how much sleep a person gets on average, there are questions that cover most of the normal reasons for sleeplessness, such as history of sleep disorders, chronic pain, stress, heart disease, depression, or arthritis.
There is even the vicious cycle of sleep deprivation leading to obesity that leads to sleep apnea which leads to more sleep deprivation. Yikes!
Of course what life insurance underwriters look at are the individual health issues and try not to make leaps of assumption like, bad night’s sleep equals heart attack equals decline.
Bottom line. What it does bring to light is the interconnection between one health issue and another. Things like getting a good night’s sleep can’t be poo-pahed away as unimportant.
February 19th, 2010
Family history is one of those issues that just isn’t much fun to explain and frankly, from a life insurance underwriting standpoint, is a little hard to make a mortality risk case for more often than not.
Now I’ll give the actuaries the benefit of the doubt when, let’s say, a male age 40 is being treated for blood pressure and cholesterol, and maybe he’s a bit on the obese side and his father died in his mid 40′s from a heart attack. I can see the link. I can see how an underwriter can foresee a possible progression in that story.
But when that scenario gets the same treatment as a male age 40 in perfect health whose father died at, say, age 58 or 59 of a heart attack, is that really right? Can’t we give the guy that’s got his health locked in the benefit of the doubt?
Let me clear a few things out of the way before we come back to that. Family history of cancer doesn’t have to be an issue. ING Reliastar doesn’t factor cancer into their underwriting. Sibling family history doesn’t have to be an issue. American General and ING Reliastar don’t underwrite sibling history. The family history of a parent dying of a heart related issue prior to age 60 can be ignored by West Coast Life if the proposed insured is over age 60 or with Genworth Life and Annuity if the PI is over age 65. Those things don’t take exceptions.
Occasionally you can get a guy like the second one I described above some slack if he has had a full cardiac workup to rule out any heart issues. That would be an exception and it is an exceptional day when we can get an underwriter to buy it.
But today I spoke at length with an underwriter with an A+ rated company (different A+ company than the aviation post I wrote earlier) and he said that if a client would qualify at preferred select (best rate class) in all other ways (without a cardiac workup), they will ignore the parent dying at age 58 or 59 of a cardiac event. Small window of opportunity, but it’s huge. With all other companies, unless you can get an exception with a cardiac workup, that would be their third best rate class.
In real numbers! Let’s say the client is 50 and wants $500,000 of 15 year term. At the third best rate class they would be looking at $1100 to $1200 a year for that policy. With the company I am talking about, if that parent died at age 58 or 59, less than $800 a year. That’s not chump change.
Bottom line. Like I said, small window, but…..so many people get shoved into the wrong company over this issue, and they don’t have to. If you fit the criteria above and your agent insists that the third best rate class is as good as it gets, you have the wrong agent.
February 1st, 2010
Part of the life insurance business is helping clients understand that companies weigh the mortality risk of each client, and the higher the risk, the higher the premium.
I’m often asked by, say, someone who has experienced a heart attack, why the insurance company doesn’t just exclude death due to heart attack and give them great rates anyway. After all, health insurance companies and disability income policies often have an exclusion for pre-existing conditions. With life insurance they either accept you as a risk or the decline to accept the risk completely. If they accept the risk it is priced by their actuaries to include acceptance of any health issues that are known.
I know first hand that it doesn’t feel fair when a health issue, especially a well controlled health issue, prevents you from getting the best rates, or at least better rates than you were approved for. I have a condition called Raynauds that has kept me from getting the best rate class on prior applications for my own insurance. Raynauds is syndrome that causes the small capillaries in my hands and feet to constrict when I get cool. I get cold fingers and toes. Not exactly a mortality issue, but there is a one in a bazillion chance that the Raynauds could be the “R” is CREST syndrome. CREST is really bad and it will kill you before you reach your 60′s in general.
After nearly 30 years of Raynauds and no sign of CREST, my doctor tells me that the chances of developing CREST are really non existent. But, it still effects my rates. Fair? I don’t think so, but it’s not my money that will pay out the millions to my wife if I die.
They have to weigh the risk and in order to understand why some pay more than others it really helps to put it in the context of, what if it was your money? Would you really charge the same for a completely healthy 45 year old male and a 45 year guy who has diabetes and is 50#’s overweight. Yah! Me either.
Bottom line. It might not ever feel fair if you don’t get the rate you want, but underwriters really do work hard to get you the best rate they can justify. In combination with an independent agent that knows where to find the best underwriting for any given issue, you can be assured that you won’t have to spend any more than is absolutely necessary.
January 16th, 2010
It’s that time of year when fall starts giving way to winter and we get those giant wet snowstorms that turn many from sedentary leaf peepers into snowplows.
It’s also prime season for people to visit the ER with heart attacks or heart attacks symptoms that turn out to be some other thing they’ve strained. Case in point, me! Not too long ago I broke my left arm and post surgery was told to let it rest in a sling for 3 weeks before starting anything other than some simple motion therapy they had outlined. My wife and I went on a trip and I convinced her I could drive part of the way without straining anything.
The day after we got back I woke with tightness in my chest, shortness of breath and pain in my left arm. After heart and blood clot issues were ruled out we decided that I had actually strained my chest muscles driving. Caused a lot of cardiac symptoms but fortunately not any issues.
Others are not so fortunate. I had plenty of life insurance and no immediate need for it. We’ve lost a few people in our community lately for which the opposite is true, an immediate need and no life insurance.
Whether it’s shoveling snow or hunting or cutting wood, or just doing the list of honey-do’s that you’ve been putting off for a long time, putting a strain on an under exercised body is a prescription for disaster.
What about life insurance for those who survive heart attacks? Count on it being more expensive than before, but generally a year out from the event and a good stress test will get you back in the game. Factors like your age at the time of the event and how many vessels were involved will play in to how good the rates can be, but with the help of a knowledgeable independent agent, you should be able to get on the road back to cardiac and life insurance health.
Bottom line. Take care of yourself. Let prudence guide your life. Don’t be like me and you’ll get better life insurance rates.
November 2nd, 2009
Sometimes when I ask the medical questions that are part of the first interview with prospective life insurance clients I get the feeling that I should have gone through them twice, or three times.
Each time I should say something like, “Now when I go through the questions this time I want you to carefully think about each one, reflecting on whether your answer represents the medical facts or just your opinion. What I need are the facts”.
Really. When I ask “Have you ever been diagnosed with or treated for chest pain, high blood pressure, heart murmur, heart attack, stroke, cholesterol or any disorder of the heart or circulatory system”, how can a person answer no when they have had mitral valve prolapse all of their adult life? I know in the whole scheme of cardiac issues it certainly isn’t a big one, but they know they have it and even if they don’t equate it to a heart murmur (which they probably should), it has to fall into the catch all at the end asking about ANY disorder of the heart.
So, in this case the difference between a yes and a no answer to the question is the difference between preferred and standard rates. In many cases that is enough for a client to get in a huff and decide they don’t want the policy after all or that they are going to find some agent who can figure out some way for them to get the best rates even though they don’t qualify. And it’s all about being honest to a fault when answering health questions. I wonder if it would change if they had to answer the questions under some kind of oath?
Bottom line. Do yourself and your life insurance agent a favor and just answer the questions honestly. If you’re not sure if your answer should be yes or no, explain the situation to the agent and at least give them a chance to include the information in their thinking, or if it really isn’t important, to throw it out.
October 15th, 2009
Abnormal ekg’s make up a significant percentage of of the reason for postpones and declines on life insurance applications. Often it’s news to the applicant and just as often it’s something that their doctor may have told them about a long time ago and told them it wasn’t anything to worry about. After all, “It’s not like I had a heart attack or something”.
A critical thing to keep in mind is that how two companies handle an abnormal ekg can be as different as night and day. On plenty of occasions I have shopped “abnormals” that led to a decline with one company and was able to get it approved standard and occasionally better with another company. Certainly on more than one occasion we have been able to disprove the abnormality when a client is willing to get an independent ekg from their own doctor. While a person would hope that all ekg’s are created equal, an ekg done in a doctor’s office, generally a 12 lead ekg is often more reliable and different than a 6 lead ekg done by a paramedical person while you’re lying on your living room floor.
So, is your doctor wrong when they know you have an abnormality but they tell you it’s nothing to worry about? The truth is they’re probably right on the money because they know you, your health history, your lifestyle and if the abnormality is fairly benign, whether it has changed over the years.
So, is the underwriter wrong? Probably not based on the information they have and their company’s underwriting philosophy. He is probably following the guidelines. Therein lies the rub in this situation. Both are doing their job correctly but they seem to have adversarial opinions. The real truth is that the opinions aren’t adversarial because they’re not offering an opinion on the same thing. One opinion is about you alone and how you’re doing and the other opinion is about you pooled together with say, all the other people who have a right bundle branch block and what their overall mortality experience is compared to people without that abnormality.
Bottom line. Since you will likely never get the two sides to see eye to eye on the subject, when faced with an abnormal ekg, armed with a copy from the insurance exam and preferably an second go round with your own doctor, enlist an independent agent who can shop as many companies as it takes to get a rate that works for you.
September 24th, 2009
It’s amazing how a heart attack or a visit to the ER with chest pain can make you consider mortality. Even when you come away with a quick fix like a stent, life just seems a bit more fragile. So how do life insurance underwriters view cardiac issues? Can you get approved after someone has tuned up your ticker?
Several years ago I had a call from a man that explained that he had recently had a two vessel angioplasty and was wondering if he could get life insurance. I explained that in a lot of cases life insurance is very attainable after a cardiac procedure, but I needed a bit more information. I asked him where he was calling from, meaning with my question what state. He said he was calling from the hospital. I asked him how long ago he had the stents placed and he told me two days earlier. This guy had a sudden understanding of mortality and wanted to get protection in place right away.
I explained to him that in most cases we were looking at a year out from the angioplasty and a stress test showing good results, most importantly a strong ejection fraction which is an indicator of how much, if any, heart damage was done. We weren’t able to help him that day, but a year later he became a customer.
So, what does an underwriter want to see for optimal results in applying for life insurance after a cardiac event? First is some time. A year out from the treatment is pretty standard unless you are willing to take a big hit on rates. A few companies will consider prior to one year but they charge according to their perceived risk in stepping up early. The stress test is critical. Most cardiologists are going to have you do a stress test 6 months or so after the procedure just to see how well the repair is doing. Some wait as much as a year.
The primary indicator from the stress test that underwriters look for is the LVEF, left ventricular ejection fraction, a measure of how efficiently your heart pushes blood out of the left ventricle. Normal is in the 65% to 70% range for a person with no heart damage. Very few companies will consider coverage if a person’s LVEF is under 50%.
Other factors that they look at would be your age when the event happened. Prior to age 50 is problematic. Truth is that heart attacks at that age are out of the ordinary and indicative of aggressive heart problems. The possibility of recurrence is high. Prior to age 40 is going to be hard to find any takers at all.
Changes in life style play into underwriting. With obesity being a major risk factor for heart disease, a patient who aggressively undertakes a diet and exercise regime aimed at taking weight out of the equation will get more favorable consideration.
Cardiac rehab is something that is good to do and underwriters recognize that. What they are looking at is who is taking the issue seriously after the emergency has passed.
Bottom line. After a cardiac event you will not see preferred plus rates again, but if you do all of the right things and the damage was minimal, affordable life insurance is certainly a possibility.
July 18th, 2009
Life insurance is, always has been and always will be, about offsetting those financial losses that come with premature death. The problem that most people have with the concept is, that in spite of all of the evidence to the contrary, they seem to have a hard time believing that premature death is an issue.
Well, today we’ve all been witness to people that we knew, maybe not personally, but nevertheless, people we knew dying far too young.
We woke this morning to news that Farrah Fawcett had succumbed to long battle with cancer. At age 62, just 6 years old than me, she died. Women are supposed to live to 79 these days. She wasn’t supposed to die.
And then just minutes ago we found out that Michael Jackson passed away at age 50 apparently from a heart attack. There are plenty of opinions about how Michael Jackson lived his life, but there’s no turning your face away from the fact that three children just lost their 50 year old Dad.
Bottom line. There are plenty of days for being in denial about mortality. This wouldn’t be one of them.
June 25th, 2009
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