I just wrote yesterday about the difference between life insurance underwriters and doctors when it comes to how they view information and another on popped on the scene today that could be an interesting bit of sparring. The question at the center of this is whether a medical test result that falls in the normal range can be used against a life insurance applicant as not normal enough?

The test in question is one of the results gleaned from an echocardigram a client had done and in particular his LVEF, left ventricular ejection fraction. This test has a normal range of 50%-65% or sometimes 70’% and refers to the percentage of the blood in the left ventricle that is pumped out with each beat of the heart.

The client had a mild case of myocarditis several years ago and his physician wife has him get cardiac workups on an annual basis, probably because they’re free or at least cheap. Well, this guy does treadmill stress tests the same way he does his daily runs, with gusto. From his last one six months ago he (again) went the full 14 minutes and the conclusion:

1. Exercise MET’s 16.9 2. Patient had no chest pain during the test 3. Above average functional capacity 4. Negative for significant ST depression 5. Hypertensive response to exercise 6. Clinically and electrically negative for evidence of ischemia. You couldn’t go out and buy a better result. The man walks 3 days a week, runs 3 days a week and goes to the gym 2-3 days a week. His lipid panel is to die for. He doesn’t have any family history of heart disease. So what’s the problem?

His LVEF is 50%. Underwriters are looking at that glass as half empty and saying it is almost out of the normal range and his cardiologist is saying that the underwriter is making the classic mistake here of thinking that a higher EF is somehow better when in reality it doesn’t work this way. They’ve also said that a normal range for LV EF is about 50%-65% and that as long as the LV EF falls anywhere in that range, there is absolutely no scientific basis (and there is presumably no actuarial basis either) to conclude that a person with a higher LV EF will have a higher life expectancy or a lower expected rate of developing cardiovascular problems.

The cardiologist is saying that normal is normal and that since the patient has always had a LVEF between 50% and 55% since he has been tested that 50% isn’t low normal, it is simply normal. Now understand that if his normal was 55% to 60% there wouldn’t be any underwriting fuss at all. It would be normal and the underwriter would not give you any more credit for mortality risk if it was 68% to 73%. In fact I’ve worked several cases where some underwriters will completely ignore the LVEF if it is high.

So we’ve got this fuss going on between underwriters using books to decide how to rate a person and cardiologists who are saying that their books don’t have any bearing on reality. The client has already been approved twice at standard citing the low normal ejection fraction as the issue and has challenged me to get him a better offer. I don’t need to be challenged to do my very best for a client and I find some merit to his argument. Interesting stuff!

Bottom line. One of my pet peeves with life insurance underwriters is when they start playing doctor and making medical decisions that are outside of their area of expertise. Even most life insurance medical directors would admit they don’t know all of the latest medical research on many of the cases they are asked to review. It’s good that we have a lot of underwriters and medical directors in our portfolio who haven’t carved all of their underwriting in stone yet. If you have any questions or have run into a similar issue, call or email me directly. My name is Ed Hinerman. Let’s talk.