I ended my last post with a review of the criteria I was given and the following concerning the application I had submitted to a major life insurance company.
1. HIV+ diagnosis was made 3 or more years prior to application.
2. Client has received Anti-retroviral treatment consistently for 3 or more years.
3. Viral load is undetectable.
4. CD4 lymphocyte count is within normal range. Baseline CD4 and nadir will be requested.
5. Client has NO history of Hepatitis C.
6. Client has NO history of IV drug abuse and is a non smoker.
7. NO history of AIDS defining illness.
In addition to the above criteria, below is an example of an ideal scenario:
1. Client was diagnosed HIV+ between the ages of 20-39.
2. Client has been HIV positive for 5 or more years, with consistent treatment documented. Serial blood work and medical surveillance is documented.
3. CD4 Count was HIGH at time of diagnosis. (Note: CD4 count between 200-500 is considered the intermediate phase; CD4 count less than or equal to 200 increases the risk for AIDS- related opportunistic infection/cancers). The CD4 nadir (lowest value) is predictive for long-term mortality.
4. Client’s viral load is low at time of diagnosis.
5. Routine blood work, including renal and liver function, is consistently normal.
6. Hepatitis B surface antigen is negative.
7. If HIV virus was contracted from unprotected sexual contact, client is currently practicing safe-sex and/or is in a monogamous relationship. (Client is not regularly treated for non-HIV sexually transmitted infections).
8. Client has no signs of early coronary artery or renal disease.
I reviewed labs and medical records and everything was a go, but in order to avoid the previous experience, I had an associate speak with an underwriting director with the company and go through the criteria one by one and confirm that this is what they were looking for. There was question in anyone’s mind that this life insurance application should fly to approval. No informal application. They wanted a formal application so we moved ahead with the application and exam with the company, client, examiner and me all fully aware of his HIV+ status. They got the medical records and declined the application. They declined the poster child and their reason, well, look at number one under “ideal scenario”. Their reason given for the decline was his age of diagnosis being prior to age 35. He was diagnosed at 25 and his age now is 33. He has not had a detectable viral load since starting treatment.
So I asked for clarification, thinking surely someone didn’t communicate clearly to someone else and instead of getting a call from the underwriter I got an email from the life insurance company legal department saying that any further communication on the case needed to be directed to them. Upset with this turn of events and the fact that the attorney I was to communicate with was on vacation I expressed my concern that nothing was being done and I cc’d the underwriter who had confirmed my client’s poster child status and the president of the life insurance company. So I ticked off the legal department and got this response,
Let me be very clear about one thing. As an attorney for XYZ Life Insurance, I am specifically instructing you to deal with me or my colleague, Joe Blow, exclusively, regarding this matter. I will instruct underwriting to not engage you regarding this matter and if your communications continue along the tenor of the below email, I will have your emails blocked from XYZ’s servers and all future communications will be by facsimile or regular mail.” So, I emailed the president of the company and the underwriter directly and asked:
“Mr Boss and Mr UW,
This whole thing has spiraled out of control and I need to know a few things to ascertain my position with XYZ.
1. Does this attorney have the authority to disallow me to communicate with anyone other than him in XYZ as he demands below and does he really have the authority to block my email from XYZ servers as he threatened below?
2. How can he be allowed to say that there has been no representation of the possibility of underwriting HIV+ when Mr UW reviewed the underwriting criteria before this application and gave it the green light?
3. Why is there no reconsideration happening when my client clearly met the guidelines provided? I will gladly quit fussing if someone shows me where he doesn’t fit into those guidelines, but the attorney has hijacked this thing. And if there is a review of the case happening, why are me and my associate being left out of the loop.
Forgive my presumption in coming directly to you, but in 15 years in brokerage and over 30 in the business I have never been treated in this manner and can’t allow a customer to be treated in this manner.”
Bottom line. It gets even soggier and muckier. This was a stranger than fiction experience for me and the fact that I had dragged a client into the fray made me feel like a jerk of giant proportions. If you have any questions, call or email me directly. My name is Ed Hinerman. Follow on to part 3 and then let’s talk.