Things pop up day to day in my business that remind me that I haven’t written about some particular life insurance pitfall in a while. Just as much as any life insurance impaired risk you might present, the inaccurate BS information that doctors put in or allow to be in your medical records can torpedo your life insurance application and get you declined. Case in point, not that unusual at all, is a CEO life insurance client I am currently working with. The guy has a boatload of issues that trip the gag reflex of even some of the best life insurance underwriters, but we had buried all of their excuses not to approve the policy……until.

About a year ago this guy had a CT of the chest and it showed a small nodule in the lung. That was December 2012. The CT showed a nodule in the right lower lobe of the lung and was characterized as a likely fissural lymph node. They did a follow up CT scan in March 2013 and the nodule was gone. The doctor explained to the client that sometimes you get a little inflammation and on a CT it shows as a nodule. Well on the new CT he had another nodule in a different part of the lung, again characterized as probable minor inflammation. His doctor was not concerned and told him they could check on things every few years, but, the report from the CT administrator had a standard language line in it that said, ” If the patient has a smoking history or other risk factors for lung cancer, followup chest CT in 12 months.”

This isn’t what he was told by his doctor and he never read the report. His doctor reviewed it with him as far as the results but his recommendation was to take a look every few years. That line, “If the patient has a smoking history or other risk factors for lung cancer, followup chest CT in 12 months”, would be in every report of a lung CT done by that company, whether there was a smoking history or other risk factors or not. Their computer spits that out and whether your doctor thinks it’s necessary, that recommendation is still there. Life insurance underwriters see it as a valid recommendation even though it is in direct conflict with this person’s primary care doctor interpretation.

And that is the nature of medical records. They are full of inconsistencies that trend toward making the client look non compliant when in fact the patient is being completely compliant with the person they have chosen to be in charge of their medical care, their primary care doctor. What can be done? In a case like this the PC needs to come out strongly with a letter and notes in the client’s records stating that, while they appreciate the fact that the CT facility has this standard recommendation, here’s why it doesn’t fit in his patient’s case. They have to assert themselves as being the professional in charge and defend their recommendation. That’s what should be done. The ugly truth is that most doctors don’t believe defending their stance is necessary or important and they leave their patients in an untenable position trying to be approved for life insurance.

Bottom line. It’s hard to see a problem like this coming ahead of time, but to the extent that a person can, they should be proactive in making sure that things reconcile in their medical records or life insurance applications can come to a grinding halt. If you have questions or need help with a matter of inconsistent medical records information, call or email me directly. My name is Ed Hinerman. Let’s talk.

 

 

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