Why is it important for Life Underwriters to be proficient at underwriting mature ages?
Underwriting mature ages is becoming an increasingly important skill for underwriters due to the substantial growth of people ages 65 and older.
Between 2015 and 2030, the number of people in the world aged 60 years or over is projected to grow by 56%, from 901 million to 1.4 billion, and by 2050, the global population of older persons is projected to more than double its size in 2015, reaching nearly 2.1 billion (United Nations World Population Ageing Report).
The growth is largely attributed to declines in diseases that cause mortality and longer life expectancy. With a growing elderly population, life underwriters can expect to see more mature age cases on their desk. Underwriting older ages has a much different focus than younger ages and underwriters need to be aware of what to look for.
Why is underwriting mature ages complex?
Underwriting the elderly is a complex process. In addition to specific health impairments that may negatively affect mortality, the assessment of an applicant’s physical and mental function, adverse events such as prior falls or fractures and other objective measurements such as laboratory findings all may have implications concerning future mortality risk. Additionally, the level of functioning an applicant possesses may have greater significance in determining the remaining lifespan than any specific health impairment(s) he or she may have.
Two key sources of information life underwriters need for mature age cases
1) The Attending Physician
The attending physician is an extremely important corroborative source of information regarding the proposed insured's medical history. The elderly may have memory loss, depression, reduced hearing, a general distrust of strangers, or numerous other reasons for being a poor historian on an insurance examination.
2) Special paramedical exams
Special paramedical exams include routine testing for cognitive/mental impairment, gait and mobility, and depression. These exams can provide a lot more valuable information than a physician's insurance medical examination where only supplemental functional assessment testing is possible.
The ideal sources of underwriting information for an underwriter would be a combination of special paramedical examinations and the attending physician's actual medical records detailing current medical impairments.
What should underwriters be aware of/on the look out for?
Adverse changes in heath should present a red flag and trigger further investigation. Some of these include:
- Decline in physical function
- Existing disease deterioration
- Recent or multiple hospitalizations
- Chronic cough
- New onset asthma
- Depression
- Falls
- Fluctuation in weight
The key to underwriting mature age
When underwriting the elderly, it is important to consider the overall picture and weigh all the factors. The most important factors include personal history, risk factors, symptoms, medication taken, and recent medical examinations and tests. Each of these factors can provide significant clarification, especially when medical history or symptoms are described in a vague way on the application – and they often are.
Things to consider when underwriting mature ages:
Some people have a poor understanding of health
We have to be careful when underwriting clients with a poor understanding of their health condition as this usually results in poor medication compliance. For example, they don’t know why they are taking a certain pill so they don't take it consistently. Non-compliance with medication is a serious consideration for underwriting the elderly.
Symptoms could be vague
Furthermore, the symptoms are often described in a very vague way making current medical assessments (special paramedical exams/insurance medical exams) and APS' that much more important. Sometimes the last office visit (LOV) on appointments will not be as current as underwriters would like, but there is high likelihood that we will get the overall picture of person’s health and their current status regardless.
Understand drug interactions
Drug to drug interactions can predispose the elderly to weakness, physical and mental slowness and falls. It is important to have periodic assessments of prescribed and non-prescribed medications (including herbal) to identify these risks.
No family doctor should be a red flag
People at a mature age who do not have a family doctor should be a big red flag, even if they declare to be “in great health”. There are several screening tests and exams that should be done from certain ages onward and an absence of these cannot be ignored. These include but are not limited to:
- colonoscopies
- BMD
- annual blood work
- bi-annual mammograms
Likewise, look out for clients that claim to see homeopathic doctors. Herbal medicine, although some may find it helpful, is not considered a standard in elderly care or screening. Look for the signs/symptoms that are prompting herbal or homeopathic treatment.
