Laboratory Tests
A View from Underwriting
aboratory testing has come a long way in the past
several years — and it’s not only impacting diagnoses
and treatment of disease, but it can also give insight into
implications on mortality. To arrive at the best possible
decision, our underwriters frequently include biometrical
data from blood tests, urinalysis and specific screening tests
in their decision making.
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As noted in Dr. Segel’s article, underwriters evaluate test results
to obtain prognostic information to help assess mortality risk.
The testing tools at our disposal are always evolving, and John
Hancock undertakes a rigorous process to determine which
will be of most value in underwriting life insurance applicants.
Factors that we consider include:
• Use of test – is it going to help us assess a disease with
high mortality?
• Ease and cost of test – in an underwriting setting, a simple
blood test may prove to be a better tool than a complex
imaging study — and more cost-effective too!
• Acceptance by clinical medicine – does research indicate
that the test is effective?
While routine laboratory testing gives us understanding of
the cause of abnormal test results, reflexive testing can
provide more in-depth information, or even lead to additional
discoveries about the health of the proposed insured. For
example, in the case of elevated liver function, a subsequent
test of CDT — an alcohol marker — would determine
whether alcoholism might also be of concern in the case.
Here are some examples of common laboratory tests and
how they are used in underwriting:
Carcinoembryonic antigen (CEA)
While this blood test is used in clinical medicine to detect cancer
tumor recurrence and prognosis with respect to diagnosed tumors,
recent studies have shown that CEA could also have significant value
as a predictor of mortality risk for certain life insurance applicants.
Prostate-specific antigen (PSA)
Although deemed by some to be controversial, PSA testing
contributes to a progressive approach to underwriting prostate
cancer (see our Fourth Quarter, 2012 Journal for details).
Glycated hemoglobin or glycosylated hemoglobin (A1c)
Combined with other health indicators, this test allows for a more
complete health profile of a person diagnosed with diabetes.
Pro-Brain natriuretic peptide (p-BNP)
This test is designed to provide added protection against the
risk of undiagnosed or incipient Congestive Heart Failure (CHF),
other coronary risks and valve disorders. Underwriters look at
echocardiogram (ECHO) findings to decide which elevated p-BNP
values are significant when considering mortality risk on a life
insurance applicant.
Carbohydrate deficient transferrin (CDT)
Underwriters use this alcohol marker to help predict mortality risk.
It is more accurate when used in association with other indications
of alcohol excess, including smoking, elevated HDL cholesterol and
elevated GGT.
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In these case studies see how John Hancock underwriters used laboratory results to help arrive at the
best possible offers.
CASE
1
70-year-old male, Non-Smoker, $5 million Permanent policy, 6’, 220 lb, BP 140/90
Health History
• APS: Myocardial infarct in 2004 → stent to RCA
• 2010 TST wnl
• Exam shows mild pedal edema
• Underwriter is concerned about possibility of Congestive
Heart Failure (CHF) given edema → p-BNP is 73
(inconsistent with CHF)
John Hancock Decision?
Standard. With a history of heart disease and pedal edema,
CHF is a possibility. The normal level of the cardiac enzyme
Pro-BNP reassures that there is no CHF and we are able to
offer Standard rates.
Scenario A
CASE
2
35-year-old male, $5 million Term policy, 6’3”, 225 lb, BP 135/90
Health History
• APS: Non-smoker
• MVR clear
• Admits to 2 drinks/day
• BCP: ^GGT, ^HDL
• Reflex CDT: negative result
John Hancock Decision?
Preferred. In this scenario, there are red flags for alcohol
excess: elevated GGT and elevated HDL. The admitted alcohol
use of two drinks per day is not consistent with excess.
The CDT, which is negative, gives us a comfort level that
alcohol is not a contributing factor here and we are able
to offer Preferred.
Scenario B
35-year-old male, $5 million Term policy, 6’3”, 225 lb, BP 135/90
Health History
• APS: Smokes 1 pack/day
• DUI in remote past
• Admits to 2 drinks/day
• BCP: ^GGT, ^HDL
• Reflex CDT: positive result
John Hancock Decision?
Decline. There are several red flags for alcohol excess in this
proposed insured: tobacco use, DUI, elevated GGT, elevated
HDL. The CDT in this scenario helps us determine the course
of action. A positive CDT is indicative of daily alcohol use of
five or more drinks. Along with the other red flags, we are
confident that this is not an insurable risk.
As you can see, lab results are an integral part of today’s underwriting review process. While our medical team
keeps abreast of the latest developments in laboratory testing, our underwriters are translating that knowledge
into the best possible offers for your clients.
Submit your next case to John Hancock and let our underwriting team put their expertise to
work for you — call 1-800-505-9427, option 2.
For Agent Use Only. This material may not be used with the public.
Insurance products are issued by: John Hancock Life Insurance Company (U.S.A.), Boston, MA 02116 (not licensed in New York) and John Hancock Life Insurance Company of New York, Valhalla, NY 10595
MLINY02051318157
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