DISABILITY INSURANCE
Guidelines Update 2012
MetLife Disability Insurance is dedicated to providing the best possible underwriting experience
for brokers and clients. As part of this commitment, we are undergoing a thorough update of
our medical underwriting guidelines by evaluating how we underwrite medical conditions and
identifying where we can make better offers.
This document includes the medical conditions we have recently updated.


Those with no major changes are in black.
Those with improvements are in green and include a brief explanation of what’s
changed.
Turn the page for an interactive Table of Contents.
MetLife
Metropolitan Life Insurance Company
200 Park Avenue
New York, NY 10166
metlife.com
As of 12/21/2012
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L1212295828[0214]
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Disability Insurance Medical Underwriting Update
2012
Press Control + Click on the subject you would like to learn about.
ABDOMINAL AORTIC ANEURYSMS (AAAS) ..........................................................................................................................6
ACHILLES RUPTURE .........................................................................................................................................................6
ACHILLES TENDONITIS .....................................................................................................................................................6
ADRENAL INSUFFICIENCY..................................................................................................................................................6
ANEMIAS ......................................................................................................................................................................6
ANKYLOSING SPONDYLITIS................................................................................................................................................6
ANTIPHOSPHOLIPID ANTIBODY SYNDROME..........................................................................................................................6
ANXIETY DISORDERS .......................................................................................................................................................7
AORTIC ROOT DILATATION ...............................................................................................................................................7
ARNOLD CHIARI MALFORMATION......................................................................................................................................7
ARTERIOVENOUS MALFORMATIONS ...................................................................................................................................8
ATRIAL PREMATURE CONTRACTIONS (APCS) .......................................................................................................................8
ATHLETIC HEART SYNDROME ............................................................................................................................................8
AV BLOCKS ...................................................................................................................................................................8
BENIGN PROSTATIC HYPERTROPHY ....................................................................................................................................8
BREAST DISORDERS ........................................................................................................................................................9
BRUGADA .....................................................................................................................................................................9
BUNION .......................................................................................................................................................................9
BURSITIS.......................................................................................................................................................................9
CARDIOMYOPATHY .........................................................................................................................................................9
CAROTID ARTERY ANEURYSM ...........................................................................................................................................9
CAROTID BRUITS ............................................................................................................................................................9
CAROTID INTIMA-MEDIA THICKNESS ...............................................................................................................................10
CAROTID OR VERTEBRAL ARTERY DISSECTION ....................................................................................................................10
CAROTID STENOSIS .......................................................................................................................................................10
CARPAL TUNNEL ..........................................................................................................................................................10
CATARACTS .................................................................................................................................................................10
CELIAC DISEASE ...........................................................................................................................................................10
CEREBRAL ARTERY ANEURYSM ........................................................................................................................................10
CERVICAL CANCER ........................................................................................................................................................11
CERVICAL OR THORACIC DISC DISEASE ..............................................................................................................................11
CERVICAL OR THORACIC SPRAIN/STRAIN ...........................................................................................................................11
CHALAZION .................................................................................................................................................................11
CHIROPRACTIC MAINTENANCE ........................................................................................................................................12
CLUB FOOT .................................................................................................................................................................12
COARCTATION OF THE AORTA .........................................................................................................................................12
COCCYX DISORDERS ......................................................................................................................................................12
COSTOCHONDRITIS .......................................................................................................................................................12
CREST SYNDROME ........................................................................................................................................................12
DEPRESSION ................................................................................................................................................................13
DEQUERVAIN’S TENOSYNOVITIS ......................................................................................................................................13
As of 12/21/2012
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DEXTROCARDIA ............................................................................................................................................................13
DIASTOLIC DYSFUNCTION...............................................................................................................................................13
DISCOID LUPUS ............................................................................................................................................................13
DRUSEN .....................................................................................................................................................................13
DUPUYTREN’S CONTRACTURE .........................................................................................................................................13
EBSTEIN'S ANOMALY.....................................................................................................................................................13
EHLERS-DANLOS SYNDROME ..........................................................................................................................................14
EOSINOPHILIC FASCIITIS .................................................................................................................................................14
EPICONDYLITIS .............................................................................................................................................................14
EPISCLERITIS ................................................................................................................................................................14
FATTY LIVER ................................................................................................................................................................14
FLAT FEET ...................................................................................................................................................................14
GALLBLADDER DISORDERS..............................................................................................................................................14
GLAUCOMA.................................................................................................................................................................14
GYNECOMASTIA ...........................................................................................................................................................14
HAMMER TOE .............................................................................................................................................................14
HEART CHAMBER ENLARGEMENT ....................................................................................................................................14
HEMOCHROMATOSIS ....................................................................................................................................................15
HEPATITIS B ................................................................................................................................................................16
HEPATITIS C ................................................................................................................................................................16
HIP DISORDERS ............................................................................................................................................................16
HYPERCOAGUABLE DISORDERS........................................................................................................................................16
HYPERPARATHYROIDISM ................................................................................................................................................16
HYPERTENSION ............................................................................................................................................................16
HYPOPLASTIC LEFT HEART SYNDROME .............................................................................................................................17
HYPOTHYROIDISM ........................................................................................................................................................17
ILLICIT SUBSTANCE ABUSE ..............................................................................................................................................17
KIDNEY CANCER ...........................................................................................................................................................17
KNEE LIGAMENT SPRAIN ................................................................................................................................................17
KNEE MENISCAL TEARS .................................................................................................................................................17
KNEE REPLACEMENT .....................................................................................................................................................18
LATTICE DEGENERATION ................................................................................................................................................18
LIPIDS (CHOLESTEROL, TRIGLYCERIDES) .............................................................................................................................18
LONG QT SYNDROME ...................................................................................................................................................18
LUMBAR DISC DISEASE ..................................................................................................................................................18
LUMBAR SPRAIN/STRAIN ...............................................................................................................................................18
MACULAR DEGENERATION .............................................................................................................................................18
MARFAN’S ..................................................................................................................................................................18
MARIJUANA ................................................................................................................................................................18
MELANOMA ................................................................................................................................................................19
MICROALBUMINURIA ....................................................................................................................................................19
MIXED CONNECTIVE TISSUE DISEASE ...............................................................................................................................19
MORTON’S NEUROMA ..................................................................................................................................................19
NEVI ..........................................................................................................................................................................19
OVARIAN CANCER ........................................................................................................................................................19
PACEMAKERS...............................................................................................................................................................20
PANCREATIC CANCER ....................................................................................................................................................20
PATELLAR DISLOCATION ................................................................................................................................................20
As of 12/21/2012
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PATELLOFEMORAL SYNDROME OR PATELLAR TENDON RUPTURE............................................................................................20
PATENT DUCTUS ARTERIOSUS (PDA) ...............................................................................................................................20
PERIARTERITIS NODOSA .................................................................................................................................................20
PERICARDITIS...............................................................................................................................................................20
PERIPHERAL ANEURYSMS ...............................................................................................................................................21
PHEOCHROMOCYTOMA .................................................................................................................................................21
PLANTAR FASCIITIS .......................................................................................................................................................21
POLYCYSTIC OVARY SYNDROME (PCOS) ...........................................................................................................................21
POLYMYALGIA RHEUMATICA (PMR) AND TEMPORAL ARTERITIS............................................................................................21
POLYMYOSITIS .............................................................................................................................................................21
PRESCRIPTION DRUG ABUSE ...........................................................................................................................................21
PROSTATITIS ................................................................................................................................................................21
PROTEINURIA ..............................................................................................................................................................21
PSORIASIS ...................................................................................................................................................................21
PSORIATIC ARTHRITIS ....................................................................................................................................................21
PTERYGIUM.................................................................................................................................................................22
PULMONARY EDEMA .....................................................................................................................................................22
PULMONARY ATRESIA ...................................................................................................................................................22
RENAL ARTERY STENOSIS ...............................................................................................................................................22
RETINAL DETACHMENT ..................................................................................................................................................22
SARCOIDOSIS ...............................................................................................................................................................22
SCLERITIS ....................................................................................................................................................................23
SCLERODERMA.............................................................................................................................................................23
SHOULDER REPLACEMENT .............................................................................................................................................23
SHOULDER SEPARATION / DISLOCATION ...........................................................................................................................23
SICK SINUS SYNDROME..................................................................................................................................................23
SPINAL DEFORMITIES (SCOLIOSIS) ....................................................................................................................................23
SPINOCEREBELLAR DEGENERATION ..................................................................................................................................23
SPONDYLOSIS ..............................................................................................................................................................24
SPONDYLOLISTHESIS......................................................................................................................................................24
STROKE ......................................................................................................................................................................24
SUPRAVENTRICULAR TACHYCARDIA (SVT) .........................................................................................................................25
SYNOVITIS...................................................................................................................................................................25
SYSTEMIC LUPUS ERYTHEMATOSUS ..................................................................................................................................25
TARSAL TUNNEL SYNDROME...........................................................................................................................................25
TENDONITIS ................................................................................................................................................................25
TETRALOGY OF FALLOT ..................................................................................................................................................25
THORACIC AORTIC ANEURYSM ........................................................................................................................................25
THORACIC AORTIC DISSECTION .......................................................................................................................................25
THORACIC OUTLET SYNDROME .......................................................................................................................................26
THYROIDITIS ................................................................................................................................................................26
TRANSIENT ISCHEMIC ATTACKS (TIAS) .............................................................................................................................26
TRANSPOSITION OF THE GREAT ARTERIES ..........................................................................................................................26
TRICUSPID ATRESIA.......................................................................................................................................................26
TRIGGER FINGER ..........................................................................................................................................................26
UTERINE CANCER .........................................................................................................................................................27
VENTRICULAR PREMATURE CONTRACTIONS (VPCS) ............................................................................................................27
VENTRICULAR TACHYCARDIA ..........................................................................................................................................27
As of 12/21/2012
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VISCERAL ANEURYSMS ..................................................................................................................................................28
VISUAL IMPAIRMENT.....................................................................................................................................................28
WEIGHT LOSS ..............................................................................................................................................................28
WOLFF-PARKINSON-WHITE (WPW) ...............................................................................................................................28
UPCOMING UPDATES .......................................................................................................................................... 29
FOR MORE INFORMATION ................................................................................................................................... 30
Then
As of 12/21/2012
Now
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L1212295828[0214]
Date of
Update
Page |
Then
Now
Date of
Update
If specific criteria are met, AAAs not 10/22/12
treated with Surgery or
Endovascular Stent that are small
in applicants over age 50 can be
possibly considered with an
exclusion rider.
Abdominal Aortic
Aneurysms (AAAs)
All untreated Abdominal Aortic
Aneurysms were a decline
regardless of size or age of
applicant.
Achilles Rupture
No major improvements in ratings.
6/22/12
Achilles Tendonitis
No major improvements in ratings.
6/22/12
Adrenal Insufficiency
No major improvements in ratings.
11/30/12
Anemias
Individuals with a history of
Megaloblastic anemia were
offered with an extra premium
for up to five years after
resolution.
Individuals with a history of
Megaloblastic anemia due to folic
acid deficiency may be standard at
1 year after recovery. And
individuals with a history of
Megaloblastic anemia due to B12
deficiency may be standard at 2
years after recovery.
Applicants with Anemia due to
pregnancy or menstruation were
declined for hemoglobin under
10.
Anemia of pregnancy with
hemoglobin of 9.6 mg/dl or greater
may be standard. Anemia due to
menses may be standard for
women with a hemoglobin of 9.6
mg/dl or above.
No specific underwriting
guidelines for anemia due to
insufficient dietary intake of iron
were in the manual possibly
resulting in unnecessary declines
or rated offers.
Applicants with stable, mild anemia
due to low dietary intake of iron,
such as for those on vegan diets,
and who are asymptomatic may be
standard.
Ankylosing Spondylitis No major improvements in ratings.
No specific guidelines existed,
Guidelines now exist and after an
Antiphospholipid
possibly resulting in unnecessary initial 2-year declination period
Antibody Syndrome
declines or inconsistent high
substandard offers.
As of 12/21/2012
5/25/12
2/24/12
8/24/12
offers may be made for the more
favorable cases.
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Then
Anxiety Disorders
Now
Guidelines for Simple and Social Applicants with a history of Simple
Phobia did not exist, possibly
or Social Phobia with mild disease
resulting in unnecessary declines. may be offered, with Standard
being available for the most
favorable cases of Simple Phobia.
Applicants with Generalized
Anxiety Disorder were usually
declined.
Mild cases of Generalized Anxiety
Disorder may be offered coverage
(an extra premium rating, rider
and, in some situations, a limited
benefit period would apply)
depending on the severity of initial
symptoms and the time since
resolution of those symptoms.
Applicants with a history of
Obsessive Compulsive Disorder or
Post Traumatic Stress Disorder
were usually declined.
The most favorable cases of
Obsessive Compulsive Disorder or
Post Traumatic Stress Disorder,
with durable histories of continued
stability and without a history of
work absence may be offered
coverage (an extra premium rating,
rider and limited benefit period
would apply)
Aortic Root Dilatation Guidelines did not exist, which
5/4/12
Arnold Chiari
Malformation
3/30/12
As of 12/21/2012
If specific criteria are met, aortic
may have resulted in unnecessary root dilatation may possibly be
considered; a rated policy and an
declines.
exclusion rider may apply. Ratings
may be able to be reduced and
benefit periods increased if the
aortic root size has been stable for
a period of time.
Guidelines did not exist, possibly Guidelines now exist, possibly
resulting in unnecessary declines. resulting in offers for the most
favorable cases.
Date of
Update
6/29/12
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Arteriovenous
Malformations
Atrial Premature
Contractions (APCs)
Athletic Heart
Syndrome
Then
Now
No guidelines were covered in the
prior Manual for non-surgical
treatment of AVMs of the brain,
possibly resulting in unnecessarily
high substandard offers or
declines.
Guidelines are now provided for
non-surgical treatment of AVMs of
the brain, increasing the likelihood
of a lower-rated substandard offer.
All applications from individuals
with a history of subarachnoid
hemorrhage due to AVM of the
brain and with no residual
symptoms were declined for at
least 5 years after surgical
treatment, and then both high
and low percentage ratings and a
limited benefit period were
applied.
Offers may now be made as soon
as 2 years after surgical treatment
for those who have fully recovered
from subarachnoid hemorrhage
due to AVM of the brain, and
thereafter either only low or no
percentage ratings and no
limitations on benefit period are
applied.
Mainly considered individuals if
APCs were noted incidentally
(asymptomatic) and with a
normal heart; otherwise
assessed on an individual case
by case basis.
Individuals with mild symptoms, a
structurally normal heart, and not
on treatment, can be considered
for standard.
No credits were allowed.
Credits are now available for a
normal echocardiogram.
Applicants may be considered
standard.
No specific guidelines existed,
possibly resulting in unnecessary
declines or substandard offers.
Date of
Update
10/19/12
3/16/12
Individuals with no to mild
symptoms and with some forms of
ratable heart disease can be
considered with an additional small
rating.
12/21/12
AV Blocks
Reviewed. No major changes
2/10/12
Benign Prostatic
Hypertrophy
Reviewed. No major changes
5/25/12
As of 12/21/2012
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Breast Disorders
(Including abscess/
cellulitis; fibroadenoma;
hamartoma; mastitis;
fibrocystic disease;
mastodynia; lipoma;
abnormal mammograms;
macromastia; breast
augmentation; cysts, etc.)
Then
Now
Many breast disorders were not
covered in the Manual, possibly
resulting in unnecessary declines
or rated/ridered offers.
Guidelines are now available in the
Manual for most breast disorders,
resulting in consistent decisions
and the best possible offers.
Date of
Update
1/6/12
Brugada
Reviewed. No major changes
6/29/12
Bunion
Bursitis
Reviewed. No major changes
6/22/12
For recurrent cases, 30, 60 and 90 For recurrent cases, 90-day EP
day EP policies were only
policies are available at Standard
available with a 180 day modified rates, without a rider, beginning 6
exclusion rider.
months to 1 year after symptoms
resolve.
12/21/12
Individuals with completely
All cases of dilated
cardiomyopathy whether present resolved dilated cardiomyopathy
for at least 3 years may be offered
or resolved were a decline.
with an extra premium and limited
benefit period and standard may
be possible if over 5 years.
5/25/12
Cardiomyopathy
All cases of hypertrophic
cardiomyopathy were a decline.
Carotid Artery
Aneurysm
Carotid Bruits
As of 12/21/2012
Individuals with hypertrophic
cardiomyopathy who are stable for
at least 5 years and meet the most
favorable criteria may be offered
with an extra premium and a
limited benefit period.
No guidelines were covered for
Guidelines are provided for carotid
carotid artery aneurysms that
artery aneurysms that were
were repaired, possibly resulting repaired, increasing the likelihood
in unnecessarily high substandard of a lower-rated substandard offer.
offers or declines.
No specific guidelines existed,
Specific guidelines are provided,
possibly resulting in unnecessary increasing the likelihood of lowerdeclines or high substandard
rated substandard offers.
offers.
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9/21/12
7/27/12
Page |
Then
Now
Carotid
Intima-Media
Thickness
No specific guidelines existed,
possibly resulting in unnecessary
declines or high substandard
offers.
Specific guidelines are provided for
Increased Carotid Intima-Media
Thickness, increasing the likelihood
of Standard or lower-rated
substandard offers.
Carotid or Vertebral
Artery Dissection
No guidelines were covered,
Guidelines are provided, increasing
possibly resulting in unnecessarily the likelihood of a lower-rated
high substandard offers or
substandard offer.
declines.
9/21/12
Carotid Stenosis
No specific guidelines existed,
possibly resulting in unnecessary
declines or high substandard
offers.
Applicants with chronic
symptoms were declined.
Specific guidelines now exist,
increasing the likelihood of lowerrated substandard offers.
7/27/12
Applicants with symptoms can be
considered on an individual basis,
with the best cases offered
disability income insurance with an
exclusion rider.
8/10/12
Applicants with full recovery
after surgery could qualify for a
Standard offer after 2 years.
Applicants with full recovery after
carpal tunnel surgery may qualify
for a Standard offer after 1 year.
Unoperated bilateral senile
cataracts with normal to mild
visual impairment were given a
general eye rider and a rating.
Unoperated bilateral senile
cataracts with normal to mild visual
impairment are given a specific
cataract rider.
Carpal Tunnel
Cataracts
Celiac Disease
Cerebral Artery
Aneurysm
As of 12/21/2012
Operated bilateral senile
cataracts with normal to mild
Operated bilateral senile cataracts
visual impairment post surgery
with normal to mild visual
were given a general eye rider
impairment post surgery are
placed for 3 years.
standard after 6 months.
No major improvements in ratings.
All applications from individuals
with a history of surgical
correction of a cerebral artery
aneurysm and with no residual
symptoms were declined for at
least 5 years after treatment.
Offers may now be made as soon
as 2 years after complete
obliteration of a cerebral artery
aneurysm by any means for
persons who have fully recovered.
Percentage ratings were applied
at all durations after the
declination period that followed
surgical correction of a cerebral
artery aneurysm.
Percentage ratings are not applied
beyond a few years after the
declination period that follows
complete obliteration of a cerebral
artery aneurysm.
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L1212295828[0214]
Date of
Update
7/27/12
10/26/12
4/6/12
9/21/12
Page |
Cervical Cancer
Cervical or Thoracic
Disc Disease
Cervical or Thoracic
Sprain/Strain
Chalazion
As of 12/21/2012
Then
Now
In cases of in situ (Stage 0), 90day elimination period policies
would be offered with a modified
exclusion rider 6 months after
completion or treatment.
Individuals with Stage 0 cervical
cancers applying for 90-day
elimination period may be eligible
for a Standard offer.
Stage 1a cervical cancer had a
postponement period of 5 years
after diagnosis.
Individuals with Stage 1a cervical
cancer may be offered a policy with
a rider after as little as one year
post-treatment and a Standard
policy may be available after 3
years.
Stage 1b cervical cancer cases
were always declined.
Stage 1b cervical cancer cases with
favorable prognostic features may
be offered rated policies after 5
years and Standard offers after 9
years.
After a single episode of
symptoms treated without
surgery, an exclusion rider would
apply if the episode resolved less
than 4 years before applying.
In the same situation, an exclusion
rider would be applied if the
episode resolved less than 3 years
prior to application. After that a
Standard offer could be considered.
If an individual had any residual These cases can be considered for
symptoms after surgery, a decline an offer based on the severity and
was recommended.
stability of the residual symptoms.
In the most favorable cases an
exclusion rider would be applied,
while others may be offered with
increased premiums and/or benefit
period limits along with the
exclusion rider.
All instances were given an
The most favorable cases (no work
exclusion rider if the most recent absence nor need for physical
episode resolved less than one
therapy or similar treatments) can
year ago.
be considered for a Standard offer,
even if the episode resolved
recently.
No major improvements in ratings.
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L1212295828[0214]
Date of
Update
2/17/12
11/30/12
11/30/12
9/28/12
Page |
Then
Now
Chiropractic
Maintenance
Anyone undergoing routine
chiropractic maintenance, with
any visits within the year before
applying, was given an exclusion
rider.
The most favorable cases (no
significant history of spinal
impairment and truly receiving
routine maintenance) can be
considered for a Standard offer if
stable and symptom-free for at least
3 years.
Chronic Obstructive
Pulmonary Disease
(COPD)
No major improvements in ratings.
2/17/12
Club Foot
No major improvements in ratings.
6/22/12
Coarctation of the
Aorta
Coccyx Disorders
No major improvements in ratings.
6/15/12
No major improvements in ratings.
12/21/12
Costochondritis
Crest Syndrome
As of 12/21/2012
No major improvements in ratings.
No major improvements in ratings.
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L1212295828[0214]
Date of
Update
11/30/12
12/21/12
6/29/12
Page |
Depression
Then
Now
All cases of Adjustment Disorder
with Depressed Mood were
issued with exclusion riders for
mental/nervous disorders and at
least a 35% rating.
Applicants who have recovered
from very mild cases of Adjustment
Disorder with Depressed Mood,
and who have had at least 3 years
without symptoms or treatment
can qualify for standard rates.
All cases of Minor (subclinical)
Depression were issued with
exclusion riders for
mental/nervous disorders and at
least a 35% rating.
Minor Depression is given much
more individual consideration.
Ratings are based on severity of
symptoms, treatment and time
since recovery. Those with minimal
or mild cases may qualify for
Standard rates after durable
recovery off of treatment for at
least 3-5 years. Some will require
an exclusion rider.
Date of
Update
9/21/12
DeQuervain’s
Tenosynovitis
Dextrocardia
No major improvements in ratings.
8/10/12
No major improvements in ratings.
6/8/12
Diastolic Dysfunction
No major improvements in ratings.
5/18/12
Discoid Lupus
No major improvements in ratings.
6/29/12
Drusen
There were no guidelines for
drusen which may have resulted
in unnecessary general eye riders
being placed on the policy.
For applicants under age 40, if
specific criteria are met, best cases
may be considered with a specific
rider for macular degeneration.
Applicants with chronic
symptoms were offered
disability insurance with extra
premiums, limited benefit
periods and exclusion riders.
For applicants over age 40, if specific
criteria are met, best cases may be
considered for a standard policy.
Applicants with chronic symptoms
8/10/12
can be considered on an individual
basis, with the best cases offered
disability insurance with an
exclusion rider.
Dupuytren’s
Contracture
Ebstein's Anomaly
As of 12/21/2012
Applicants with full recovery
Applicants with full recovery after
after surgery for Dupuytren's
surgery for Dupuytren's may qualify
could qualify for a Standard offer for a Standard offer after 1 year.
after 2 years.
No major improvements in ratings.
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11/2/12
5/18/12
Page |
Then
Now
Ehlers-Danlos
Syndrome
No major improvements in ratings.
Date of
Update
6/29/12
Eosinophilic Fasciitis
No major improvements in ratings.
6/29/12
Epicondylitis
Episcleritis
No major improvements in ratings.
8/10/12
No major improvements in ratings.
12/21/12
Guidelines did not exist, possibly
resulting in unnecessary declines
or rated/ridered offers.
Flat Feet
No major improvements in ratings.
6/22/12
Gallbladder Disorders No major improvements in ratings.
11/2/12
Glaucoma
No major improvements in ratings.
9/28/12
Gynecomastia
No major improvements in ratings.
1/6/12
Hammer Toe
No major improvements in ratings.
6/22/12
Heart Chamber
Enlargement
No guidelines existed, which may The most favorable cases may
have resulted in unnecessary
possibly be standard and specific
declines or substandard offers.
criteria for other scenarios may
result in improved substandard
offers.
9/7/12
As of 12/21/2012
Guidelines now exist, and the most
favorable cases may be standard.
1/20/12
Fatty Liver
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L1212295828[0214]
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Then
Hemochromatosis
Now
All applicants with a history of
Proposed insureds with hereditary
treated hereditary
hemochromatosis and good
hemochromatosis were a decline. compliance with treatment
program, normal liver function
tests, iron saturation and ferritin
tests, and without complications
can be offered disability income
insurance after 2 years of stability
and may even be standard after 5
or more years of stability.
All applicants with untreated
hereditary hemochromatosis
were a decline.
As of 12/21/2012
Date of
Update
7/20/12
Proposed insureds with a type of
hemochromatosis that is known to
carry a lower risk who are
untreated but with normal liver
function, iron saturation and
ferritin tests, and without
complications can be offered
disability insurance at standard
rates after 1 year of stability.
Those individuals with untreated
hereditary hemochromatosis that is
known to carry a higher risk who
have normal liver function, iron
saturation and ferritin tests, and
without complications, can be
offered disability insurance at an
extra premium charge and with a
limited benefit period after 5 years
of stability and a standard policy
after 10 years of stability.
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L1212295828[0214]
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Hepatitis B
Then
Now
Applicants with a history of
hepatitis B who had fully
recovered (negative surface
antigen) could be considered for
a rated policy with an exclusion
rider after one year and for a
Standard policy after 2 years.
Those with a history of hepatitis B
who had a full recovery within 6
months of the infection, can be
offered a policy with an exclusion
rider after 6 months, and a
Standard policy after 1 year.
Individuals with a history of
chronic, inactive infection
(“carriers”) and normal liver
function tests could be offered a
rated policy with an exclusion
rider and a 2-year benefit
period.
Those with well-established
chronic, inactive infection, and
normal liver function tests may be
offered a policy at Standard rates
with an exclusion rider.
Those with a history of chronic
hepatitis B which resolved to
inactive infection after
treatment, and who, at the time
of application had abnormal liver
function tests, would be
declined.
Proposed insureds with a history of
chronic hepatitis B which resolved
to inactive infection after
treatment and who, at the time of
application, have abnormal LFTs,
may be considered for a rated
policy.
Date of
Update
1/27/12
Hepatitis C
No major improvements in ratings.
Hip Disorders
Applicants with a history of hip
replacement surgery 1 to 3 years
ago could be offered a policy
with +50% extra premium, a 2year benefit period limit and an
exclusion rider.
These same individuals may be
offered a 90 or 180 day EP policy
with an exclusion rider only, if
there are no residual symptoms
and no concerning underlying
cause.
8/31/12
Hypercoaguable
Disorders
No specific guidelines existed for
the various hypercoagulable
states, possibly resulting in
unnecessary declines or
inconsistent high substandard
offers.
All cases of hyperparathyroidism
were declined until surgery was
completed.
Guidelines now exist and after an
initial 2-year declination period
offers may be made for the more
favorable cases.
8/24/12
Favorable cases where the
applicant's personal doctor has not
recommended surgery may be
considered for a rated offer with a
rider and limited BP.
4/13/12
Hyperparathyroidism
Hypertension
As of 12/21/2012
4/13/12
No major improvements in ratings.
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L1212295828[0214]
3/23/12
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Then
Hyperthyroidism
Now
No major improvements in ratings.
Date of
Update
6/29/12
No major improvements in ratings.
5/18/12
(Multinodular Goiter,
Toxic Adenoma, Grave’s
Disease)
Hypoplastic Left
Heart Syndrome
No major improvements in ratings.
Hypothyroidism
Illicit Substance Abuse No major improvements in ratings.
Kidney Cancer
6/8/12
11/30/12
All applicants with a history of
kidney cancer were declined for
at least 7 years after treatment.
Offers may now be made starting 5
years after completing treatment
for the more favorable cases.
At 7 to 10 years after completing
treatment, percentage ratings
were generally very high for
early-stage kidney cancer and,
for those of very early stage,
limited benefit periods were
often short.
At 7 to 10 years after completing
treatment, percentage ratings are
generally much lower for earlystage kidney cancer and, for those
of very early stage, limited benefit
periods are longer.
10 years after completing
treatment for early-stage kidney
cancer, moderately high
percentage ratings still often
applied, and limited benefit
periods were often still short.
10 years after completing
treatment for early-stage kidney
cancer, percentage ratings are
either no longer applied or are very
low, and limited benefit periods are
either longer or not applied.
Knee Ligament Sprain No major improvements in ratings.
Knee Meniscal Tears
As of 12/21/2012
Applicants with a history of
meniscal tear were offered
standard rates 2 years after
symptoms resolved, whether
treated surgically or not.
3/2/12
8/17/12
Cases of non-recurrent cartilage
tear may receive a standard offer 1
year after symptoms resolve,
regardless of the manner of
treatment.
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L1212295828[0214]
8/17/12
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Then
Now
Date of
Update
8/17/12
Knee Replacement
No major improvements in ratings.
Lattice Degeneration
There were no guidelines for
If specific criteria are met, standard
lattice degeneration which may may be available
have resulted in unnecessary
general eye riders being placed
on the policy.
Guidelines for cholesterol did
Pre-pregnancy levels are used
not consider the normal changes preferentially when underwriting
associated with pregnancy,
pregnant women, usually resulting
possibly resulting in less
in more favorable offers.
favorable offers.
11/2/12
Long QT Syndrome
No major improvements in ratings.
6/29/12
Lumbar Disc Disease
With any history and no surgery,
an exclusion rider was applied.
All instances were given an
exclusion rider if the most recent
episode resolved less than one
year ago.
Lipids (cholesterol,
triglycerides)
Lumbar Sprain/Strain
A Standard offer may be considered 11/30/12
after at least 3 symptom-free years
The most favorable cases (no work
11/30/12
absence nor need for physical
therapy or similar treatments) can be
considered for a Standard offer, even
if the episode resolved recently.
With a history of multiple
After 2 symptom-free years, a
episodes treated without surgery, Standard offer may be possible.
an exclusion rider always applied.
If specific criteria are met, some
Macular Degeneration The old guidelines placed a
general eye rider on most cases cases will have a specific rider for
of macular degeneration.
macular degeneration applied.
No major improvements in ratings.
Marfan’s
Marijuana
As of 12/21/2012
3/30/12
11/2/12
6/29/12
In addition to any rating for
If the applicant otherwise qualifies 11/30/12
marijuana use, tobacco smoker
for non-smoker rates, then no
rates also applied even when the additional smoker rates are applied.
applicant was not a tobacco user.
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L1212295828[0214]
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Melanoma
Then
Now
Within each stage, all cases were
rated similarly, not allowing for
more favorable offers for lower
risk.
Within each stage, individuals with
more favorable features are given
more favorable ratings.
Early stage melanomas were
generally rated higher and the
durations before offers could be
made were often longer.
With favorable features, early stage
melanomas generally have lower
ratings and durations before offers
are possible is shorter.
Higher stage melanoma lesions
were often declined permanently
or, if offers were possible,
durations before offers could be
made were very long, ratings
were higher, and benefit periods
very limited.
Offers are now possible for cases
with higher stage lesions with
favorable features. And, in general,
durations before offers are shorter,
ratings are lower, and benefit
periods are longer.
Date of
Update
2/10/12
Microalbuminuria
No major improvements in ratings.
2/24/12
Mixed Connective
Tissue Disease
No major improvements in ratings.
6/29/12
Morton’s Neuroma
No major improvements in ratings.
6/22/12
Nevi
In cases of dysplastic nevi (DN), a Standard may be available,
rider was always applicable with a depending upon the number of DN,
history of any number of DN.
the age of the client, and the family
history of melanoma.
2/3/12
Ovarian Cancer
As of 12/21/2012
In cases of dysplastic nevi (DN)
the rider applied was for any
disease of the skin.
If a rider is needed in cases of
dysplastic nevi, it is limited to only
neoplasms of the skin.
All cases beyond stage 1a were
considered uninsurable.
Cases beyond stage 1a may be
considered on an individual basis
after 10 disease-free years.
Ovarian borderline tumors or
tumors "of low malignant
potential" were not part of our
guidelines and may have been
rated as invasive cancer, resulting
in harsher ratings and/or more
declines.
Ovarian borderline tumors are
considered separately from
invasive ovarian cancers and the
more favorable types may qualify
for rated offers as soon as 3 years
after completion of treatment and
for Standard offers as early as 8
years after completing treatment.
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L1212295828[0214]
2/3/12
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Then
Now
Pacemakers
Always declined.
Will be considered on an individual
basis for a possible substandard
offer.
Pancreatic Cancer
Patellar Dislocation
No major improvements in ratings.
Applicants were offered standard
rates two years after symptoms
had resolved, whether treated
surgically or non-surgically.
Cases of non-recurrent patella
dislocation may receive a standard
offer 1 year after symptoms
resolve, regardless of the manner
of treatment.
8/17/12
Patellofemoral
Syndrome or Patellar
Tendon Rupture
Guidelines did not exist, possibly
resulting in an unnecessary
exclusion rider.
Guidelines now exist and the most
favorable cases may be offered
standard.
8/17/12
Patent Ductus
Arteriosus (PDA)
Applicants with unoperated PDAs Individual consideration will be
were a decline.
given to applicants with small,
uncomplicated PDAs that do not
require surgery and the more
favorable cases will be able to be
offered.
7/27/12
Periarteritis Nodosa
No major improvements in ratings.
6/29/12
Pericarditis
Applicants who are asymptomatic
and with incidental findings of
small pericardial effusions were a
decline.
Applicants with incidental findings
of small, asymptomatic pericardial
effusions may be considered for
disability with an exclusion rider.
Applicants with a history of
pericardial effusions where
surgery was required were always
a decline.
Individuals two years post
successful surgery for
complications of pericarditis who
are asymptomatic and completely
recovered may be considered for a
policy with an extra premium and
limited benefit period, and after 5
years may be offered standard.
As of 12/21/2012
Date of
Update
9/7/12
4/27/12
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7/27/12
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Then
Now
Date of
Update
For iliac or femoral artery aneurysms 12/21/12
Peripheral aneurysms For iliac or femoral artery
aneurysms that have not been
that have not been repaired, offers
surgically repaired, those that
may be made after 5 years after
were due to atherosclerosis were discovery of those due to
declined, and no specific
atherosclerosis, and for those of
guidelines were provided for
other cause, specific guidelines are
those of other cause.
provided, increasing the likelihood of
a lower-rated substandard offer.
No guidelines existed for treated
lower extremity artery aneurysms
other than femoral, and then only
if they were due to trauma or
were congenital, and only if
treated by surgery.
Guidelines exist for treated femoral
as well as iliac and popliteal artery
aneurysms, of any cause, and
whether treated surgically or by an
endovascular procedure, increasing
the likelihood of a lower-rated
substandard offer.
Pheochromocytoma
All applicants with a history of
Offers may be made as soon as 1
surgically treated femoral artery year after surgical treatment of a
aneurysm were declined for at
femoral artery aneurysm.
least 2 years after treatment, and Thereafter, only a rider would be
a limited benefit period was
applicable without a limited benefit
imposed if within 5 years since
period or a percentage rating.
treatment. A percentage rating
always applied.
No major improvements in ratings.
12/21/12
Plantar Fasciitis
No major improvements in ratings.
6/22/12
Polycystic Ovary
Syndrome (PCOS)
No guidelines existed, possibly
resulting in unnecessary declines
or rated/ridered offers.
All cases were a decline.
Polymyalgia
Rheumatica (PMR)
and Temporal Arteritis
Polymyositis
Prescription Drug
Abuse
Guidelines for Polycystic Ovary
Syndrome now exist, and the most
favorable cases may be standard.
1/20/12
Offers are now possible beginning 2
years after completion of
treatment for those who are
completely recovered.
5/4/12
No major improvements in ratings.
No major improvements in ratings.
6/29/12
11/30/12
Prostatitis
No major improvements in ratings.
5/18/12
Proteinuria
No major improvements in ratings.
2/24/12
Psoriasis
No major improvements in ratings.
4/27/12
Psoriatic Arthritis
No major improvements in ratings.
4/27/12
As of 12/21/2012
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Then
Now
Pterygium
No major improvements in ratings.
Date of
Update
12/21/12
Pulmonary edema
No major improvements in ratings.
12/21/12
Pulmonary Atresia
No major improvements in ratings.
5/18/12
Renal Artery Stenosis
No specific guidelines existed,
possibly resulting in
unnecessarily high substandard
offers or declines.
Specific guidelines now exist,
increasing the likelihood of a lowerrated substandard offer.
8/17/12
Retinal Detachment
There were no guidelines for
unoperated retinal detachment
which may have resulted in
unnecessary declines.
If specific criteria are met, a specific
rider for retinal detachment would
be applied.
11/2/12
Operated retinal detachment had With one episode treated
a modified general eye rider
successfully, standard may be
placed on the policy.
available after one year (an exclusion
rider would be applied for the first
year following surgery).
With a history of two or more
episodes, if specific criteria are met,
Standard may be considered 3 years
after successful surgery (an exclusion
rider would be applied for the first
year following surgery)
Sarcoidosis
As of 12/21/2012
Stable stage I individuals would
only be considered for a
Standard offer if they had been
stable for at least 5 years and
were applying for 180-day EP.
Stable stage I applicants can be
considered for a Standard rating
after 4 years of stability and for
policies with EPs as short as 60
days.
Stage II individuals with
(infiltrates on chest X-ray) were
declined.
Stage II applicants may qualify for a
rated policy if they have normal
pulmonary function tests, no
current symptoms, and have been
stable for at least 5 years.
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Then
Now
Scleritis
No specific guidelines existed,
possibly resulting in unnecessary
declines or substandard offers.
If the cause is known and specific
criteria are met, applicants can be
considered after one year with an
eye rider and a rating based on the
specifics of the causal condition; if
the cause is unknown and specific
criteria are met, applicants may be
considered after two years with an
eye rider.
Scleroderma
Shoulder
Replacement
No major improvements in ratings.
6/29/12
No guidelines existed, possibly
Guidelines now exist and the most
resulting in unnecessary declines. favorable cases may be offered
with an exclusion rider.
8/10/12
Shoulder Separation / Applicants with a history of more Applicants who have recovered
than 2 episodes of dislocation or fully after multiple episodes of
Dislocation
Date of
Update
12/21/12
8/10/12
separation were offered
disability insurance with an
exclusion rider for the shoulder.
dislocation or separation, whether
treated surgically or not, may be
offered a Standard policy for 90 or
180 day EP policies after 3 years
symptom-free.
Sick Sinus Syndrome
Always declined.
Applicants with sick sinus
syndrome stable for at least one
year will be considered on an
individual basis for a possible
substandard offer.
9/7/12
Spinal deformities
(scoliosis)
Applicants with moderate spinal
curvatures (21-40 degrees)
applying for 90 day EP policies
were always rated 30% and had
an exclusion rider.
If no significant symptoms, a 90 or
180 day EP policy may be offered at
Standard rates with an exclusion
Rider.
12/21/12
Any surgery for scoliosis
precluded offers of disability
insurance for a period of 5 years
after recovery.
For surgical intervention without the
insertion of prosthetics (such as
Harrington rods), the postponement
period is 3 years, after which a policy
may be offered with a +30% rating
and an exclusion rider.
Spinocerebellar
Degeneration
As of 12/21/2012
No major improvements in ratings.
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Then
Spondylosis
Spondylolisthesis
Stroke
Now
Individuals under age 50 who
have incidentally-detected
spondylosis would be offered a
policy with a modified exclusion
rider, covering related disability
with a 90 or 180 day elimination
period and a 2 year benefit
period.
After a single episode of
symptoms treated without
surgery, an exclusion rider would
be applied if the symptoms
resolved less than 4 years prior to
application.
After a single episode of
symptoms treated without
surgery, an exclusion rider would
be applied if the symptoms
resolved less than 4 years prior to
application.
After a single episode of
symptoms of spondylolisthesis
treated without surgery, an
exclusion rider would be applied
if the symptoms resolved less
than 4 years prior to application.
Other than for strokes due to oral
contraceptives, applications from
individuals with a history of most
forms of Stroke were declined.
All applications from individuals
with a history of stroke due to
oral contraceptives were
declined for at least 3 years after
the stroke.
As of 12/21/2012
Date of
Update
Similar cases can be considered for a 11/30/12
Standard offer.
An exclusion rider would be applied
if the symptoms resolved less than 2
years prior to application. After that
a Standard offer may be considered
for the most favorable cases.
Similar cases can be considered for a 11/30/12
Standard offer.
In the same situation, an exclusion
rider would be applied if the
symptoms resolved less than 3 years
prior to application. After that a
Standard offer may be considered.
After an initial declination period,
depending upon the specific
reasons for a stroke and upon any
associated disorders, offers may
now be made for persons who have
fully recovered without residual
neurologic deficit from most forms
of stroke.
7/13/12
Offers may now be made as soon
as 1 year after a stroke for persons
who discontinue use of oral
contraceptives and fully recovered
without residual neurologic deficit
from a stroke attributed to use of
oral contraceptives.
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Supraventricular
Tachycardia (SVT)
Then
Now
Single episodes of SVT even if
asymptomatic were postponed
for one year.
Individuals with infrequent SVT
episodes of short duration who are
asymptomatic or very minimally
symptomatic and without
underlying heart disease can be
offered.
Date of
Update
4/13/12
Recurrent SVT successfully
controlled with medication can be
offered.
Recurrent SVT controlled with
medication was a decline.
Applicants treated with successful
ablation can be considered
standard after two years.
Guidelines for treatment with
ablation were not specifically
provided likely resulting in
unnecessary declines or ratings.
Synovitis
No specific guidelines existed,
possibly resulting in unnecessary
declines or substandard offers.
Specific guidelines are now available 12/21/12
which will consistently allow for the
most favorable offers possible.
Systemic Lupus
Erythematosus
No major improvements in ratings.
6/29/12
Tarsal Tunnel
Syndrome
Tendonitis
No major improvements in ratings.
6/22/12
For recurrent cases, 30, 60 and 90
day EP policies were only
available with a 180 day modified
exclusion rider.
For recurrent cases, 90-day EP
policies are available at Standard
rates, without a rider, beginning 1
year after symptoms resolve if
treated non-surgically. If treated
surgically, all EPs are available at
Standard rates 6 months after
complete recovery.
Tetralogy of Fallot
No major improvements in ratings.
Thoracic Aortic
Aneurysm
No specific guidelines existed
which may have resulted in
unnecessary declines.
Thoracic Aortic
Dissection
As of 12/21/2012
No specific guidelines existed
which may have resulted in
unnecessary declines.
12/21/12
5/18/12
If specific criteria are met, Thoracic 11/30/12
Aortic Aneurysm treated with
surgery or endovascular stent may
be considered. An exclusion rider
may apply.
If specific criteria are met, Thoracic
11/30/12
Aortic Dissection due to trauma may
be considered. An exclusion rider may
apply.
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L1212295828[0214]
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Then
Thoracic Outlet
Syndrome
Thyroiditis
Transient Ischemic
Attacks (TIAs)
Now
Applicants who had not been
Applicants who have been treated
treated surgically were given an non-surgically may qualify for a
exclusion rider regardless of
standard offer after 5 years
current symptoms.
symptom-free.
No major improvements in ratings.
All applications from individuals
with a history of a TIA were
declined for at least 5 years after
the TIA.
Offers may now be made after a
much shorter declination period
after a TIA.
After the declination period, no
specific guidelines for any form of
TIA were covered, possibly
resulting in unnecessary
substandard offers or declines.
After the declination period,
specific guidelines are provided for
most scenarios in which TIAs may
occur, increasing the likelihood of
an offer – substandard or possibly
even Standard – in the most
favorable situations.
Date of
Update
8/10/12
6/1/12
7/13/12
Transposition of the
Great Arteries
No major improvements in ratings.
5/18/12
Tricuspid Atresia
Trigger Finger
No major improvements in ratings.
5/18/12
As of 12/21/2012
Guidelines did not exist, possibly
resulting in unnecessary
exclusion riders.
Guidelines for Trigger Finger now
exist and the most favorable cases
may be offered Standard.
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L1212295828[0214]
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Uterine Cancer
Then
Now
Applicants with a history of any
type of uterine cancer were
declined for at least 7 years after
treatment.
For favorable cases, offers may
now be made beginning 1 year
after completion of treatment for
the most common form of uterine
cancer– endometrial
adenocarcinoma
At 7 to 10 years after completion
of treatment, percentage ratings
were generally very high for
uterine cancer of any type and
limited benefit periods were
often short.
At 7 to 10 years after completion of
treatment, percentage ratings are
much lower or not applied for
early-stage endometrial
adenocarcinoma and, for very
early-stages, benefit periods are
either longer or not limited.
Beyond 10 years after
completion of treatment for
uterine cancer of any type,
moderately high percentage
ratings were often still applied,
and limited benefit periods were
sometimes still short.
Beyond 10 years after completion
of treatment for early-stage
endometrial adenocarcinoma,
percentage ratings are no longer
applied and benefit periods are
either longer or not limited.
Ventricular Premature Individuals were mainly
considered if VPCs were noted
Contractions (VPCs)
Individuals with mild symptoms, no
evidence of heart disease or
incidentally (asymptomatic) and hypertension, and not on
with a normal heart; otherwise
treatment can be considered for
assessed on an individual case by standard if only occasional VPCs or
case basis.
possibly with a small rating if only a
few VPCs.
No credits were allowed.
Ventricular
Tachycardia
As of 12/21/2012
Date of
Update
3/23/12
3/16/12
Credits are now available for a
favorable exercise stress test.
No major improvements in ratings.
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Then
Visceral Aneurysms
Now
For splenic or renal artery
aneurysms that have not been
surgically repaired, the prior
manual declined those due to
atherosclerosis and provided no
specific guidelines for those of
other cause.
Date of
Update
For splenic or renal artery aneurysms 12/21/12
that have not been repaired, offers
may now be made 5 years after
discovery of those due to
atherosclerosis and, for those of
other cause, specific guidelines are
provided, increasing the likelihood of
a lower rated substandard offer.
Visual Impairment
All applicants with a history of a Offers may now be made as soon as
surgically treated renal artery
1 year after surgical treatment of a
aneurysm were declined for at
renal artery aneurysm, and
least 2 years after treatment, and thereafter although a rider would be
then a limited benefit period was applicable, neither a limited benefit
imposed if within 5 years since
period nor a percentage rating are
treatment. A percentage rating
applied.
was always applicable.
No major improvements in ratings.
9/28/12
Weight Loss
No major improvements in ratings.
Wolff-ParkinsonWhite (WPW)
A standard offer was not
available for WPW with minimal
symptoms or occasional SVT
(supraventriuclar tachycardia).
After two years, a standard offer
can be considered for favorable
cases with stable minimal
symptoms and/or SVT controlled
with medication.
No offer was available for WPW
associated with a history of
frequent or prolonged
symptoms.
After two years of good control
with no further symptoms, an offer
for a history of WPW with frequent
or prolonged symptoms can be
considered with a rating and limited
benefit period. Favorable cases may
be considered for a standard offer
after six years.
WPW treated with radio
frequency ablation (RFA) was
not covered in the manual,
possibly resulting in unnecessary
declines.
WPW with RFA is now covered in
the new manual and a standard
offer can be considered after one
year for favorable cases, after
successful RFA with no use of antiarrhythmic medication and no
recurrence of symptoms and/or
arrhythmias.
As of 12/21/2012
2/17/12
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Upcoming Updates
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Adjustment Disorders
Adrenal Insufficiency
Aortic Aneurysms
BRCA
Coagulopathies
Crohn’s Disease
Diverticulitis
Gastritis
Hearing Loss
Immune Disorders
Kidney Stones
Lyme Disease
Mitral Stenosis
Osteoarthritis
Osteoporosis/Osteopenia
Peptic Ulcer Disease
Raynaud's
Substance Abuse
Syncope
Underweight
Vertigo
Weight Loss Surgery
As of 12/21/2012
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L1212295828[0214]
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For More Information
Monthly Underwriting Alerts provide further details about the conditions and how our
underwriting guidelines were improved.


Career representatives: find the Alerts on iMetlife, FieldFIRST or iMetLife Resources
under Products > Disability Income > Underwriting.
Brokers and independent representatives: contact your DI Wholesaler or internal sales
partner.
If you have any questions, please call the DI Resource Line at 800-929-1492.
As of 12/21/2012
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