precision underwriting

Using laboratory testing history databases to evaluate applicant risk can provide underwriters a more complete picture of applicant health. Laboratory history data provides quick access to physician-ordered laboratory testing results, it verifies applicant self-reported medical disclosure, and it can reduce costs as a possible alternative to an Attending Physician Statement order. Recently, we presented some of the benefits of using this data in the underwriting process.

LabPiQture™, ExamOne’s unique laboratory testing results database, provides deep insights into the health history of applicants. During Women’s Health Month, we’ve taken a deeper look at the conditions most commonly diagnosed in female life insurance applicants.

Top five diagnoses found in historical laboratory reports of female life insurance applicants

top-diagnoses-female-life-insurance-applicant

Encounter for general exam without complaint, suspected or reported diagnosis
This encounter captures most general exams that are not the result of a complaint or other diagnosis. In laboratory data, this code is most commonly associated with routine non-OBGYN checkups, and is seen commonly in both men and women. For underwriting, this can generally be considered a low-risk code and may indicate an applicant who is active in maintaining his or her health.

Disorders of lipoprotein metabolism and other lipidemias
Lipid metabolism disorders affect the conversion of lipids into energy, oftentimes causing harmful amounts of lipids to build up in the body. These build-ups can result in cell and tissue damage in the brain, nervous system, liver, spleen and bone marrow. In laymen’s terms, this is the most common code for high cholesterol and is generally associated with lipid panel (total cholesterol, HDL, triglycerides, etc.) results.

Encounter for other special exam without complaint, suspected or reported diagnosis
In our data, these almost exclusively indicate OBGYN encounters involving pap smears. This code can be used to capture encounters related to dental, vision and hearing; however these do not generate laboratory/tissue specimens. Pap smears are the most common tissue pathology results in the LabPiQture database and are often accompanied by HPV (a virus linked to cervical cancer) screens.

Essential (primary) hypertension
This is high blood pressure that doesn’t have a known secondary cause and tends to develop gradually over many years. Risk factors of primary hypertension include age, weight, family history and tobacco use. Complications may include heart attack or stroke, aneurysm, heart failure, and metabolic syndrome—which increases the chance of developing diabetes.

Encounter for screening for infectious and parasitic diseases
This encounter can denote screenings for various bacterial or viral diseases, such as tuberculosis and HIV. As a screening code, this header is most often associated with STD (including HPV) panels. In the large majority of cases (as in HPV and prenatal screens), these are routine tests with comparatively low positivity rates. In certain subpopulations, however, this code can be suggestive of high-risk behavior, including intravenous drug use.

Other common diagnoses in female life insurance applicants

Insurers should also be aware of additional diagnoses among female life insurance applicants, such as the following.

(E03) Other hypothyroidism – 13.6%

(E11) Type 2 diabetes mellitus – 10.8%

(R73) Elevated blood glucose level – 9.0%

(E66) Overweight and obesity – 5.4%
This statistic is interesting to note for insurers, especially since an ExamOne study found a notable rate of obesity nondisclosure in female applicants.

female-applicant-obesity-nondisclosure

Summary of the analyzed population

In our analysis of the most common diagnoses in female life insurance applicants, the mean age of a female applicant with a LabPiQture hit was 45. The mean encounter count for a female hit was 19, but this conceals a substantial level of variation. The median encounter count was 10, while 13% of hits involved only a single encounter, and 1% of hits involved 73 or more unique testing events.

Gathering a comprehensive health picture of your applicants

Laboratory history data can be a valuable resource for insurers determining applicant health risk. When evaluating this type of diagnosis data, it’s also important to remember that some codes are tentative, or ruled-out by subsequent testing, and do not always confirm the current presence of a disease. This is where additional health data sources can further inform or confirm suspected conditions.

Check back on the blog next month when we take a look at the most common diagnoses in male life insurance applicants based on LabPiQture data.

At the recent Association of Home Office Underwriters (AHOU) meeting, Executive Vice President, Betsy Sears, shared insight that our data analytics team has collected and analyzed comparing self-disclosure to positive confirmations of various laboratory tests. Our insurance clients tell us consistently that fraud is a top concern – whether intentional or unintentional applicant nondisclosure, it can cost companies millions.

Since not everyone could join us at AHOU, we wanted to share a few highlights from Betsy’s presentation. Here are 3 stats that our recent study uncovered about the life insurance population.

  1. Five percent of applicants understate their weight by more than 25 pounds. It’s been known individuals sometimes may stretch the truth on their driver’s license when it comes to updating their weight number. Some believe they still weigh the same as they did at age 16 when they first completed the “weight” box at their local DMV. When it comes to applying for life insurance, are these people a little more truthful? The answer is not entirely. We recently studied the results of more than 40,000 applicants. An astounding 20.7% of individuals whose BMI was more than 30, stated a normal build class (BMI under 30) during the application.
  2. Tobacco nondisclosure involves knowingly omitting this information. Above I stated that there is intentional and unintentional nondisclosure. When it comes to tobacco, it’s a fairly safe assumption to say an individual knows if he or she smokes. It’s a term commonly referred to as “smoker’s amnesia” when a person conveniently forgets about his or her smoking use. In our study, 23% of individuals who tested positive for cotinine, denied tobacco use at the time of the application. If an individual knows an exam will not be completed, their tobacco use will not be confirmed. This allows them to receive the same rates as a non-smoker while carrying roughly twice the mortality risk.

Present value of premium savings from avoiding a smoker classification in 20-year term policies:
20 year-old female, $100,000 face amount: $180
60 year-old male, $1 million face amount: $50,000 

  1. New hepatitis C (Hep C) infections have nearly tripled since 2010. According to Quest Diagnostics, Hep C is a silent disease because symptoms can take decades to develop. More than 3 million people in the United States have a chronic Hep C virus infection but are not aware because they do not look or feel sick. Our team discovered 77% of applicants who tested positive for Hep C did not disclose during the application. It is possible many of these individuals did not know of their existing condition prior to receiving their laboratory results.

Final thoughts

Each of the above conditions can contribute to other health-related diseases such as heart disease, stroke and cancer – all of which can have serious mortality implications. We invite you to join us for our upcoming webinar where Betsy Sears will reveal more hidden truths that are omitted from the life insurance application and how you can protect your bottom line.

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