Game na ba kayo?!! Sa Underwriting?

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Game na ba kayo?!! Sa Underwriting?
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Applause naman!!!
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Game Na Ba Kayo!??!?
Sa Underwriting!?
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A
C
B
D
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Sample Question
D
C
B
A
A. I HAVE B. I DONT HAVE

• WHO AMONG YOU HAVE CELLPHONES - ?
• BUT ARE NOT NOKIA?

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CASE 1 Applicant 25-y/o professional basketball
player, with unremarkable yearly annual PE x
2yrs. Six months ago, he had a vehicular
accident with pulmonary contusion by Chest CT
Scan and echocardiography showed mild
pericardial effusion and asymmetric septal
hypertrophy. Contusion and pericardial effusion
disappeared after 1 month. Presently
asymptomatic. Actively playing. Applying for P5M
coverage. How will you assess his case?

• 1. STANDARD
• 2. POSTPONE
• 3. DECLINE
• 4.SUBSTANDARD

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HOST COMMENT for CASE 1

• YOUNG MALE
• ACTIVE IN SPORTS -
• Assume NON-SMOKERS
• TEMPORARY RESTRICTIVE VENTILATORY DEFECT from
  LUNG CONTUSION -
• SELF LIMITING
• ACCIDENT-RELATED PERICARDIAL EFFUSION
• minimal, transient

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ASYMMETRIC SEPTAL HYPERTROPHY
CO-HOST COMMENT for CASE 1

• Sudden death risk?
• Does his current job predispose him to such?
• Other risks attached to this cardiac finding?

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Comments on Case 1 by the Expert Panel
Emiliano B. Canonigo Jr., MD Medical
Director (SunLife Philippines)
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CASE 1 Applicant 25-y/o professional basketball
player, with unremarkable yearly annual PE x
2yrs. Six months ago, he had a vehicular
accident with pulmonary contusion by Chest CT
Scan and echocardiography showed mild
pericardial effusion and asymmetric septal
hypertrophy. Contusion and pericardial effusion
disappeared after 1 month. Presently
asymptomatic. Actively playing. Applying for P5M
coverage. How will you assess his case?

• 1. STANDARD?
• 2. POSTPONE?
• 3. DECLINE?
• 4.SUBSTANDARD?

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Case 2 42 year-old , s/p TAHBSO 1 yr ago for
twisted ovarian cysts, history of slipping
downstairs and landing on her buttock 2yrs ago.
Retired Teacher , now selling life insurance.
Taking Vitamins.
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How do you evaluate this applicant?

• A. ACCEPT AT STANDARD
• B. ACCEPT as RATED
• C. POSTPONE
• D. ASK FOR ADDITIONAL REQUIREMENTS

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HOST COMMENT for CASE 2

• Female - no more ovaries. NO hormone
  replacement therefore menopausal.
• Slipping accident - predisposes to ASEPTIC HIP
  necrosis of the FEMORAL HEAD

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Case 2 Evaluation CO-HOST COMMENT

• Life - STANDARD
• RIDERS - NO WPD - because subject expected to
  develop gait / walking problem in a decade or so.
• Bundling with
• Health Care Coverage - Rated.
• Reimbursement - No.

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Comments on Case 2 by the Expert Panel
Ammie Zafra, MD SVP-CS Medical
Director (Prumerica) -
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Case 3 40 y/o male, Filipino, company checker,
asymptomatic. In 1979, had open mitral valve
commissurotomy at PHC due to RHD. 55,
140lbs.BP110/80 CR83. Gr3/6 holosystolic
murmur.AB 6th LICS, MCL. On crutches.PMHx gt Dx
Diabetic in 2001gtMar 2002 - Internal Fixation
tibia-Fibula, physical injuries 2 to alleged
VAHOW DO YOU ASSESS THIS CASE?

• 1. ADDITIONAL REQUIREMENTS?
• 2. POSTPONE?
• 3. DECLINE?
• 4. SUBSTANDARD?

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COMMENTS ON CASE 3

• gt 20 years post surgery
• living like normal person
• Normal activity
• cardiac performance like those in active sports
• Risk of stroke
• nil

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HOST COMMENT ON CASE 3
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CO-HOST COMMENT ON CASE 3

• Issues
• Other requirements

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Case 3 40 y/o male, Filipino, company checker,
asymptomatic. In 1979, had open mitral valve
commissurotomy at PHC due to RHD. 55,
140lbs.BP110/80 CR83. Gr3/6 holosystolic
murmur.AB 6th LICS, MCL. On crutches.PMHx gt Dx
Diabetic in 2001gtMar 2002 - Internal Fixation
tibia-Fibula, physical injuries 2 to alleged
VASo, HOW SHOULD WE ASSESS THIS CASE?
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Case 4 Applicants medical evaluations done by a
3-yr accredited Medical Examiner were being
submitted in bulk by a new provincial Branch
Manager who , to facilitate processing, would
advance payment to the accredited doctor and in
return request for reimbursement from office.

• The Doctor is well-respected in the area.
• The Branch Officer is a Pastor.

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Case 4 Is there cause for alarm?

• A. NONE
• B. YES

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What? - Me , worry on that case??

• Hmmmn, lets see

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Comments on Case 4 by the Expert Panel
Ammie Zafra, MD SVP-CS Medical
Director (Prumerica)
Victorio Yap SVP Chief Underwriter (FortuneLife)
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Case 5(BFL)A 46 y/o female applying for 2.5M
insurance with non-specific ST-T wave changes on
ECG as the only pertinent finding on medical
examination. She smokes 6 sticks (maximum) of
cigarette per day for 20 years.
How do you evaluate this case? A. More
requirements B. Debit for ECG Smoking C.
Postpone D. Standard
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Not So Sure To Tell What C ardiacfindings are
there
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Risks of Dying From Smoking
SOURCE Richard Peto, Alan D. Lopez, Jillian
Boreham, Michael Thun and Clark Heath Jr.
Mortality from Smoking in Developed Countries
1950-2000. Oxford UniversityPress. 1994
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United Kingdom Current Risks

• On average, among 1000 20-year-olds who smoke
  cigarettes regularly
• About 1 will die from homicide
• About 6 will die from motor vehicles
• About 250 will be killed by smoking in MIDDLE age
  alone ( 250 more in OLD age)

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SEQUENCE OF EVENTS

• LARGE INCREASE IN CIGARETTE USE BY YOUNG ADULTS
• MISLEADING DELAY NO LARGE INCREASE IN LUNG
  CANCER ETC. FOR SEVERAL DECADES

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Chief source of misunderstandingLOOONNNGGGG
DELAY between increase in smoking and full
increase in death risk

• Example of long delay US MALES
• Large increase in cigarettes before 1945, but no
  large increase since1945
• male cigarettes high, but male lung cancer still
  low 1945-85
• main lung cancer increase while there was no
  large increase in male cigarette use

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Comments on Case 5 by the Expert Panel
Edilberto Torres, MD Past Medical Director -
(Ret.) (PhilAmLife)
Victorio Yap SVP Chief Underwriter (FortuneLife)
HOLUAP Founding Chairman
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POPULATION HAZARDS OF SMOKING China Current Risks

• On present smoking patterns, about 50 million of
  the children and teenagers in China today will
  eventually be killed by the habit.
• Of these, about half (25 million) will still be
  only in MIDDLE age when they are killed, losing
  20-25 years of non-smoker life expectancy.

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DEATH IN MIDDLE AGE (35-69) 1990, USA

• As of 1990 in the USA, tobacco was causing about
  1/3 of all deaths in MIDDLE age (plus "only"
  about 1/6 of the deaths at older ages)Those
  killed by tobacco in MIDDLE age lost on average
  about 20-25 years of
  non-smoker life expectancy

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Smoking kills more people by OTHER DISEASES than
by lung cancer

• 1985 US deaths attributed to tobacco by the US
  Surgeon General Lung cancer 110,000 Vascular
  150,000 Others 140,000 Total caused by
  tobacco 400,000 (Tobacco / all deaths 0.4M /
  2M)

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MALE MORTALITY RATIOS

• (regular cigarette smoker non-smoker)
• 3 1 at age 35-69(suggesting about 2/3 of male
  smoker deaths in middle age caused by tobacco)
• All agesabout HALF of all regular cigarette
  smokers eventually killed by
  their habit.

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Smoking is already causing about one-sixth of all
developed-country deaths This proportion is
still rising. If it stays at or about one-sixth,
then at least one-sixth of the population will
eventually be killed by tobacco 200 million,
out of 1.2 billion.
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Annual deaths attributed tosmoking in 1990 and
in 2030 1990 2030
Developed 2M 3M Developing 1M 7M
WorldTotal 3M 10M Mmillion deaths / year
Peto, Lopez et al, 1994
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The Mortality risk from Smoking is always HIGHER,
and increases with increasing number of
cigarettes consumed.

• Up to 12-20x mortality risk of lung cancer
  compared to general population

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Estimates of Relative Risks of COPD related to
smoking
It does not get any better in COPD risk
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Comments on Case 5 by the Expert Panel
Edilberto Torres, MD Past Medical Director -
(Ret.) (PhilAmLife)
Victorio Yap SVP Chief Underwriter (FortuneLife)
HOLUAP Founding Chairman
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Case 6 (BFL) A 37 y/o male, weighs 180 lbs, 5ft
7in tall, applying for 2M insurance. He smokes
half pack of cigarette per day for 15 years. He
still have a stainless cylinder ( as internal
fixator) on left tibia due to fracture 17 years
ago.

• How do you evaluate this case?
• A. More requirements
• B. Debit for Smoking and leg implant
• C. Postpone
• D. Standard

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57in 67inches 1.70m 180lbs --gt 80kgs

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Disregard the metal
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Comments on Case 6 by the Expert Panel
Lawrence Yew Regional Manager SCOR - Asia Pacific
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Case 7 (BFL) A case of 57 y/o male applying for
3.2M. The only pertinent finding on medical
examination was triglyceride 305.72mg/dl.

• How do you evaluate this case?
• A. More requirements
• B. Debit for hypertriglyceridemia
• C. Postpone
• D. APS

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Elevated triglycerides

• Issues
• Isolated increase
• Changing risks of CAD event

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Comments on Case 7 by the Expert Panel
Edilberto Torres, MD Past Medical Director -
(Ret.) (PhilAmLife)
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Case 8 37 y.o. female, single, company
executiveFace amount applied for PhP 2M no
existing insurance coverageFamily history
Mother died at age 55 years of breast
cancerMedical history Annual company medical
check ups in January 2001 and 2002 blood chem,
urinalysis, stool exam, ECG, Chest X-ray done,
results normal.
AZ
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Case 8 contd Non-smoker does not drink
alcoholic beveragesFME Ht 5 ft. Wt 140
lbs. BP 110/70 mm Hg Pertinent PE finding
() lumpy breasts, no definite mass lesion noted

• How do you evaluate this case?
• A. More requirements
• B. Debit for Family Breast Dis Hx lumpy
  breast finding
• C. Postpone
• D. APS

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Reproductive factors for Breast Lumps Early onset
of menses and late menopause artificial menopause
associated with decreased incidence of Breast
CA Women with first full term pregnancy before
age 20 Nulliparous have higher risk Breast Ca
lowest in population that breastfeeds
OF BREASTS, BUMPS AND LUMPS
OF BREASTS, BUMPS AND LUMPS
OF BREASTS, BUMPS AND LUMPS
OF BREASTS, BUMPS AND LUMPS
OF BREASTS, BUMPS AND LUMPS
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OF BREASTS, BUMPS AND LUMPS
OF BREASTS, BUMPS AND LUMPS
OF BREASTS, BUMPS AND LUMPS
OF BREASTS, BUMPS AND LUMPS
OF BREASTS, BUMPS AND LUMPS
OF BREASTS, BUMPS AND LUMPS
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Comments on Case 8 by the Expert Panel
Lawrence Yew Regional Manager SCOR - Asia Pacific
Ammie Zafra, MD SVP-CS Medical
Director (Prumerica)
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Case 9 47 y.o. male, married, businessmanFace
amount applied for PhP 3.5M with existing PhP
2M insurance coverageFamily history ()
Hypertension, father, still living at age 75
years () Diabetes mellitus, mother, still
living at age 73 years () Diabetes
mellitus, brother, still living at age 43 years
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Case 9, page 2 Medical history Executive check
up in June 2000 at Makati Medical Center blood
chem, urinalysis, stool exam, Treadmill, Chest
X-ray, Upper GI series done, results all
normal Smokes 1 pack of cigarettes for the past
15 yearsDrinks 2 bottles of beer once a week
(Friday night out)
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Case 9, page 3 FME Ht 58 Wt 145
lbs. BP 120/80 mm Hg
Essentially unremarkable PE findingsMUR 1
glucosuria Trace protein WBC
0-1/hpf RBC 0-1/hpfBlood chem
FBS 120 mg BUN, creatinine, uric acid, total
cholesterol, HDL, LDL, triglycerides, SGPT
results are all within normal limits
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How do you evaluate this applicant?

• A. ACCEPT AT STANDARD
• B. ACCEPT AT A RATING
• C. POSTPONE
• D. ASK FOR ADDITIONAL REQUIREMENTS

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Comments on Case 9 by the Expert Panel
Emiliano B. Canonigo Jr., MD Medical
Director (SunLife Philippines)
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Game Na Ba Kayo!??!?
Sa Underwriting!?