SAA is "discovered" at some point in the underwriting process. Through the medical records, laboratory tests or the applicant’s driving record, evidence surfaces that give an underwriter reason to believe the applicant has SAA.

Medical File -- SAA can be documented in the client’s medical file. A chart note where the physician "advises" the client to reduce their alcohol intake or simply stop drinking strongly suggests SAA. This is also true of chart notes that report the client’s desire to reduce or completely stop drinking.

While the medical file is a critical underwriting document, it may not always portray an accurate picture about SAA. For example, if the physician is opposed to all forms of alcohol consumption, the client may be unfairly labeled with a diagnosis of SAA just for social drinking. There is also the possibility of bias with third party reporting of SAA, such as a possible drinking problem reported by a spouse.

It is also important to look for a history of depression if SAA is suspected. Unfortunately, many users of alcohol are depressed to begin with, and experience a kind of "self-medication" relief while drinking. This, however, is short-lived, and always leads to even deeper depression when the user is not drinking.

Abnormal Liver Function Tests -- There are specific blood tests available from either the medical file or the blood work done for life insurance that can be very useful in determining whether someone is abusing alcohol or has liver disease. The following tests may show elevated levels due to excessive alcohol consumption:

• Gamma Glutamyl Transferase (GGT)
  
• Bilirubin
  
• Alanine Aminotransferase (ALT)
  
• Mean Corpuscular Volume (MCV)
  
• Aspartate Aminotransferase (AST)
  
• Triglycerides
  
• Alkaline Phosphatase (AP)
  
• Uric acid

(See Medical Testing Tutor, for a detailed discussion of the individual tests)

There are also "special blood tests" that are used to clarify cases of SAA. One of these is the CDT (see this link for a description and how it is used in SAA cases http://www.labone.com/insurance/cdt.html)

MVR -- The motor vehicle report may reveal a previous history of one or more DUI (driving under the influence of alcohol) arrests.

SAA cases usually present more questions than answers. Getting answers to the questions is not an easy task. The following guidelines will help agents sort out which cases are worth pursuing and which cases are not.

1. Always ask a SAA client to complete an Alcohol Questionnaire. This provides a "baseline" from the client regarding present and past alcohol consumption. Alcohol Questionnaires are available from most carriers. Review the completed questionnaire with the client. Many times additional information that is beneficial to the client is obtained in the review process.

2. Always have a copy of abnormal liver function test sent to the client’s attending physician. The client’s physician may want to repeat the tests or order new ones. The updated medical records can then be used to "reopen" the case or present it to a different carrier.

SAA is complicated by the underlying problem of all forms of substance abuse: denial. Many times clients with SAA simply deny the facts of the case. There is little point in arguing with the client who is in denial. It is better to walk away from the case once it is apparent that the drinking history is more complicated than presented by the client. There will be clients with SAA who do not have a problem with alcohol. With careful attention to their true consumption pattern and repeated or expanded laboratory testing, agents can successfully find coverage to this group of applicants.