• Provide agents with the most current medical information they need to package and present their cases

• Provide agents with the most current medical information that will be of interest to their clients

• Provide agents with the most current medical information to improve their own health awareness

All baby boomers need to read this book!
Robert W. Griffith, MD
Editor, HealthandAge.com 

This book is a great gift for a financial advisor to give to all clients with senior parents.
Dick Bell, CLU, ChFC, President 2004 Society of Financial Service Professionals

Learn more and Order here

The epidemic of obesity in America is producing a parallel epidemic liver disease called NAFLD (non-alcoholic fatty liver disease).  NAFLD is becoming the most common cause of elevated liver enzymes surpassing both hepatitis C and alcohol use.  What is NAFLD and what should life insurance agents know about it?

NAFLD is the liver’s reaction to insulin resistance.  Insulin resistance, also known as the metabolic syndrome affects 23% of U.S. adults, 40% of U.S. adults over 60 and up to 60% of obese adults.  See this previous RiskTutor Newsletter for more underwriting information on the metabolic syndrome: Newsletter Link

NAFLD is a diagnosis of exclusion (i.e. rule out other causes of elevated liver studies) and this unto itself creates underwriting problems.  Most underwriters see elevated liver enzymes as being either the results of hepatitis (B or C), medications, or alcohol issues.  In many cases the first step to rule out these causes.  But how do you do this?

First you determine if your client meets the criteria for the metabolic syndrome and possible NAFLD.  Here are the criteria:

1. Abdominal waist circumference in men > 40 inches and in women > 35 inches

2. Hypertension (>130/85)

3. Fasting Glucose > 100 mg/dl

4. Fasting Triglycerides > 150 mg/dl

5. Decrease HDL, men < 40mg/dl, women < 50mg/dl.

If the client meets the criteria for NAFLD, then you need to help them rule out other causes.

The client’s doctor can order a hepatitis panel to determine if there is a current or chronic viral infection of the liver.  A negative hepatitis panel is step one.

Obtaining a list of all the medications the client is taking is the next step.  This needs to include prescribed drugs as well as vitamins and herbal remedies.  With the dramatic increase in the use of Complimentary and Alternative Medicine (CAM) in the United States, it is possible that client’s are taking supplements that could impact their liver tests.  Ruling out medications and supplements as the cause for elevated liver tests is step two.

The final step is to determine alcohol.  The best way to do this is with an Alcohol Questionnaire you can obtain from any life insurance company.  Ruling out alcohol abuse is step three.

Bottom Line: Elevated liver tests are a common and frustrating part of underwriting life insurance.  However, many of these cases are caused by NAFLD, which is insurable and in some cases at standard rates.  If the client fits the criteria for the metabolic syndrome, you need to rule out other causes of the elevated tests.  If the client doe not fit the criteria, then use the three-step process to determine the cause of the elevated tests as well as the rating.

New research has suggested that there may be something in cigarette smoke that has antidepressant properties.  This also explains why smoking is much more common among people with depression.

This may also go a long way in explaining why it is so difficult for smokers to quit even using aids like the nicotine patch.  It appears that the antidepressant effect from cigarettes is not nicotine alone, but some unique chemical found in the smoke of the burned tobacco. 

Zyban (bupropion) is an antidepressant that was developed to treat cigarette addition. Smokers who respond to Zyban seem to loose their love of cigarettes.  This suggests for certain smokers cigarettes are a tolerated means of self-medication for treating an underlying depression but not a habit the smoker necessarily enjoys.

Bottom Line: Clients who smoke but want to quit need to be made aware of this new research and discuss it with their doctor.  Ignoring the possibility of underlying depression could deny smokers the one approach that could free them of their habit.

Lotrel (amiodipine and benazepril) is a “combination” drug used to treat hypertension.  Its RiskTutor classification is Green (minimal underwriting concerns).

Bottom Line: If an applicant is taking Lotrel, you need to gather additional information to determine the degree and the severity of the problem.  As mentioned earlier in this newsletter,

you need to pay special attention to other risk factors that might suggest the Metabolic Syndrome.

Clients with hypertension are insurable unless they are classified as out of control or “malignant.”  However, certain hypertension medications can be used for more serious cardiac problems including congestive heart failure.  Never assume, use the correct screening questionnaire.

Female, 72, Non-smoker, $4,000,000 Individual Coverage
Height 5’ 2”, Weight 143 lbs
Current Medications: Lotrel, Lipitor, and Celebrex

The applicant was postponed for life insurance based on a comment in her medical file that she had “possible early memory loss” within the last six months. 

Discussion: Memory loss is a concerning finding for all underwriters.  It could be the first signs of Alzheimer’s disease, depression, or a host of other causes.  It could also be a normal reaction to a stressful situation.  Many times the medical file does not provide enough information to accurately assess the risk.  In this case, the medical file failed to document the recent death of the applicant’s husband after a prolonged battle with cancer.  The stress and grief of that situation turned out to be the “source” of her memory issues.  Her physician, disagreeing with the action by the life insurance company, administered a screening test for memory loss.  The applicant’s test was normal.  Armed with this additional information, the agent was able to obtain a number offers at standard rates.