Prostate Cancer - 'Watchful Waiting'?

[Norton]

Has anyone here had coverage underwritten for someone with a current prostate cancer diagnosis who had a 'watchful waiting' protocol instead of medical procedure to treat? I have a potential client, 57M/NT, otherwise healthy but diagnosed at age 49 with Stage I, and he receives checkups and observation every three months. In nearly eight years, he's had virtually no advancement of the cancer, and has had about 8-9 biopsies. PSA scores are good (usually about 1.5) and Gleason is 6.

I've spoken to three underwriters at North American and one said it'd be up to a medical director and I'd just have to apply, and the other two said they'd be able to do a 'quick quote' if I send an abridged pathology report with his vital info... no promises or guarantees, of course.

He'd like to get $125k of coverage for mortgage protection purposes. How would you approach this one, if he were your client? If I can't get him underwritten, it seems like $25k with Kemper GI and $100k of accidental death may be my best solution, at least for the time being... any other thoughts?

 

[tlmarketing]

The guy needs a new doctor....What kind of doctor puts a 49 year old on a watch and wait for stage 1 prostate cancer? Maybe when they are 60+, but this borders on absurd.

He is a decline across the board....exception may be the niche program that an agency Life Again developed with Symetra recently.

 

[Norton]

What kind of doctor puts a 49 year old on a watch and wait for stage 1 prostate cancer?

Since you asked... He says his treatment/monitoring is done by a top doctor at the University of Miami. Apparently due to the rise in PSA screening, this is becoming more common and accepted in medical circles... as discussed in recent articles on the American Cancer Society's website, as well as research released through the Dana Farber Institute and Harvard Medical School, among others.

Expectant management (watchful waiting) and active surveillance for prostate cancer

It's more the "active surveillance" described in the above article than just watching and waiting...

So why do you say with such certainty that he's a decline across the board? Even North American Life couldn't make that assumption yet. One of their underwriters told me the other day that he *could* be up to standard depending on specifics of his case, which I would never expect, but if so, couldn't a Table 6 or 8 be possible? (I really don't know and haven't tried any cases like this before... But if they say Standard isn't already a definite no, I'd have to echo Lloyd Christmas in my thinking: "So, you're saying there's a chance!")

 

[tlmarketing]

This is where insurance medicine and real world medicine hit the "fork in the road"
life insurance companies only get one shot to underwrite him, whereas medical doctors get to continually evaluate and make changes as necessary.

As far as the prostate cancer itself, he's too young to be a "watch and wait" from an insurance standpoint....exception being the program i previously mentioned to you.

I base my comments on experience but would love to be proven wrong as I write a lot of prostate cancer life cases each year.

The other thing is since it is cancer, it's not going to be a table rating...it would be a flat extra. Survivors with no cancer, similar age might get hit with a $6 - $7.50 flat for 3-4 years.

 

[BNTRS]

Actually I'd bet he's a solid postpone rather than a decline with many carriers. The net effect for you the agent is the same, but the ramifications on his MIB is different.

This one is up to underwriting discretion, so you won't find any solid recommendations on carriers here. Your best plan of action is to order the charts (APS) and start discussing the case with underwriting departments at various carriers.

I'd start with the carriers that are generally known for their underwriting leniency: Pru, Principal, ANICO, LFG, and LSW.

I'd also discuss with Banner and American General about this in the hopes that it would be rated, and if that happened these two would likely be the most competitive price wise.

Survivability for prostate cancer is really good so the odds favor the idea that he lives. But anytime you increase the probability of dying by just a little bit it causes problems.

 

[tlmarketing]

I don't think he's a postpone...I think he's a decline.

If he just finished treatment and applied, insurance companies may say postpone since not enough time has passed since treatment....but on this one there is no treatment or treatment plan, that's why I think he will be declined.

 

[WinoBlues]

Personally I would do a trial app through one of my brokerages that has the majority of the companies I would quote him with. After sending the staff underwriter an in depth cancer questionnaire and APS if I had it. That way the underwriter could shop it without affecting the MIB.

As a side note, I would a a frank conversation with this client about the need for permanent coverage.

 

[LGilmore]

"He'd like to get $125k of coverage for mortgage protection purposes"

Before you kill yourself trying to find a solution for this case, get a commitment on what's he's willing to pay for premiums... You could do a ton of footwork, find him the best deal for his condition on the planet and him look at the premium and say "that's too much" .

Been there, done that, actually done that more than once, should have known better, but I want to help people.

I would be asking if he has coverage now? If so, see if it converts.

Trust me, I have a stack of people like this who simply didn't like the price their health created. Best of luck, but find out how committed the prospect is before you spend a whole bunch of time on it.

 

[Norton]

I base my comments on experience but would love to be proven wrong as I write a lot of prostate cancer life cases each year.

As much as I would've loved to prove you wrong and get this client an approval... I wanted to update my findings on this case. I heard from a couple carriers after submitting medical reports to the underwriters -- one was a straight 'no thank you', while the other told me that if his Gleason score was a 4 instead of a 6, they would have considered. They said his age (57) and stage (T1c) were considerations contributing to the whole picture, but if his Gleason was lower... oh well. I'll looking into the LifeAgain/symetra program, along with Kemper GI for him as a permanent option.

Would I be correct in assuming you write the LifeAgain policies? If so, do they appoint directly with agents and what are commissions like?

 

[Mehler91]

Have you looked at Americo? They have a SI Term (up to $400k), UL (up to $400k), WL, and a GI WL up to $30k