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LOMA 301 I*STAR > Chapter 4 > Flashcards

Chapter 4 Flashcards

1
Q

What are sources of underwriting information?

A
  1. application
  2. MIB
  3. APS
  4. Medical tests
  5. Personal hx interviews
  6. inspection reports
  7. pharmaceitical database.
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2
Q

Applications for life insurance coverage includes two basic types of information what are they?

A
  1. general information about Cx, benefiticary,

2. MEdical hx about Cx.

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3
Q

Insurers can use additional applications forms to collect information about the Cx’s medical hx. What are they?

A
  1. non-medical supplement - form that contains proposed insured;s answers to general medical hx questions.
  2. Paramedical report - form that contains a proposed insured;s answers to medical hx questions and the results of the examination conducted.
  3. medical report- form for general medical hx completed bya physician, who is not the proposed insured’s personal physician. Extensive.
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4
Q

What is a non-medical limit

A

max amount of insurance the insurer will issue without a physical examination

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5
Q

What is MIB (MIB Group Inc)

A

not-for-profit membership corporation that maintains ifnromation about individuals who have applied for insurance coverage from member compnies
- created to protect companies and customers from propsoed insureds hwo komit information or provide false information.

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6
Q

How do u/w of member companies interact with MIB?

A

1) by providing impairment information they gather on applications for insurance to MIB
2) requesting information about applicants from MIB

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7
Q

Before making a request for MIB information about a proposed insured, an insurer must do what?

A
  1. obtain cx’s written auth for the release of information to the memeber company on a form naming MIB as an authorized source of information
  2. furnish the cx with wirtten notice specifying that a report regarding the person’s insurability may be sent to MIB.
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8
Q

MIB also maintains an Insurance Acitvity Index (IAI) what is this?

A

provides information abotu the number of times an MIB request for information about a particular applicant was entered into the system during the last two years.

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9
Q

Who is an examining physician?

A

a physician who examines a proposed insured at the request of the insurance company.

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10
Q

Who is an attending physician?

A

the primary care physician or specialist who has provided medical care for a proposed insured at the individuals request.

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11
Q

What is Electronic Health Records (EHRs)

A

digital versions of a patient’s paper records that include the patients medical history, dx, rx, tx, immunizations, tests, and labs.

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12
Q

What is a specialized medical questionnair?

A

provides details ifnormation about a specific illness or condition
- ie CAD, CP, DM.

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13
Q

When UWs need clarification or additional details about information included on an insurance application they frequently request an APS. What is this?

A

propsoed insured’s medical records and is completed by a physician who has treated or is currently treating the rposed insured.

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14
Q

when would an UW order an APS?

A
  1. A&A requirement
  2. medical/app mentioned a specific illness
  3. application indicates a recent doctor visit and UW wants to confirm absence of antislections.
  4. information on the application isnt consistent with infor form MIB or Prescription hx search
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15
Q

What is a personal history interview?

A

A conversation ebtween an UW or other insurance company employee and the proposed insured that is designed to verify the accuracy of information already recevied about the posed insrued or to obtain any additioanl ifnormation needed for UW.
- can be used to detect cognitive impairement.

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16
Q

What is an inspection report?

A

type of investigative consumer report that consumer reporting agency prepares about the proposed insured.

  • usually includes some basic medical info that is in a PHI.
  • personal and financial ifnromation focus.
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17
Q

What are some commonly ordered medical test for UW?

A
  1. ECG
  2. Urinalysis
  3. Blood chemistry
  4. saliva test.
18
Q

what do pharmacy benefit managers do?

A

manage ifnroamtion in the pharmaceutical database which contains records of px filled by individuals enrolled in health care presciptions benefit programs.

  • valuable source for conditions/treatments.
  • needs cx’s written consent to obtain details
19
Q

Define the term impairment

A

physician or psychological abnormality that results in a loss of function.

20
Q

How does age have a direct impact on mortality risk?>

A

age 15-39 are much more likely to die from an accident or injury than from other impairments.
- indicator of antiselection

21
Q

How can gender make UW difficult?

A

applicants biological gender may be different from applicants identified gender.
- prices/medical hx varies between sec .

22
Q

What is build?

A

the shape of foirm of the body.

includes: height, weight, and distribution of weight.

23
Q

Build charts do not address rapid weight gain/loss, therefore lost of UW use BMIs. What is this?

A

Body mass index- measures indiciduals body fat based on the weight relative to their hight.
Formula:
Weight/ height x 703.

24
Q

UW must also assess the risk of personal information which includes: occupation, avocation, MVR, smoking hx, ETOH, drug use, physical abuse, travel, criminal hx, citizenship etc… What sources can provide this information?

A
  1. application for insurance- avocations, SM and drug use, criminal activity, emplouement hx
  2. Agent statements- face on face impression
  3. Inspection reports.- avocation driving hx, police records,
    employment
  4. personal questionnaires- adidtional forms to get additional details. forms part of application.
  5. MVR- motor vehicle rport.
25
Q

Insurance underwriters evaluate two categories of occupational hazzards. What are they?

A
  1. accident haxzzrds- associated with activities that present a signifcant risk of injury- ie: construction, lumber, demolition, firefighting
  2. Health hazards- associated with risk of illness. Ie: laboratory, analysts of toxic chemicals, radium exposure, poision gas.
26
Q

Why is driving risk relevant to morbidity?

A

MVA are a primary cause of accidental death, people who have many traffic violations generally pose greater risks for fatal accidents.

27
Q

Whats the difference between an amateur and professional?

A

person’s who pursue a particular activity as an occupation is a professional, and those who pursue the activity as an avocation/leisure is considered an amateur.

28
Q

Why is smoking/tobacco use relevant to UW risk?

A

people who use tobacco in anyform have higher mortality rates.

29
Q

How can insurers establish different rates for tobacco users?

A
  1. seperate premiums rate schedules-

2. assigner tobacco users higher ratings for impairments that are sensative to tobacco use: DM, CAD, COPD

30
Q

How can UW review ETOH use in applicants?

A

MVR, APS, PHIs, questionnaires, and labs (LFT/ CDT)

31
Q

What is drug abuse?

A

the excessive or inappropriate us of px drugs, or the use of illegal drugs.

32
Q

How do UW assess Drug use/abuse hx?

A

through investigations regarding faceamount requests, APSs, urine, drug use quesionnaire, b;lood profile, and/or an inspection report.
* results must be kept confidential

33
Q

How does a history of physical abuse affect morbidity rates?

A
  • difficult to use since laws in many jurisdictions prohibit use of information regarding possible abuse.
  • UW must determine degree to which the risk is acceptable or unnacceptable.
  • risk of trauma on body, risk of comorbidities.
  • info from hospital,
34
Q

What should an UW focus on when UW the morbidity risk of criminal activity ?

A
  1. time of criminal ct
  2. time enganging in act
  3. nature of offence commited
  4. applicants hx in relation to charge
35
Q

UW usually decline applications for a proposed insured with what kind of crimnal records

A
  1. recent activity
  2. arrest for multiple charges
  3. involvement in criminal activity over a period of tim e
    • comorbidities.
36
Q

What must an UW consider when UW a person’s aviation activities?

A
  1. total hours of experience
  2. total annual flying hours
  3. certification or ratings.
37
Q

In what cases are aviation exclusions typically use?

A
  1. extend of hazards cannot be measured
  2. the pilot has a hx of certain medical impairements. (mental health/stroke)
  3. proposed insured is unwilling to pay the extra premiums and would prefer an exclusion.
38
Q

Why do insures not typically insure applicants who reside abroad for extended periods of time?

A
  1. difficult to UW information
  2. investigating claims
  3. when its used as “trip insurance”
39
Q

When insuring foreign citizen’s insurers give favorable consideration to which applicants?

A
  1. those who intend to become perm residents
  2. those who own resident visa
  3. those who own property or bank accounts in the country in which the insurer does business.
40
Q

What are the two categories of occupational hazzards?

A
  1. accident hazards- risk of injury

2. health hazards- risk of illness

LOMA 301 I*STAR (12 decks)

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