Underwriting Resource Guide

[The Admiral]

The info received usually gives you enough of a clue that you can start to make preliminary judgments on what's going on. Say they have a history of abnormal echo/EKG/other heart testing. You might not be able to prove they have a specific issue like aortic regurgitation but something is definitely up. And if something's up, the standard they use might suggest downgrading from Level to Graded. Other times it might be just the compromise they make to avoid an APS to go from level to graded and hope you can still pitch it with a rating. Lord knows we do that on the life side ALL the time. Outright declines could be the result of a combination of codes and information gettin referenced and carriers not liking what they see. For example, say you have COPD and a current smoker... not the hottest risk in town.

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My question is, more specifically, how does a carrier justify downgrading or declining coverage when the only adverse info received is based solely on the MIB and MIB rules prohibit rating or declining a case?

 

[The Admiral]

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My question is, more specifically, how does a carrier justify downgrading or declining coverage when the only adverse info received is based solely on the MIB and MIB rules prohibit rating or declining a case?

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Still would like to get your thoughts on the above question.

 

[John Galt]

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Still would like to get your thoughts on the above question.

Very good question, id also throw in since the agent is a fiduciary to the pi, why cant or wont most carriers tell us why there is a rate up or decline, i mean we have already asked the health questions, the agent and the pi both sign off on the hippa forms and yet nothing nada, keep us in the dark. Its equal to someone applying for a mortgage but the mortgage loan officer cant look at the borrowers credit report, only the loan uws have access, i dont think that would fly.

 

[The Admiral]

Originally Posted by The Admiral View Post

Still would like to get your thoughts on the above question.
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Very good question, id also throw in since the agent is a fiduciary to the pi, why cant or wont most carriers tell us why there is a rate up or decline, i mean we have already asked the health questions, the agent and the pi both sign off on the hippa forms and yet nothing nada, keep us in the dark. Its equal to someone applying for a mortgage but the mortgage loan officer cant look at the borrowers credit report, only the loan uws have access, i dont think that would fly.
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Right on John Galt! Why don't carriers simply add verbiage to the applicant's authorization on the application stating the information can also be revealed to the agent? We as agents are the ones doing the field underwriting and asking the health questions.

It's obvious to me carriers are indeed making decisions of rating up, down grading or declining coverage based solely on MIB. How are they getting away with this when MIB expressly prohibits it?

Where are you UW Guy? You still have not answered the question.

 

[UW Guy]

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Still would like to get your thoughts on the above question.

Sorry for the delay... Based on what I can see, it's likely they're surmising what they can from the codes and using it to revise their offer instead of taking six weeks to wait for records and likely come out to the same place.

As for justifying it... I read posts here all the time similar to your frustration. MIB isn't supposed to be the sole reason but there are some codes that tell you a lot from just a few simple spots. So from my viewpoint they're trying to give you an expedited compromise offer instead of going through the cost and time of getting the records to prove what they already were given a clue about. It's the "horseshoes and hand-grenades" approach to underwriting for a sub-optimal risk market.