Underwriting A Client With Chronic Pain & LTC

Underwriting A Client With Chronic Pain & LTC

When considering an applicant for traditional Long Term Care or Hybrid Life/LTC coverage, it is important to understand the implications of Chronic Pain.  Whether a client admits to having it or their medications indicate that they are dealing with some form of it, in order to accurately pre-qualify and create reasonable expectations with your client, it is imperative to understand how the issue originated, how it is being dealt with, and what that means to an underwriter.

First, we should understand the definition of “chronic” pain to distinguish it from “normal” pain.  Pain from an injury is your body’s way of telling you something is wrong.  Typically, once the injury heals, the pain goes away, but chronic pain is different…the body keeps hurting for weeks, months or even years after the injury.  Doctors typically define chronic pain as any pain that lasts for 3 to 6 months or more.  Whether it originated from one issue or a combination of issues, it can wreak havoc with insurance underwriting, especially for Long Term Care.

Due to the impact chronic pain has on a person, other symptoms can manifest…feeling tired all the time, a lack of appetite, trouble sleeping, mood changes, or overall weakness.  Because it interferes with your daily life, chronic pain can lead to self-esteem issues and make you feel angry, depressed, anxious and frustrated.  These problems can then lead to subsequent health issues which is why underwriters are so careful in assessing the impact chronic pain can have on the client’s morbidity as well as mortality risk.

Treatments options vary for chronic pain depending on the cause and severity.  Some chronic pain can be relieved with exercise or, in some cases, ongoing physical therapy, while others utilize mild pain relievers, alone or typically in combination with exercise.  Unfortunately for some, relief is only achieved by using stronger medications, i.e. muscle relaxers, regular injections and the dreaded opioid medications and all the issues that they bring to the table.  Suffice it to say, that if a client is currently using ANY type of opioid medication, regardless of the frequency, they will typically not be eligible for traditional LTC coverage.  The client will need to show a period of stability for 6 – 12 months or possibly longer without the medication along with a lessening or preferably cessation of the chronic pain before they could apply for traditional LTC coverage.  There are some Hybrid carriers who will consider a client suffering from chronic pain even when treating with opioids due to the blended underwriting that is utilized, but detailed pre-qualification should be done prior to taking an application.

Although there are times that even just seeing the words “chronic pain” in a client’s medical records will be enough to cause a decline for coverage, the reality is that an agent only knows what a client is willing to reveal prior to taking an application.  Getting a list of a client’s medications before taking the app can save you and your clients a great deal of time and minimize the possibility of disappointment.  It allows us to provide you with a list of questions to go back to the client with to establish their insurability.

As always, Insurance Advisors is here to support you though all phases of a sale.   It is our goal to assist you in growing your business while having a positive impact on your client’s lives.  We encourage you to utilize our pre-qualification tools to show your clients that you can provide them with the best service possible.

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