Field Underwriting for LTC Specialists

Asking a client about their income and health history can feel intrusive, until you realize it's the difference between a smooth long-term care approval and a painful decline. Learn how strong field underwriting protects your clients, your pipeline, and your reputation.

In this episode of the Buddy Study Podcast, a veteran LTCi field underwriting specialist joins the study group to break down how to ask the right questions before an application ever reaches underwriting. From financial discovery to medical red flags, the conversation covers a repeatable process advisors can use to reduce declines, save time, and build trust with clients and referral partners alike. The discussion also works through a live case study, showing how these principles hold up when a real client presents an unfamiliar medical condition.

We explore:

• Why decline rates vary so widely between agents, and what that means for your clients
• The "Say Yes to the Dress" mindset for presenting product options based on budget
• How to uncover a client's true financial capacity to determine the right benefit and duration
• Key medical interview questions around medications, T-scores, MRIs, and lab abnormalities
• Why pending tests, unresolved treatment recommendations, and CPAP compliance can trigger denials
• The often-overlooked underwriting question about a client's plans to live abroad in retirement
• A live case study walking through how to underwrite an unfamiliar diagnosis

This episode is designed to help advisors:

• Ask more thorough, guided questions during the discovery process
• Reduce back-and-forth with underwriters and speed up approvals
• Present product options in a way that builds client trust instead of resistance
• Approach unfamiliar medical conditions with a repeatable underwriting framework

CHAPTER MARKERS

0:00 Welcome & Session Overview
 1:23 Why Field Underwriting Matters: A Decline Rate Story
 7:34 The "Say Yes to the Dress" Approach to Budget Talk
 11:14 Uncovering a Client's True Financial Capacity
 13:57 Building the Health Interview: Meds and T-Scores
 16:28 MRI and Lab Work Red Flags to Watch For
 20:03 Joint Issues, Compliance Gaps, and Denial Triggers
 30:52 The Overlooked Question: International Residency Plans
 32:02 Case Study: Underwriting a Chiari Malformation
 44:18 Inside the Field Underwriting Questionnaire
 47:43 Family History of Longevity and Retirement Risk
 49:47 Closing Thoughts and Advisor Takeaways

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🔎 About Buddy Study Podcast

The Buddy Study Podcast helps insurance professionals and financial planners master Long-Term Care Insurance through case studies, expert interviews, and carrier product updates. Our goal is to help advisors become more confident, efficient, and knowledgeable when helping clients plan for long-term care.

Transcript

Welcome & Session Overview

SPEAKER_00 0:05

Hey everyone, welcome to another edition of the Buddies Study Group. And I think it's the most wonderful time of the year. I try to make sure this presentation happens once a year. I think it has consistently since we've uh had this study group. No better person to do it. We have Miss Linda joining us today, who's going to take us through a little bit about field underwriting for long-term care specialists. And as I mentioned in the agenda, um a lot of the trainings I've done over recent weeks, whether it be helping to save declines, right? And save your cases, or helping to overcome objections, or any of the number of kind of foundational principles of being a long-term care specialist, finding the right product fit. All of those things are helped immensely by good field underwriting. So we've been talking about so many things that are supported by it. Uh, I thought it was time to bring this session back around and um really show you how it's done um through Linda coming here to tell us all about it. I know we have a lot of people starting summer vacation a little early. So uh got a little bit of a smaller crowd, but Linda really appreciates you being here.

Why Field Underwriting Matters: A Decline Rate Story

SPEAKER_00 1:23

Um always my favorite session of the year, and you can take it away whenever you're ready.

SPEAKER_02 1:26

Thank you. Thank you. You know, I learned something really interesting about the value of having a um good underwriting. So um, for example, I was on that NGL trip, and I only sold one third of what other people's sold, and yet I was in the the top 10, right? I got to go on that. And what and I was actually surprised. I had no idea about how important this this rate was until they were around the table. And the first thing uh that uh Joe said was, you know, we have to, I just have to ask, how do you have a 7% um declaration rate? And I never I didn't know what mine was, and I never really thought about it, right? I you do your due diligence, you put the things that you put your applications in, you want to make sure that people don't get declined. And as most of you know, NGL is one of the hardest, tightest underwritten companies out there. So um, you know, 7% to me, actually, I don't know if that felt good or not. When I understood that the general population of qualified agents is running about 25%.

SPEAKER_00 2:40

It's intensely.

SPEAKER_02 2:42

And when you look at uh uh financial planners who sometimes have you know a 40 or 50 percent rate because they don't even ask about height and weight or look at height and weight, um uh it's amazing, right? So, you know, one of the values that, you know, as I looked around myself, I said, gosh, at 25%, that would be one in four that gets declined. That's an awful lot of backpedaling on trying to make sale, a lot of time and effort, a lot of unhappy feelings from a client. And if you're working as a uh a resource to financial planners, um, are you really doing them a favor? Right. I mean, your job as a long-term care specialist is to be that specialist so that their clients are happy all the time. Um, and the way to make them happy is that when they apply, um, there's a you know, 93% chance that they're gonna get their long-term care policy, right? That's what we're looking for. So um uh, you know, it brings huge value to you when um you can say, you know, I'm I'm I bring a specialist, um, I am a true specialist. And one of those things that I do for you is to make sure with it everything possible that your client is going to go through claim, uh, go through underwriting the first time. Um, and they're not gonna have that feel bad feeling, right? And you're not gonna waste that financial planner's time either, because I don't know how many of you work with financial planners, but I can tell you that the vast I at least you know 60% of my um sales are in partnership with financial planners, which means that I'm often on the um the the webinars with them as we talk about product and I'm sending my ideas to the financial planner, which takes their time. And then we sit back together and we meet with the client, and then um we often meet, then they sit down oftentimes with their client to reinforce what I just said, and then I'm back with their client to do the application, and then to have to say to them, Oh, I'm so sorry they were denied. I mean, that does not that that does not bode well for a great relationship. So it's just really, really important. Um, this this whole concept of underwriting. And um so what do I do? Um, I talk about it as if it's as much as uh financials, right? I get on the phone and I'm and and I talk to them. I have a form that I use that they can just fill out. Um, Diane is actually using the the new um uh uh form that you pay for, and um and and she loves it. I'll be evaluating that over the next month so I can give you feedback on that as well. Um uh you know, when when I work with a client, I want to know everything. And it's amazing. People give you everything. If you come across as a professional and you are comfortable with asking the questions, they will answer your questions. And if they hesitate, you explain why you're asking these questions. Now we we are not using this information for anything but to help them, right? And if we don't ask these questions, we could be causing harm. So by by making uh this such a difficult process that they have to have to go through this all over again and they may not choose to do that, and then they just lost the opportunity for long-term care insurance. Um, so uh, you know, you you always want to show them uh what is appropriate for their health, and um because if you come back with the product that's going to be significantly more expensive, the chances of them purchasing go way down.

SPEAKER_00 6:36

Hey, Linda, a couple things, and I I have a question for you too. Number one, uh, I think the analogy you give that I use all the time is to say yes to the dress, you know, not wanting to show somebody a dress that's they find out is later out of their budget from a health perspective or otherwise, and dealing with that disappointment. But um number two, I think being a good field underwriter is the number one way to get introduced to more financial planners, like you were saying, because I think there are many financial planners out there who know long-term care and know the market, but because of the nature of their work, they don't want to know intimate details about their client. They don't want to actually participate in the underwriting process with them. Are you finding that that is one of the entry points that you see? I actually don't want to touch the underwriting piece. My relationship with

The "Say Yes to the Dress" Approach to Budget Talk

SPEAKER_00 7:34

my clients has never had anything to do with their health.

SPEAKER_02 7:37

There are some. I actually have a lot of financial planners who are intimately related with their, they feel very comfortable talking about these things with their clients, and then there are others who don't. So it's it's very individual in terms of whether they feel comfortable asking these questions or not. Um, but I don't know if everybody knows say yes to the address, because this is one of my favorite analogies, which is um saying yes to the dress is a wedding dress program. And um people come and these dresses could be $30,000 or more. I mean, they could be buying a house by buying a wedding dress. I mean, it's crazy. Anyways, they go into the into this shop and the first thing they the salesperson asks is, what is your budget? And if somebody says my budget is $10,000 for a wedding dress, they will not show this person anything more than $10,000 because they know that if they show them a $12,000 dress and their budget is $10, they're gonna love that $12,000 dress and they're gonna walk out empty-handed because they can't afford that $12,000 dress. Now, if somebody comes in and they say their budget is $20,000 for a wedding dress, then they don't mind showing them a $30,000 wedding dress because they're already off the charts spending something ridiculous on a wedding dress. So they're fine with giving them, you know, they can give them something that's even greater and it's not going to impact their budget, right? If somebody has $20,000 for a dress, they can spend $30,000 on a dress. But if somebody's spending $5,000 on a dress, they may not be able to spend $7,000 on a dress. Well, long-term care, um it is this feeling in people's minds about what they can they can afford. And when you talk to people about their individual um uh assets, it's interesting, but I usually find that people will downplay what they can afford versus what the financial planner says they can afford. So I have, I was sitting with a client and they filled up my form and I said to them, the financial planner, so I've I've pretty much narrowed it down. I've, you know, they're saying they're about one to 1.5 million. They don't mind it, they're not worried about a death benefit. They just want to get the biggest bank of their dollar. So I will show them a hybrid, but you know, I think we're going to be focusing more on a traditional policy. Um, and uh, and she says, what, 1.5 million? They have so much more than that, right? So um, so always keep back at in the back of your mind that sometimes, you know, in terms of finances, people will um make their uh their assets less to you because they don't want you overselling them. So if somebody said, you know, I have six million dollars, then you're thinking, oh, I can sell them anything. And they don't they they want to avoid that kind of giving the agent the cop blush to spend anything. So, but if you always show them the cost benefit of their policies, that's when they're much more likely to increase the benefit and the premium themselves. Right. So you give them options and and better to have lower price on the on the on the choices and they bring themselves up as opposed to um showing them something too high, like say yes to the dress, and then they say, I can't afford it.

SPEAKER_00 10:51

Um I'm glad you went into that and and kind of peeled that back because um, yeah, people will give you a budget that is representative, maybe not of their true budget, but exactly how much of their budget, their actual budget that they want you to have control of or or to put into this plan. And the interesting thing is when you start to bring

Uncovering a Client's True Financial Capacity

SPEAKER_00 11:14

health into the picture, your budget's not decided by you at the end of the day. It's decided by underwriters, it's decided by carriers. And that can uh in many ways cap you more than your financial budget can, right?

SPEAKER_02 11:30

Exactly. Exactly. So what I always tell people is when I start out is I, you know, I always start out with um, you know, obviously this is a financial product, you know, we need to understand. Um, so it's important for me to understand uh your finances so that I can help you choose the appropriate product uh value as well as um how you might pay for this, whether it's a short time or over a long period of time. And uh and and sometimes I'll get pushback, like you don't really need to know how much, you know, how much I have. I'm like, all right, well, let me ask you how much could you spend in a year and uh that you could feel comfortable spending in a year so that you could still make it into retirement. They'll look at me and they'll say, Well, I don't know. It depends on how much I get. I said, exactly, which is why I need to know if I should be selling you a two-year policy or an eight-year policy or an unlimited policy, right? I don't know what I should because I don't know what you can co-fund on this policy. So whatever I give you as a number for long-term care, you have to have enough assets to uh fully fund the benefit, right? That the cost. And if you can't do that, I'm not gonna sell you six years of benefit if you can only co-fund two years of benefit. So let me ask you again, why don't you tell me what your what your income is and and and are you renting? Do you own how much the value of your home is? What is your mortgage? And what have you set aside for retirement? And boom, boom, boom, the numbers start to come in, right? Because now they understand what you're doing. And I'll say them, I I can't, I don't even know what to tell you. Just, you know, if they're not gonna share you their numbers, they're likely not gonna buy. So why waste your time? When they start coming forth with with information, then they're much more likely to uh that now they're invested, and now you're going to be able to work with them and actually help them. So we get through the finances and then we say, you know, you know, the other thing is we're in a great time. There's a lot of options for long-term care. Um, you know, generally speaking, you know, it, you know, the healthier you are, the the less expensive the products are. So it's really important for me to make sure that I choose the the most appropriate product for you. But the last thing I'd want to do is make you go through all the work of applying for a product that you wouldn't qualify for because it doesn't matter how healthy, how um uh how much you understand it,

Building the Health Interview: Meds and T-Scores

SPEAKER_02 13:57

it always feels bad when you uh get denied. And I don't want that to happen. So uh let's start with some questions. You know, I start with their their meds, right? And we have their meds, we um and um we understand uh what that what those meds go to. So um if they are taking osteoporetic medication, you need to know what's their T-score. And it's okay to wait for them to find their T-score. Um, the last thing, you know, and you can ask them, did they say it was mild? Did they say it was moderate? Did they say it was severe? Did they give you any indication about how your osteoporosis was doing? And sometimes they'll say, oh, yeah, they told me it was nothing to really worry about. It was very, very light, you know, that's or they can say, yeah, they were a little, they were they were talking that it was, you know, could be moderate to severe. We don't really know. So then we need to know um, you know, what is that T-score? And it's the highest T-score, I should say, the lowest T-score because it's a negative, the lowest T-score of any joint that's critical. So they could all be, you know, in the osteopenia range, you know, less than 2.5 and um more than 2.5, negative 2.5, and and you have one that's negative 3.7, and you're gonna start to get into difficulty with some companies. So it's really, you know, it's it's it's okay to wait for them to come back with information. That's why you do your your interview first, you get all the information that you can possibly get, and and they can you send them an email to remind them, listen, it was great talking with you. Um, as soon as I have your T scores, then I'll be able to, you know, put together some quotes for you. Um, somebody has an aneurysm, another thing, you know, it's just an aneurysm. They're not gonna do anything about it. Well, of course they're not gonna do anything. They can't do anything for it, but it could, if it if it erupts, it's a problem, right? So it just because there's no treatment doesn't mean it's not a problem. You know, doctors are not going to stress people out uh about something that they can't do anything about, right? So they're just gonna say, ah, it's an aneurysm, don't worry about it. There's nothing we need to do about it, which is true, but it could still be a significant problem and can deny them from uh, you know, the vast majority of companies. So if somebody says they have an aneurysm, the question is, what size? And again, you don't even think about underwriting someone until

MRI and Lab Work Red Flags to Watch For

SPEAKER_02 16:28

you know what size. Um, you know, so there are certain diagnoses you really want to know. I have asked the question about MRIs. Have you ever had an MRI? It's a very general statement, but it gives you a lot of information. It tells you um what joints are bothering them, and then it can, you know, if they say, Oh, I had an MRI of my back, okay, and then it takes you that leg, right? I had an MRI of my head. Um, well, MRIs of heads are are scary for underwriters because a lot of people show what's called white matter changes. White matter changes could be indicative of MS, of early dementia, uh, or or that they may have an earlier sign of dementia in life than than the average population. So, generally speaking, insurance companies aren't particularly fond of white matter white matter changes. Now, companies will um insure white matter changes, given that they, you know, they don't have any other symptoms that you know, they come up with and and and their age and and and everything's good. So um there are a number of companies that will still ensure with white matter changes, but be aware, not all of them do. So it's asking about MRIs, especially for people who say they have migraines. If somebody says they're they're on a migraine, migraine uh medication, they typically have MRIs. Somebody has tinnitus or hearing issues, they typically have MRIs because they're gonna look for tumors or anything else that might be causing these problems. And as soon as they have an MRI and they're over 55 or 60 years old, the potential for white matter changes significantly increases. That could minimize their ability to get some policies. So that's always a good question to ask. And you'll keep it in your mind, especially around migraines and uh tinnitus and things like that, that has to do with the ears or eyes, visual changes, anything like that, they'll do MRIs. Um, and then I always ask a general question. Uh, when you go to the doctor and you have your lab work done, is there anything that comes out outside of normal, a little high, a little low? Um, because anemia, you know, most people would not think of that as a problem, but anemia is a problem. Blood, uh, whether it's too high or too low, can indicate significant um illness and chronic illness. Um, you know, you have too many red blood cells, you know, you they worry about overclotting, right? So there are there are all kinds of things that can that that just a little bit side outside of normal that is not um diagnosed as as a reason for it um or is not getting better with treatment, they you need to be aware of so that you can send it to the underitus to make sure that they they have those specific numbers. They have anemia, this is their number, this is how long they've had it, um, and and you know, all bleeding has been uh ruled out, right? So you can get underwritten by companies with abnormalities on either side of normal, but you got to be able to explain them. Right. So again, uh what's I supposed to say if you're looking for process-related tips or case studies. Oh, that's from you.

SPEAKER_00 19:42

Yes. I'm encouraging people to ask you questions before I ask you all the questions.

SPEAKER_02 19:46

Oh, okay. Okay, good, good, good. Yeah. So um, that's another um uh so another thing to to think about. So I always I always go through the blood work, then I ask another general question, which is have you do you have any, have you ever been to a doctor or physical therapist, had any x-rays or

Joint Issues, Compliance Gaps, and Denial Triggers

SPEAKER_02 20:03

MRIs for any knees, hips, shoulders, necks, any joint, any problems with any joints. And most people a lot will say to you, Oh, yeah, no, I have some aches and pains. And but if you've never they've never been to a doctor, then it's not an issue. But if they've been to a doctor, then you have to go to the next step because a lot of times people go to doctors and the doctors say, Why don't you go do some PT? And then they say, Oh, you know what? I don't really really need PT. I'm I'm feeling fine. I can handle it on my own. Then they have this open-ended medical um uh requirement from the doctor that they haven't fulfilled, they're not going, that's an you know, that's a a test or a procedure that has not yet been fulfilled and it will be a denial, right? So you or you know, so we have to get those things off the medical records. If somebody is, if a doctor says you have to have PT and you don't do PT, then you're gonna go back to the doctor and say, listen, I know you recommended PT. It's in my medical record. Can you please take it out of the medical record and let that and make it some note that says, I'm all better, I've recovered, I did exercises on my own and I've resolved, and it's no longer an issue.

SPEAKER_00 21:10

Um related to medical non-compliance, right? That's gonna really be one of the worst.

SPEAKER_02 21:17

Yeah, and and it's and I think it's really that there's something outstanding that hasn't been done that was supposed to be done. So um, and which means in the in the insurance side, it's still a problem. If you haven't, if you haven't taken the medication or done the treatment, then how do then why would it go away? Right. Right. So they they don't understand the insurance company is looking for that. And and testing, I mean, you have people who go to the doctors and and then the doctor writes, oh yeah, you can get an x-ray, you can get an MRI, you can have another blood test, you can have the specialty test, get a calcium test for your for your heart or whatever. And people get, you know, people get nervous all the time. There, they have a family member who has um uh you know, dementia. And they go to the neurologist to get a mental status test early, right? Um, and then the neurologist will say to them, you know, well, do you have every made problems? And then they'll say, well, you know, I have trouble remembering names, you know, and and and and and they can mess up their medical records right from the beginning, right? So um, you know, there are products that that um, you know, three years and you're not being treated for anything, and and you can be approved with with a memory impairment, right? So if you haven't been treated and you haven't been diagnosed even for a memory impairment in three years, you can there are still policies out there that you can, there's a policy that you can still get. So um, so there are, you know, understanding and being very clear about where people are going, making sure that there's no tests that they have been recommended. And I that's one of the questions I do ask. Are there any tests or any therapies or any doctors that you have been recommended by a physician to do and you have not completed as of yet? Or you decided you no longer need including.

SPEAKER_00 23:04

I just think from my own experience, Linda, one of the big ones when we just think of like compliance versus non-compliance that I see is sleep apnea. That tends to be um for one reason or another, right? They think, oh, it's just like a light suggestion from my doctor, even though I have this equipment that I was told to use every single night. Uh, I treat it more like an accessory or only when I have trouble breathing, or I flat out hate using it and don't want to use my CPAP machine, right? I that one used to get people in trouble a lot in my experience.

SPEAKER_02 23:39

Yes. Yes. So, you know, you know, the the thing is you you try to help people remember things that you wouldn't typically remember. Um, so you can't just ask somebody, you know, are are you do you have any medical issues out there? You know, it's like um they just can't remember. It's not that trying to lie to you or hide things, they just don't remember. I mean, I've had people who don't remember when they're talking about a spouse, I completely forgot. I did I mention that she had a stroke? You know, like, no, somehow that that eluded our conversation, right? So um, but asking all these other questions, it it guides you to um them to be able to answer the questions um so that you have the answers to be able to uh choose the right policy um based on their on their underwriting.

SPEAKER_00 24:30

Make a super good point there. It's like uh, you know, is somebody not divulging one piece of information or another really down to them not wanting to tell you, or are you not asking enough guiding questions to get them an idea of what you're looking for, right? Until you get to time of application, right? The the more homework you do up front, um look, if it's going to take more time right up in the beginning and the client's expectations are set that way, knowing that when they're finally about to finish the process, they're gonna run into less snags, um, you know, all the better. And I think you make a good point. Are we asking enough guiding questions to get people to remember things? If you have a lot of health issues going on, or you had a health issue 19 years ago that's relevant because it's inside 20 years, you know, sometimes you have to be prompted to get that out to the surface. You don't think about it every day.

SPEAKER_02 25:29

Yeah. And people, you know, I think people are very optimistic and they, you know, they have their aches and pains, and then they put it behind them. And they sometimes people take medications and they feel like since they're on a medication, it's resolved the problem that they don't have those problems anymore, right? Or, you know, they had a stroke, it was over, done with, they recovered, they've got most, they have minimal symptoms from it. It's a non-issue, it's uh something of the past, they got beyond it. So um, you know, it's a just a very positive way of living. I mean, if we thought about every ache and pain we ever had, and um every, you know, not but you know, if you think about uh it's it's just uh I I think about my mom who must have a hundred million different medical diagnoses at the point. But if you asked her, how are you doing? her first answer would be, I'm good. And and if they said, you know, do you have many medical issues? She'd be like, oh no, everything's all set, you know, because in that moment, she's all set. And if you asked her if she was independent, she would tell you, yes. She is an assisted living who has an aid every single morning. But if you asked her, Are you independent? her first response would be yes, I'm independent. I could I can take care of myself. I take care of myself with AIDS, but I'm still independent. So perception of the of how you, you know, um answer questions and ask questions, a perception of people in and of themselves of feeling healthy and sound, it's they they don't really focus on these things that that that have caused them um that that insurance companies worry about. And and that's the other, you know, really understanding that it's not just about what they worry about or their doctors worry about, it's what the insurance company worries about. So that's what we're trying to help them them figure out. And and I saw that question of, you know, what medications do you take this morning? Um, you know, you'd have to follow up with what medicate do you take any other medications during the day or in the evening? Um, and are there any medications that you've been prescribed that you are not taking because they just didn't feel right or you didn't feel you need them? Right. So um, because uh, you know, they will give you an answer to your question, but it may not be the full answer.

SPEAKER_00 27:40

I do, I do like it as kind of an opener, you know. So start with the most familiar and and recently experienced, and then we'll kind of peel back the layers. I do like that.

SPEAKER_02 27:52

Yeah, no, it's a great start, but you just you want to make sure that you keep you keep going with that. And whenever they give you an answer of a problem, you've got to take it to the next level, right? So um, to ask more questions about um, you know, yeah, I I've been to PT for my back. Well, did you ever have an x-ray on your back? Right? Um, did they say that it was mild, moderate, or severe osteoarthritis, right? Did the doctor ever suggest surgery?

unknown 28:23

No.

SPEAKER_02 28:24

So these are, you know, because um again, that suggestion of surgery is a problem. Um, you know, I I had I had a person uh denied, although we were able to appeal it, he had one knee replacement done. He said his primary care, he goes back. He makes a joke to the doctor. He says, My knee feels so good, I think I'm gonna have the other one done. Right now, he was just joking. The doctor put that in the medical record. He was denied long-term care because he had a pending knee surgery on the other on the other knee. And then we had to go and he and we had to go back and and I had to have taken an x-ray on the other knee to compare with, you know, a past history of the knee to show there was no change, and have the surgeon write that there is no um, you know, there is no surgery pending, and there is no way that I can predict if or when there would be a uh, you know, a surgery on this knee in the future, a new replacement, you know, in the future. And and we were able to get him approved. But um, you know, you if there's something in that chart that indicates that that a surgery is is pending or maybe needed, um, yeah, it will be a denial.

SPEAKER_00 29:35

And it's not even about going back um on cases that have been declined by not going the extra layer to each question that you're asking. It's also if you're only going to maybe layer one, layer 1.5 of something that somebody divulges to you, there is such a high chance that you're going to pre-qualify and the underwriter is going to come back with more questions. And now, yeah, thanks. I know we just sat down and did 30 to 45 minutes of questions about your health, um, but I didn't ask enough questions. And now there's more questions coming back. So we need to sit down and I need to ask you a bunch of questions again, and you need to study things about your medical history again, right? Um, that lengthens the process as well. It's not just a bad outcome when somebody's declined and you have to pivot or appeal or something of that nature. You win some, you lose some. Some things are out of your control, but I think asking as many questions as you can. So that underwriter just comes back with a response instead of more questions uh where you can really helps the process too.

SPEAKER_02 30:42

Absolutely. One thing that you know that we don't think about always asking, but I do now because um international travel is so big, and and people don't necessarily think

The Overlooked Question: International Residency Plans

SPEAKER_02 30:52

about international travel with regards to long-term care insurance. So another underwriting question to make sure you ask is do you plan to stay in the United States for retirement? Or do you envision yourself living abroad? Because the last thing you want to do is get through an application and then they say, and then they read it, right? So they they're reading their product and then they say, wait a second, you know, I was just thinking about it. You know, I might want to live abroad, and and you've got a product that that that no longer meets their needs. So um uh, you know, and they wouldn't necessarily have even been stimulated on that concept until they read the contract because it wasn't brought to their attention at the beginning. And they didn't really think about it until they saw it. So um, you know, something else to to add to your underwriting is to are they planning on staying in the United States or what the potential is for them to go outside the United States. So any questions?

SPEAKER_00 31:50

Yeah, um you guys, we get Linda here once a year for this session. Uh she's a wealth of knowledge. Uh, she could probably do this session for three hours, so please ask any questions

Case Study: Underwriting a Chiari Malformation

SPEAKER_00 32:02

that you have. Yeah, of course. Hey Suzanne.

SPEAKER_01 32:07

Hi there, hi are you? Um got into client for somebody who had a chiari malformation, but he's working as a sheriff and he's fine. So I'm guessing it must be asymptomatic, but I'll find out more details. But have you had that come up? And if so, are there any carriers that you think will be favorable?

SPEAKER_02 32:26

So good question. So, whenever there are malformations, even say you know, a lot of times people have um uh genetic change, you know, that they were just born this way, right? They just sometimes they're just they're born with something in their brain that just malformed or um um, and these are not well received by insurance companies, generally speaking. Um they the easiest ones to get through would be bankers, right? Because it's not going to ask something specific. It's you know very simplified underwritings. They would get through an Equitrust Bridge because they're they're great. They just have a right, um, and um they could also um likely they would likely get through on uh nationwide annuity as well, and and the one America annuity, and they very well mightly get through uh One America um because they just tend to be uh more flexible in their underwriting. Oh and um so the what I usually do when it's very specific and I don't know, um, then I would look at um sometimes uh uh John Hancock with uh John Hancock or um Bright House or One America um tend to be a little bit more flexible um in their in their underwriting uh for yeah.

SPEAKER_01 33:47

So it was um we actually applied with Care Matters Annuity and got declined because the diagnosis code came up, but it didn't come up in going through the questions. You know, there's nothing in any of the medical questions that asked that.

SPEAKER_02 34:00

No, there wouldn't be like that. Is so specific. There are always going to be some things that um, but if you would ask if he had ever had an MRI, that's a very general question, it might have come up because it's likely that's something that is followed over time, um, just to make sure that there's no change in those malformations. Oftentimes, you know, even if it's like every other year or something like that, or he may say, I used to have them, and and after five years of no change, they just stopped doing them. But um, in order to find something like that, it would have been found with an MRI. So then the question is, you know, yeah.

SPEAKER_01 34:39

Right. I'm hoping that at the I believe he's asymptomatic, but if that's the case, I don't know if there's any challenging it. We're gonna obviously try to challenge that.

SPEAKER_02 34:47

What was the name of it again? Was it was it called again?

SPEAKER_01 34:50

It's um P R E malformation. Let me spell it for you. It's a weird one, it's a brain malformation, it's only spelling it's um Arnold C H I A R I P R E malformation.

SPEAKER_02 35:12

Okay, yep.

SPEAKER_01 35:14

Let me see. And the person works as a sheriff, he's working, you know, so he's clearly and he seems fine from the talking on Zoom, so he doesn't seem to be right, right, right, right, right.

SPEAKER_02 35:26

So here's the thing. So what it is is you know, for everybody, so and this is what I do. I often look up to see what it is and what the issues are. So um it is a um it's a malformation when the brain tissue in the lower back of your skull goes into your spinal column. It's a structural problem with your skull tip that typically causes it. And then um, and and and so you can have headaches, which are usually the typical time with people find it. Um and and it can end up to having difficulty with balancing coordination.

SPEAKER_00 36:02

So it has a type one and type two like diabetes, that's interesting. Yeah, yeah.

SPEAKER_02 36:07

So but generally, um you know, you know, when when um say I'm wondering if it says if it can get worse if it's no symptoms and two major symptoms, and I wonder if it can many people don't have symptoms, but some people develop. So here's the problem, right? So whenever you see something like this, um, you may not have any symptoms until adolescence or adulthood. Many people don't have systems, but some people develop. So that's the problem with these types of illness that if you have this problem and the and then some of these people are going to develop something significant like balance issues. Right. This is this is this is not going to be something that most characters are going to take a risk with because they don't, you know, if they said that you would have a diagnosis and symptoms would show up by the time you're through adolescence, then they could say, okay, well, he had the malfamation, he's now 40 years old or 60 years old. Um you know, at this point, if they haven't showed symptoms by the time they're 60, they're free and clear. But that's not what the data says. So um, so then you say, okay, this is this is a diagnosis, and you don't make him crazy about it, but you said, you know, underwrite is a very um strict and um they don't, you know, you gotta remember they look at the at a pool of people instead of individuals, and I know how great you're doing. Um, but let me tell you what companies are more flexible and look more liberally at this diagnosis. And so then you'll you'll end up with um definitely with how old is the person? 65. Okay. So if they have assets, you know, you definitely have the Equitrust Bridge, right? And and you definitely have bankers. And then and then you could, and then as I said, um I it's unclear whether um, you know, like One America, Bright House, or like John Hancock would um would do that. And and so I would ask those three um and and see if you have any more flexibility. Um, and then you know that you have those two that you know you can get because he's obviously cognitively intact and he's obviously physically fit and he doesn't have any symptoms. So uh those other two would would be easy underwriting, and he could get the preferred rate with um Ampatrust Bridge.

SPEAKER_01 38:35

Got it. Thank you.

SPEAKER_00 38:36

I love that you asked that because this kind of goes to show like a slice of life of working in long-term care and insurance, right? You're going to run into conditions you have never heard of or encountered before. But I think it's important at least to start to figure out how to ask the right questions because even though we don't know what the condition is, we still have to ask the right questions about it so that we can give that extra information to underwriters. Look at the condition, look at what the symptoms are, look at how it, you know, potentially manifests over time, and think like an underwriter. You know, you've done this enough times. What are they looking out for? Like Linda said, there's potential for progression of the condition later in life, though many people can be asymptomatic for years and years and years, right? Um, it's spinal and cranial in nature, which tends to be hot buttons. So you'll want to ask about anything in combination. What symptoms are they experiencing? Things of that nature. So I think that was just a great case study. And even if you don't know what the condition is, you can kind of um you know pick at ways to find the right questions to ask to take care of that ahead of time for the underwriter.

SPEAKER_01 40:00

Thank you. Yeah, it's funny. I had actually heard of it. I knew somebody who had it, so it wasn't totally. So Linda, did you ever get um ailments and or different conditions that you've never heard of? And then you just yeah, so sort of like that one that you have.

SPEAKER_02 40:13

Like I've actually heard of that one before, but I didn't remember it. But but when I get them, I

Inside the Field Underwriting Questionnaire

SPEAKER_02 40:18

immediately put them in. Like, I'll be with them and they say, Oh, I had this blank blank. Now wait a second, let me just look it up a little bit and I'll look it up. So as soon as I saw it was um that that that that it could come about almost at any age, right? That's the biggest problem. Like, is this something that's static? They have a malformation, there's no symptoms, and no symptoms will ever develop, then that's a whole different situation, right? But if it's something that's going that could cause a problem in the future, that's the first step. And the second question is what kind of problems could it present? And if you're talking about balance, cognitive, uh, you know, it it the those symptoms that could develop in the future are not going to be um welcomed by by underwriters, right? That those are some very things for underwriters to hear.

SPEAKER_01 41:08

Definitely. Thank you so much.

SPEAKER_02 41:09

Yeah.

SPEAKER_00 41:11

Hey, Linda, while we have uh a minute or two, I just want to um you have a very extensive form questionnaire on your website that you have people fill out. And I think it's great for a number of reasons. One, which I'll get into in a second, you ask a lot of questions that people just plain are not asking out there. Two, you you take care of this as many times as you can through the form electronically, so it's not a situation of, of course, it's still work to get through, but you are not sitting there staring at them most times when they are kind of trying to figure out and answer this information. So I think there's nowadays an increased comfort in that. And number three, I don't think there's anything left unanswered on this form. And the the piece that's in person is is you kind of um, you know, driving home the point that this is going to save us a lot of time. There's questions that need to be asked. The underwriters are gonna find these things out anyway through medical records, and we're taking care of it in the most efficient way we possibly can in the comfort of your own home, filling out the form. Yeah, so right.

SPEAKER_02 42:41

The other thing about the form is this is that um what I usually do is I'll send the when I when somebody says they're interested in an appointment or a financial planner introduces me to someone, I'll send them an email. I'm really looking forward to helping you evaluate your options for long-term care, uh, long-term care planning. Uh if um, you know, please schedule a time at your convenience. Here's my link to schedule a point. If you would like me to be prepared with a table of appropriate options uh for you ready for our first meeting, please complete the HIPAA compliant questionnaire. And most people, I would say it's it's really, really high. I'm trying to think the last time that somebody didn't fill out that questionnaire when presented that way. Because everyone listens and goes, Oh my gosh. Well, of course I want, I want the quotes, right? I want to know um how much does this cost and what are the what are the options out there? So of course I'm going to fill out this form so then I can uh uh get the information the first time I talk in a meeting.

SPEAKER_00 43:46

Yeah, I'm I'm sure that goes a long way. I just want to um again, if you want to see how it's done, I I highly recommend checking out Lindisform. Please do not submit the full form, uh, but you can.

SPEAKER_02 44:00

Yeah, you're welcome to go on the website, of course.

SPEAKER_00 44:02

Yeah, you can walk through it and get a sense of the questions that she asks. But there is one page that's so important and really gives the lesson that field underwriting is not just about health, though a lot of it is. You ask a lot of financial questions that I think are very important that people just aren't asking. Do you own or rent? Do you have a second property? I love that question because that already kind of establishes uh, you know, a residence state sort of scenario. Which one are you living in most often? Do you plan to retire at the second home? Is it just a vacation home? Um, but what state would you expect to retire in? What other insurances do you presently own? You know, a lot of some of these are from the personal worksheet. Some of these are, you know, just really, really good planning questions. Do you have an HSA account? Do you own a business? On a scale of one to 10, what is your level of concern that you may spend the premium dollars and never need long-term care? Kind of feeling around for product preference, right? Between traditional and hybrid. Uh, if you had to take a guess, when do you think you might need care? I love the way that's worded. How many years would you want to be sure you could afford to fund if you did need care? And what do you feel you could afford on an annual premium basis if you were able to see the value? Um, I think the way those questions are worded are great, but some of those questions get at things that you will eventually want to find out that you can get up front. Like where is the client at today? How are they feeling without having this full full-blown conversation with you yet? Can tell you a lot. And they're more willing to kind of give that answer if I'm just at home on the couch on my laptop filling out the form, right? I just think that's so important.

SPEAKER_02 45:59

If you don't ask those questions, then how do you put together quotes? Like I wouldn't even know. Like, where do I even start? Right. So if I know how much they make, I know how much they've saved, I know it's in their retirement, I know their property situation, I know if it's important to leave money to their children, I know it's um their feelings on on leaving uh of spending and not uh using the product. I know, I know if they own a business or don't own a business and and all that stuff, then it gives me tons of information so that I can say, well, they don't have a lot of money. We're probably gonna go for shorter policies, probably gonna have to go for a little bit more depth. Let's look more in the you know, the NGL 222 annual premium rate, right? They don't have a, or they've got tons, they've got a lot more money. Now we're gonna think about more like single pays or 10 pays or something like that, because they can afford those and get them out of the way. They appreciate, they'll be much more likely to appreciate the value of cash and willing to pay extra money to have that added benefit of cash, right? So um, in terms of uh monthly benefit, in terms of duration, all those things are going to be spurred on by those questions. Also, when you expect to need care, most people will put between 80 and 85, but every so often you get people who are putting 90 plus years old that they expect care. Well, once you get to 90, the 5% compound on almost every company looks better. So, you know, I would show policies differently for somebody who says to me, uh, you know, everyone in my family's lived to 100 years old, they're not using long-term care until age 95. Then we're gonna look at 5% compound where you're gonna

Family History of Longevity and Retirement Risk

SPEAKER_02 47:43

really see the value kicking in over the age of 86.

SPEAKER_00 47:46

Yeah, and it brings up the, you know, you ask about it explicitly as a medical piece, but it also gets to the family history part of that. Do you have a family history of longevity? You ask about cognitive illness, which is often what we think about in, you know, folks that have a family history of longevity, but just knowing the longevity is such an important financial planning piece, you have much longer of a retirement to plan for than the average person, right? And therefore put yourself at more and more risk of using up that retirement and the effects that extended care can have on. So I I just want people to understand whether you're watching the recording here today, you're an old pro or you're new, field underwriting is so much more than health. Health is the complex part. Health is the part that's going to be very, very different depending on who you're in front of. But, you know, it's like Phyllis says um, when she works with clients, you know, I would get in a lot of trouble if I started signing people up for asset protection when they didn't have any assets to protect, right? It is actually my duty to make sure that this is suitable for you financially. And how can I know what level of suitability we're at if I don't know where you're at? Right. So, yeah, I think I think that form is wonderful. Use it for inspiration. Um, it's gonna capture pretty much everything you need, and I think you add something new to it every year. Anybody else have questions for Linda? Well, Miss Linda, I will allow you to uh address everybody as kind of a wrap-up, but um, I know there are more topics we can have you on for related to this side of the business. We we talked about pathwork. I know you're gonna be evaluating that. We've seen it

Closing Thoughts and Advisor Takeaways

SPEAKER_00 49:47

as a a very, very slick and um uh efficient tool for underwriting, but also you're you're just uh expert on the claim side, the appeal side, diving into medical records. There's uh a lot more we can go with this, but I I I love just um this session around learning to ask the right questions because it affects so many pieces of your business. So is there is there anything you want to say to leave the group with?

SPEAKER_02 50:20

So no, just uh uh feel free to use the forum, for you to look at the form, and uh and and it's a process. So the more you do it, the more comfortable you will feel. Do not feel uncomfortable asking these important questions. It actually increases your professionalism. People want to actually be asked these questions because it means you know your business, that you're gonna guide them more accurately than other people they may be speaking to. I have won a lot of business from people who have come from another financial planner or I mean another um agent who has given them quotes. And I start off by saying, um, let me ask you, did they go through it? Did they, you know, before I, you know, give you any comparisons, let me ask you, did they ask you about your health? And many times the answer is no. And then I start off with, well, I to be honest, I don't even know if they can be offering the products they they did. Let's go back to the beginning, right? Did they ask about your income or your assets? No, well, how do they know what to even present to you? Right. Um, so uh it it increases your professional level and the and and as soon as you come in as a professional, the other agents go away and they are with you and they will go the whole the whole go the whole way.

SPEAKER_00 51:44

Yeah, appreciate that. It separates the pros from the pretenders. And the only way to continue to get better at this is to just keep meeting with people and keep running through the process, right? I mean, everybody here has case studies that are only accrued from getting out there and meeting with people and learning about different situations and, you know, getting an uncanny level of medical knowledge for somebody who does not work in medicine, um, that that's what it's all about. You just got to keep getting your reps, just like anything else.

SPEAKER_02 52:16

Right. And I don't know if there's anyone on here that sells bankers. It's not a lot of people who can sell bankers, but if you do have an underwriting concern and you do want something that basically says if you haven't had a treatment or a diagnosis in the last three years, and that's that's where you are, then you know I can help you with that.

SPEAKER_00 52:37

Appreciate that. And appreciate everything you do to this community. Probably um, you and Rhonda are probably close to tied for most prolific speakers on the study group and every time we love it. So appreciate you very much and appreciate you all for being here. Um, and we will see you this time next week. Take care. Have a happy Fourth of July if we don't see you on Thursday.

SPEAKER_02 53:00

Thank you.

SPEAKER_00 53:01

Thank you.

unknown 53:01

Bye.