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Prostate cancer is not an automatic reason for a decline.

THIS YEAR ALONE, 234,000 men will be diagnosed with prostate cancer, according to the Prostate Cancer Foundation, Santa Monica, Calif. Nearly 10% will succumb to the disease, it says, and every 2.25 minutes a new case occurs. That's why prostate cancer is now the most common non-skin cancer in the nation, affecting 1 in 6 men.

Sobering statistics, indeed.

But what of the 2 million men who are said to be living with prostate cancer today? How do they pay for critical medical care and still afford life insurance? Are they even insurable once a diagnosis occurs?

Independent agents will undoubtedly face a client who has been affected in some way by prostate cancer. In fact, the Prostate Cancer Foundation says 1 in 14 men ages 60 to 69 will be diagnosed with it. What's more, prostate cancer is one of the slower growing cancers of all the malignant tumors. A man could be diagnosed well before age 65, but still die from it.

The younger the client, the more significant the prostate cancer history will be during the underwriting process, as the disease is most aggressive in the young.

By learning all aspects of insurability of this impaired risk, agents will be able to better advise clients on what to do.

First, treat a client with a history of prostate cancer as any other client. Determine if he actually needs life insurance. As a cancer survivor, he will have to pay higher premiums, so explore whether he can afford it.

Some basic questions to cover are:

* Is the client married? Does the spouse need financial help?

* Are there young children to be provided for after a death?

* Does the client support an elderly parent?

* What about existing mortgages or other major obligations?

If it is determined that the client does need life insurance, the next step is to explore the area of impaired risk underwriting.

Impaired risk is a specialized area in the insurance underwriting business. It requires knowledge and experience in medical implications of a disease and associated underwriting trends.

Of course, there are ranges of risk in the impaired risk segment of the market, ranging from low or mildly substandard to highly rated substandard risks. Every carrier or brokerage general agency is challenged to review the client's health history and medical risk and then devise a solution that offers the right balance between a coverage opportunity and an acceptable rate.

Many agents are simply uncomfortable asking a client about these health issues, such as whether he has had a baseline PSA (prostate specific antigen) test or personal history of prostate problems; if there has been cancer in the client's family; and, if so, what type, with whom and when.

After all, to many people there is still a misguided stigma attached to the word cancer. How to handle this?

First, be aware that the client (or prospective client) is uncomfortable, too, possibly more so than the agent. Therefore, do everything possible to build trust and a climate of safety so that the client will feel comfortable in speaking to the agent about these personal health matters.

Be empathetic. Be sincere. Be honest and tactfully direct. Above all, be extremely discreet.

Once the trust is established--which may take several appointments--be sure to verify all information provided. For instance, identify if and when any type of screening test was done, such as a PSA or prostate biopsy; whether there is a history of prostate enlargement or BPH (benign prostatic hypertrophy); if there been a diagnosis of prostate cancer and, if so, what is the location and stage of the cancer; and whether the cancer has migrated past the gland.

Be sure to collect a Gleason score. This ranks how abnormal the cancerous tissue appears under a microscope. It is a helpful tool in determining how closely the cancer cells resemble or differentiate themselves from the healthy cells.

It is also helpful to obtain pre- and post- PSA levels for those with a prior history of prostate cancer. For example, if a client is a post-operative patient of a radical prostatectomy and his PSA levels elevate suddenly and unexplainably, underwriters treat this information as crucial to their decision to offer coverage.

Remember: When seeking impaired risk insurance, the greatest difficulties occur in the gathering of accurate facts and information. Proper risk assessment is very important to a positive insurance outcome; and it is a combination of all factors that determines insurability.

Fortunately, prostate cancer is not a seemingly intractable, 'uninsurable' situation. Agents are able to get clients who have this history insured--and, more than likely, at a rate that will work for them.

For years now, life insurance companies have studied the life expectancy of prostate cancer survivors. Combined with data collected from cancer researchers, this effort has enabled carriers to lower the price of their policies, based on the finding that many of those once considered risky are no longer so considered.

When submitting the application to underwriting, one often can expect to see temporary flat extras applied or table ratings that correspond to the type of cancer, date of occurrence, and cancer stage and grade.

An estimated 200 insurance companies write life insurance policies in this country. Not all insure cancer survivors, but some do. Experience indicates that carriers use several key factors to determine insurability. (See chart on page 23 for examples.)

Furthermore, there is a greater likelihood today that agents can get clients insured under certain cancer situations. Thankfully, one of those is prostate cancer and, usually, any cancers that were diagnosed and treated early.

Conversely, there are troublesome conditions which make it more difficult to get insurance, such as a Stage 2 or higher cancer; a returning cancer; multiple cancers and, in particular, if the cancer has spread.

Becoming an impaired risk expert requires today's insurance professional to be one part medical student, one part therapist and one part financial guru.

Fortunately, there are amazing treatments available that can lead to full recovery of prostate cancer such as surgery, radiation, hormone and chemotherapies. According to most medical experts, when prostate cancer is detected early at the local or regional stage, 100% of men diagnosed will remain disease-free after 5 years.

Of course, the client will need to consult a medical doctor for specific information related to his own health matters.

PROSTATE CANCER CHECKPOINTS

Possible Requirements To Qualify For Life Insurance

The client may have to be:

1 IN REMISSION or cured of the prostate cancer

2 PAST AT LEAST 6 MONTHS since last treatment and, in some cases, as long as five years

3 IN GENERAL GOOD HEALTH

Source: David Costanza, Innovative Solutions Insurance Services, El Segundo, Calif.

* David Costanza is vice president-underwriting at Innovative Solutions Insurance Services, E! Segundo, Calif. His e-mail address is dcostanza@isislife.com.
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Title Annotation:FOCUS: IMPAIRED RISK PRODUCTS
Author:Costanza, David
Publication:National Underwriter Life & Health
Geographic Code:1USA
Date:Oct 30, 2006
Words:1135
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