The impact of chronic disease and immunity on field underwriting

By Emily Bancroft

We live in interesting times. Our collective vernaculars changed from living through the COVID-19 pandemic. Words such as “vaccine,” “immunity,” “booster” and “antibodies” are now everyday terms, whereas a few years ago, these words were mentioned a few times a year.

No one truly knows how much longer we will be immersed in these strange times as it is a new reality. Still, as we strive to understand the world around us, it helps to recognize what immunity is and how our pre-existing conditions or chronic diseases impact that immunity.

The Cleveland Clinic defines the immune system as “a large network of organs, white blood cells, proteins (antibodies) and chemicals. The system works together to protect you from foreign invaders (bacteria, viruses, parasites and fungi) that cause infection, illness and disease.”

The immune system is complex. Instead of deep diving into the various aspects, parts and types of immune systems, I will focus on the immune system holistically for this article. The immune system is critical to our well-being, and like any other body system, it can malfunction, leading to potent impacts on overall health.

Chronic illness plays a big part in our immunity. The Centers for Disease Control defines chronic illness as “conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States.” Several common diagnoses affecting a sizable portion of the population fall under the CDC’s definition of chronic illness, including:

High blood pressure.
High cholesterol.
Osteoarthritis.
Allergies.
Mental health diagnoses such as anxiety and depression.

This is not an exhaustive list, but it is a list of some of the most common chronic diseases encountered. Other major chronic diseases include inflammatory arthritis (e.g., rheumatoid and psoriatic arthritis and polymyalgia rheumatica), lupus, chronic obstructive pulmonary disease, asthma, dementia, multiple sclerosis, human immunodeficiency virus, hepatitis, chronic kidney disease and many more.

The importance of disease control, maintenance and stability are critical as mortality for uncontrolled disease increases. Inflammation is a crucial component of many chronic illnesses and increases as the body ages. Controlling inflammation helps to regulate disease progression. COVID-19 brought this reality to the forefront as people with chronic diseases had a more challenging time with the illness.

There are other factors to consider in disease control. Two critical factors are exercise/physical activity and stress levels (increased levels of cortisol, a stress hormone). If we can remain active and reduce stress, it will help to control disease activity.

When underwriting chronic illnesses, it is essential to look at the diagnosis, length of time since diagnosis, control, compliance with medical treatment and suggestions, medications and any complications. It is also essential to determine any other diagnoses the individuals may have, as some illnesses further complicate their overall health outlook. Collecting the specific details of any diagnosis is integral; it is also essential to look at the entire picture. You should gather lifestyle details such as:

Exercise (type, time spent exercising, how often the activity is being done).
Diet (any details surrounding what the proposed insureds are doing to improve their situation).
Alcohol and tobacco usage.

Since the pandemic began, many people have become more focused on improving their health, given the positive link between optimal control of chronic illness and the immune system’s ability to overcome sickness. This should allow you to obtain details from clients more easily than ever. After all the pertinent facts have been gathered, reach out to your underwriter to discuss options for your clients.

Emily Bancroft, MS, ALMI, AIRC, ACS, ALU Certified Professional Underwriter, is senior underwriter, Crump Life Insurance Services. She may be contacted at [email protected].