ON THE RISK September 2024

The September 2024 Issue of ON THE RISK. This issue is fully hyperlinked and bookmarked for easy navigation.

OTR

JOURNAL OF THE ACADEMY OF LIFE UNDERWRITING

September 2024 Volume 40 Number 3 www.ontherisk.com

IN THIS ISSUE

www.alu-web.com

Six Planes Down: The Magnitude of Nicotine ’ s Impact on Mortality | 64 J. Fariss Underwriting Adult Survivors of Childhood Cancers | 56 J. Iacovino Future Trends in Predictive Modeling and Its Impact on Life Insurance Underwriting | 68 N. Kaushik ALU Survey Results | 42 L. Boucher, et al. And More ...

OTR is a benefit of membership in

www.ahou.org

and

www.ciu.ca

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ON THE RISK vol.40 n.3 (2024)

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EXECUTIVE AND BUSINESS OPERATIONS JOURNAL OF THE ACADEMY OF LIFE UNDERWRITING OTR INTERNATIONAL EDITORS Asia Editor Dr. Himanshu Bhatia GenRe Asia Mumbai, India himanshu.bhatia@genre.com

ASSOCIATE EDITORS Vera F. Dolan, FALU VFD Consulting, Inc. dolanvp@consultancy.com Lauren Garfield, PhD RGA Reinsurance lauren.garfield@rgare.com LIVING BENEFITS Nancy Atkins New York Life njatkins@newyorklife.com

EDITOR-IN-CHIEF Bonnie Stroder, Certified FALU RGA Reinsurance 16600 Swingley Ridge Road Chesterfield, MO 63017 Phone (636) 736-5859 bonnie.stroder@rgare.com EXECUTIVE EDITOR Anne Bunkers, Certified FALU Prudential 308 Prairie Way S. Bayport, MN 55003 Phone (763) 519-2415 anne.bunkers@prudential.com ADMINISTRATIVE EDITOR Michelle Privett, Certified FALU RGA Reinsurance 16600 Swingley Ridge Road michelle.privett@rgare.com ADVERTISING MANAGER Chris Cunningham Phone (614) 579-7641 OntheriskAds@gmail.com Chesterfield, MO 63017 Phone (636) 736-7198

Asia Editor Gary Miles, FALU AXA Hong Kong gary.miles@axa.com.hk

European Editor Hilary Henly, FCII RGA International Reinsurance Dublin, Ireland hhenly@rgare.com Latin America Editor Freddy Velasco-A., AALU John Hancock Miami, FL underwritingxprt@gmail.com

CONTRIBUTING EDITORS Rochelle Fernandes, FALU The Canada Life Assurance Company rochelle_fernandes@canadalife.com Jennifer Johnson, Certified FALU RGA Reinsurance jjohnson@rgare.com

Jena L. Kennedy, FLMI LexisNexis Risk Solutions jena.kennedy@lexisnexis.com Michael Wetzel, MD Equitable michael.wetzel@equitable.com

CONSULTANTS

MEDICAL Nico van Zyl, MD Hannover Life Re nico.vanzyl@hlramerica.com SOCIAL MEDIA Meg Gallagher RGA Reinsurance mgallagher@rgare.com Lynn Dreist, Certified FALU Lincoln Financial lynn.dreist@lfg.com

Jennifer Dalton Munich Re jdalton@munichre.com

ON THE RISK is the Journal of the Academy of Life Underwriting. It is published under the direction of the Board of Directors of the Academy of Life Underwriting (ALU) comprising representatives of the Association of Home Office Underwriters (AHOU), the Canadian Institute of Underwriters (CIU), the ALU and OTR . It is published quarterly and printed by The Marek Group, Inc., Milwaukee, WI. Permission to reproduce articles must be obtained from the Editor-in-Chief unless copy- right is clearly indicated to be held by an author and/or a third party.

Disclaimer ON THE RISK is a professional journal devoted to the continuing education of its readers and to the exchange of information and ideas that serve those profes- sionals. Opinions expressed within the correspondence and articles published in ON THE RISK do not represent official opinions of ON THE RISK . Such expressions only represent the views of authors or persons quoted. Publication of articles discussing products, services or methods offered by vendors does not represent endorsement by OTR . Such information is published only for its value as business knowledge.

ON THE RISK vol.40 n.3 (2024)

TABLE OF CONTENTS

TABLE OF CONTENTS The Underwriting Quiz ............................................................. FALU Club of RGA 8 Calendar of Coming Events....................................................................................10 OTR News - Twenty-Three Years Ago, William Phillips Reflected on the Advances Made in Underwriting; As We Celebrate 40 Years of ON THE RISK , We Take a Look Back at the Evolution of Covers Over the Past 40 Years; OTR Remembers - Henry “Hank” George; 2024-2025 Certified FALUs; 2024-2025 Certified Professional Underwriters . .............................................. 12 Local, Regional and International Associations News: Highlights of the 20 th Anniversary of the International Underwriting Study Group ......................................................................................................... R. Shabetai 30 Highlights of the 2024 AHOU Conference - Embrace the Underwriting Revolution - Continued................................................................... S. Clément 34 ALU Survey Results . ....................... L. Boucher, C. Martin, L. Wheeler, K. Amen 42 Highlights of the Twin Cities Association of Home Office Underwriters 2024 Spring Conference................................................... T. Sundstrom, A. Bunkers 50 Underwriting Adult Survivors of Childhood Cancers . ........................ J. Iacovino 56 The Future of Infectious Diseases: Q&A With Dr. Michael T. Osterholm by Dr. Daniel Zimmerman . .................................. D. Zimmerman, M. Osterholm 60 Six Planes Down: The Magnitude of Nicotine’s Impact on Mortality .............................................................................................................. J. Fariss 64 Future Trends in Predictive Modeling and Its Impact on Life Insurance Underwriting . .................................................................................. N. Kaushik 68 Are “Combo Debits” Necessary? The Case of Diabetes and Smoking ............................................................................................................. S. Rigatti 70 A Pinch of Accelerated Underwriting and a Dash of Simplified Issue: Could It Be the Perfect Recipe for Risk? . ................................ T. Pickett, M. Cusumano 74 Index to Advertisers ................................................................................................ 78

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Subscription Information: Members of the Association of Home Office Underwriters (AHOU) and the Canadian Institute of Underwriters (CIU) receive OTR as a benefit of membership. Direct subscriptions are also available. One-year subscription rate: Electronic only version (global rate) - $35.00; Back issues - North America: $15.00 if stock available; Outside North America: Use OTR Online archives. Subscribe by credit card at the website - www.on- therisk.com. Otherwise, please make all checks payable to ON THE RISK . Please send change of address forms and all subscription correspondence to: OTR Publishing Services, 218 Harmony Drive, Delaware, OH 43015; Email address: otr@ontherisk.com; Website: www.ontherisk.com. IMPORTANT: Under current copyright laws protecting OTR ’s digital rights, a subscription is a personal subscription for one person only and cannot be shared with others at your company. It is illegal to share the username and password or to post the downloaded e-version PDF on a company’s intranet or to email a copy to others as a means of avoiding the purchase of additional subscriptions.

ON THE RISK vol.40 n.3 (2024)

THE ACADEMY OF LIFE UNDERWRITING

EXAMINATION GROUPS

EXAMINATION GROUPS EXAMINATION 202 COORDINATOR Marcel Padilla, Certified FALU IA Financial Group

CURRICULUM GROUP Ken Turscak, FALU Advantage Insurance Network Angela Read, Certified FALU MassMutual Marcel Carriere, Certified FALU RBC CONTINUING EDUCATION CERTIFICATION

EXECUTIVE GROUP

PRESIDENT Ann Day, Certified FALU WoodmenLife PAST PRESIDENT Jodi McDonald, Certified FALU Hannover Life Re SECRETARY Catie Muccigrosso, Certified FALU RGA Re TREASURER Doreen Brynga, FALU MassMutual DIRECTOR OF EDUCATION Julia Wysong, Certified FALU New York Life

EXAMINATION 101 COORDINATOR Sabrina Porter, Certified FALU Swiss Re Hallie Anderson, Certified FALU Thrivent Financial

Vicki Rath, FALU MassMutual

DeAnn Crane, FALU Riversource Life Insurance

Roberta Scott, Certified FALU WoodmenLife

Michael Williams, Certified FALU USAA

Ryan Sharp, FALU National Life

Lynn Dreist, Certified FALU Lincoln Financial

Marie Washington, FALU Equitable

Kate Israel, Certified FALU Nationwide

Jennifer DiGiovanni, Certified FALU Munich Re

Russell Scott, FALU Munich Re

Joe Schlesser, Certified FALU Lion Street

Lori Boucher, FALU Scor

Renee McClintic, Certified FALU Hannover Life Re

Colleen Roser, Certified FALU Nationwide EXAMINATION 101b COORDINATOR Christine Klein, Certified FALU United Life Insurance EXAMINATION 201 COORDINATOR Andrea Lovelady, Certified FALU Penn Mutual

DIRECTOR OF EXAMS Michael Hill, Certified FALU RGA Re

Tanya Trachenko, Certified FALU Wawanesa

EXAMINATION 301 COORDINATOR Debbie Dias, Certified FALU Canada Life Re Maria Mairena, Certified FALU Optimum Re Michael Helms, Certified FALU RGA Re

Anne Geddes, Certified FALU Equitable

DIRECTOR OF CONTINUING EDUCATION CERTIFICATION Cheryl Johns, Certified FALU New York Life DIRECTOR OF CURRICULUM Norm Leblond, Certified FALU Swiss Re

FORUM GROUP

Sharon Garner, Certified FALU American National

Carolyn Goshorn, Certified FALU Securian

MARKETING GROUP

Jeff Schafer, Certified FALU Co-Operators Life

Angela Read, Certified FALU MassMutual Lisa Gutierrez, Certified FALU Nationwide Sara DeForge, Certified FALU Lincoln Financial Shelley Davis, Certified FALU Protective Life

Richard Camire, FALU Optimum Re

DIRECTOR OF FORUM Amy Rider, Certified FALU Sammons Financial Group

Sarah Allsup, FALU National Life

Steven Miller, Certified FALU Partner Re

Lianne Heppenstrijdt, FALU Sun Life

DIRECTOR OF MARKETING Angie Reedy, Certified FALU COUNTRY Financial DIRECTOR OF SURVEY Kristine Amen, Certified FALU Assurity WEBSITE DIRECTOR Andrew Langemeier, FALU John Hancock MEDICAL CONSULTANTS Maryam Shapland, MD RGA Re

Taryn Maurer, FALU Sammons Financial Group

Sevi Prohasca, FALU Sun Life Matt Williams, FALU Nationwide

Kelly Monroe, Certified FALU MassMutual

EDUCATION GROUP

Suzanne Grover, FALU MassMutual Carla Martin, FALU ExamOne SURVEY GROUP Laura Wheeler, FALU Transamerica

Ryan Hedges, Certified FALU American National Insurance

Justin Barry, Certified FALU Lincoln Financial

David Marshall, FALU New York Life

Tammy Kinnes, Certified FALU RGA Re

WEBSITE GROUP

Michael Wetzel, MD Equitable

Joe Curtin, Certified FALU Gen Re

Kentish Apadoo, Certified FALU RBC Jacob Kercheval, Certified FALU COUNTRY Financial Jennifer Johnson, Certified FALU RGA Re

ON THE RISK vol.40 n.3 (2024)

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ON THE RISK vol.40 n.3 (2024) Orlando, Florida 32801, USA susan.mayer@hlramerica.com www.hannover-re.com Member of the Hannover Re Group

THE UNDERWRITING QUIZ

FALU Club of RGA

Executive Summary ON THE RISK is known for its scholarly articles on insurance topics. In keeping with this, the FALU Club of RGA offers a fun and challenging addition to OTR in the form of the underwriting quiz. This regular feature is meant to challenge the underwriting knowledge of you, the reader, encourage ALU class enrollment and promote ongoing professional education in general. If you would like to submit quiz ques- tions of your own, or if you have any comments, suggestions or questions, please contact the FALU Club of RGA at RGAFALUClub@rgare.com. We look forward to hearing from you. So now we invite you to test your wits on this quiz. Are you smarter than a FALU?

1. The greatest cause of death in rheumatoid arthritis patients is: a) Infection b) Cardiovascular disease c) Renal disease d) Pulmonary disease 2. All of the following are part of the clinical diagnosis of congestive heart failure EXCEPT: a) Lung congestion b) Edema c) Liver enlargement d) LVH 3. Functions of the liver include all of the following EXCEPT: a) Storing iron b) Destroying damaged white blood cells c) Removing toxins d) Synthesizing cholesterol 4. Which laboratory test is commonly elevated with a normal pregnancy?

a) Globulin b) Glucose c) Alkaline phosphatase d) Serum creatinine

5. The syndrome characterized by polyps predomi - nantly found in the small intestine is: a) Garner’s syndrome b) Peutz-Jeghers syndrome c) Juvenile polyposis d) Crohn’s disease

Answers on page 77

The Academy of Life Underwriting will offer four ALU examinations on April 15, 2025: ALU 101 ALU 201 ALU 202 ALU 301

The registration period for all ALU examinations opens September 1, 2024. Exam registrations are accepted through March 1, 2025; registration forms received February 1 – March 1, 2025, require payment of a late registration fee in addition to the regular exam fee.

ON THE RISK vol.40 n.3 (2024)

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ON THE RISK vol.40 n.3 (2024)

OTR CALENDAR OF COMING EVENTS September 25-27 ACLI (American Council of Life Insurers) Annual Conference in Chicago, IL. For more information visit www.acli.com. February 23-26 ReFocus Conference at the Fontainebleau Las Vegas, Las Vegas, NV. For more information visit www.soa.org. 2024 2025

September 28 - October 1 AAIM (American Acad- emy of Insurance Medicine) 132 nd Annual Meeting at the Fairmont The Queen Elizabeth Hotel, Montreal, QC. For more information visit www.aaimedicine.org. October 2-4 TWUC (Texas-Wide Underwriting Conference) in Waco, TX. For more informa - tion visit www.twuc.org. October 7-9 IDIS (International DI Society) 20 th Annual Conference in Nashville, TN. For more information visit www.internationaldi- society.org. October 8 ALU Webinar on “Behavioral Econom - ics: Tips & Tools for Underwriting Effective - ness & Beyond” with Heidi Alpren. For more information visit www.alu-web.com. October 17-18 NEHOUA (Northeast Home Of - fice Underwriters Association) 40 th Annual Conference at the Sheraton Portsmouth Har - borside Hotel, Portsmouth, NH. For more information visit www.nehoua.org.

April 15 ALU Annual Examination . For more information visit www.alu-web.com. May 4-7 AHOU 24 th Annual Conference in Anaheim, CA. For more information visit www.ahou.org.

Regional, national and international underwriting association meetings and non-profit educational events of direct interest to underwriters can be promoted in OTR ’s Calendar of Coming Events and at the ALU website - www.alu-web.com. Notify OTR of your meeting details by email to otr@ontherisk.com.

ON THE RISK vol.40 n.3 (2024)

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ON THE RISK vol.40 n.3 (2024)

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OTR NEWS: TWENTY-THREE YEARS AGO, WILLIAM PHILLIPS REFLECTED ON THE ADVANCES MADE IN UNDERWRITING AND LOOKED AT HOW IT MAY LOOK IN THE FUTURE. ENJOY THIS REPRINT FROM THE 2001 ISSUE OF ON THE RISK .

2001: Space for Underwriters? William K. Phillips, AALU Vice-President, Life of Virginia

“I have looked into the future - and it’s expensive.” I recently saw the above item as a “daily chuckle” in the local newspaper. Based on my current observations, it may be the only safe predic- tion that anyone could make about the future. Considering the future of un- derwriting is an equally dif-

has declined over the past 25 years, the remaining professional underwriters see larger, more compli- cated cases, and face greater challenges in the mar- keting and communications areas than ever before. The underwriter of the future, to be a true profes- sional and survive, must be well educated, marketing- oriented and possess high communication skills. I have worked closely with the underwriting edu - cation program for the past 8 years. Increasingly, underwriters are beginning to realize the necessity of professional training. Perhaps this is a survival instinct. For instance, the program sponsored by the Academy of Life Underwriting should be a must for the professional underwriter. I also recognize the merits of the LOMA and CLU programs. Continuing education should be an objective. States are beginning to pass regulations requiring insurance agents to pur- sue continuing education. Changing developments in medicine and mortality patterns make continuing education a must for the professional home office underwriter. The attainment of the AALU designation or even the FALU designation is no longer an end but merely a beginning. As the number of FALUs grows, recognition of the FALU designation will also increase. One barometer to watch is the help-wanted ads. Increasingly, they are mentioning the Academy of Life Underwriting program. While computers have not replaced the underwriter, their application has certainly impacted underwrit- ing. Underwriters without keyboard skills will be severely limited in the future. Just as agency offices use the computer to interact with the home office computer, the underwriter of the future will also need to be proficient in inputting, reading and interpret - ing information. Obtaining medical data from local data banks, using electronic mail to correspond with agency offices, and corresponding with insurance service organizations are but some examples.

ficult task. Even if you have been in the underwriting profession for only a few years, you have seen many significant and startling changes. I have probably been a professional underwriter longer than most of you reading this article. I remember when inspec - tion reports were ordered on nearly all cases, when nonmedical limits were $10,000 to $20,000, when replacement was a universally nasty word, when soft drinks all came in bottles, when the Raiders were in Oakland, and nobody had heard of Universal Life. Is it hazardous to predict the future considering the current climate? I do have some strong opinions about the future of our profession and the insurance business in general. In accepting the challenge of writing an article about the future of underwriting, I have committed myself to sharing some of my own beliefs. First, I believe the underwriters will survive. Twenty- five years ago, when computers began to be popular topics, some companies switched to and began dis- cussing computer underwriting. Although this may still have some limited applications, the actual un- derwriting process has survived intact. No computer has yet been designed that can give the “smell test” to an application. Today we see an increased use of “jet underwriters.” Although the number of professional underwriters

ON THE RISK vol.40 n.3 (2024)

Changes in medical treatment and diagnostic pro- cedures will call for increased knowledge by the professional underwriter. Increasingly, noninvasive diagnostic tests such as ultrasound studies, nuclear magnetic resonance imaging and blood tests will be used. As diagnostic tests become more precise, the underwriter will be called on to make more defini - tive mortality determinations and placements. Price competition in the marketplace will dictate narrower mortality bands and more specific risk appraisal techniques. I doubt that the barium enema will ever become a standard diagnostic tool, but increased use will be made of blood tests, noninvasive heart and body organ tests, and biological age. Thallium stress tests will become frequent as large cases increase. Marketing and communication skills are closely related. The professional underwriter must be able to communicate with his agency force. This means increased knowledge on his part regarding pension plans, tax considerations, sophisticated financial packages, estate planning, and the usual tasks of explaining ratings and justifying requirements. Many companies are switching responsibility for the underwriting department to the marketing officer. This trend will continue as companies “search for excellence” through more responsive organizational structures. Many jokes have been made in the past about actuar - ies and their inability to communicate. We have seen this image changing. The underwriter, to survive, must be able to communicate with his/her peers and with the agency force.

The role of the female underwriter will continue to increase. She is, in my opinion, ahead of her male counterpart in the pursuit of education. She recog- nized early that education is one of the keys to future promotion and responsibility. The increasing trend to female agents also increases the need for the female professional underwriter. If the men don’t get on the ball, the females will pass them by and be heads of underwriting shops in the majority of companies. (Please don’t interpret this statement to indicate any- thing would be wrong with having women take over ... maybe it’s about time.) In short, the professional underwriter is alive, well and shows a standard mortality for the future. Chang- es will be required, however, as we approach the 21 st century. We must become proactively knowledge- able, adaptable and innovative in our job. Productivity must be increased and more attention given to cost factors. Gone are the days when we can merely look up a rating in “the book” and justify an assessment. We need to know if that assessment is still logical and what current developments may have modified the “book” solution. Mortality will continue to be an important factor in life insurance. For some years, the professional underwriter has been riding the crest of generally improving mortality and high interest rates. As these factors level off, risk selection will become more important. The properly prepared professional un- derwriter will continue to be an indispensable part of the equation.

ON THE RISK vol.40 n.3 (2024)

AS WE CELEBRATE 40 YEARS OF ON THE RISK , WE TAKE A LOOK BACK AT THE EVOLUTION OF COVERS OVER THE PAST 40 YEARS

Just as the content of ON THE RISK has changed, so have the covers. While the covers started in a basic format to present the Table of Contents, we now showcase vibrant covers to draw the reader ’ s

attention, with an article being highlighted through the cover choice. In this issue we have included one cover from each decade since ON THE RISK was first started.

ON THE RISK 1984, Volume 1, Issue 1.

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ON THE RISK 1994, Volume 10, Issue 2.

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ON THE RISK 2004, Volume 20, Issue 1.

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ON THE RISK 2014, Volume 30 Issue 1.

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ON THE RISK 2024, Volume 40 Issue 1.

ON THE RISK vol.40 n.3 (2024)

IF YOU GO THROUGH PEN CAPS OUICKER THAN PENS

We know what it’s like to feel FOMA, or Fear Of Missing Anything. That’s why we invented Irix ® Risk Score , so you can use the power of predictive modeling to find risks—and opportunities—that aren’t visible to the naked eye.

ON THE RISK vol.40 n.3 (2024)

OTR REMEMBERS - HENRY “ HANK ” GEORGE

Henry “ Hank ” George

ON THE RISK mourns the loss of insurance pioneer Hank George, who passed away on Jan. 10, 2024. Not only was Hank known for his great contributions to the insurance industry, Hank founded the journal of underwriting ON THE RISK in 1984. Hank is also well known in the insurance industry as editor of “Hot Notes,” which he started in 2000, as well as Founder of the International Underwriting Congress conference series in 1997. Hank published more than 550 research articles and papers, ad -

dressed the Million Dollar Round Table from the main stage on two occasions, and authored two books: Getting It Issued and Underwriting: What Every Producer Must Know . Hank was also the recipient of the Academy of Life Underwriting Outstanding Achievement Award and was inducted into the AHOU Hall of Fame. As we celebrate 40 years of ON THE RISK , we take time to remember Hank and all he brought to the industry.

JOURNAL OF THE ACADEMY OF LIFE UNDERWRITING OTR

Have you ever considered writing an article for OTR ? Do you need something extra for your Performance Review? Need to add to your Resume being published in a professional journal? Sharing your exper - tise and knowledge can help elevate your visibility in your profession. OTR is looking for narrowly focused articles of 1000 words or articles with a broader focus up to 2500 words. Do you have an interest in Financial Underwriting, Technology, Avocations or Living Benefits? We are currently looking for editors who would be willing to commit to these and other topics. Visit www.ontherisk.com to review a copy of the Author Guidelines or con - tact an Editor today.

ON THE RISK vol.40 n.3 (2024)

2024-2025 Certified FALU ALU, AHOU, and the CIU are pleased to present the following 331 underwriters as Certified FALUs. Congratulations to all!

Ellen A. Abbey Gretchen Ahrens Kevin Alameddine Kristine A Amen Jillian M Anderson Hallie A. L. Anderson Kentish Appadoo Corinna R Athey Michael G. Augustine Kara Bach Mary K. Badgley Paul Baker Justin H Barry Yulia Batyrbaeva Timothy J Beauchamp Genevieve Bedard Pamela L. Bergsten Kevin Bettis Alison Ruth Bielak Joy-Ann Blackman Kristin Blake Dawn A Blanchard Ann Bledsoe Shelley M Bohle Andrea L. Brauer James Bredbeck Vanda Marie Brinson Denise M Brossett Trevor Brown Erika Butler Brown Daniel A. Buchholz Julie A. Buda Dian Budiani Meagan Bunce Anne M. Bunkers Lisa Burger Melissa S Butcher Natalie S. Bynum Suzanne Marie Calder

Stephanie Anne Carter Oneyda Santacruz Casanova Amy Ceccarelli

Ingrid Dsilva Jacqueline Duhachek Nicole Duncan Matthew Duncan Lauren M Dwire Jean Everhart Russell D Farmer Lindsey Farnick Shabihe Fatima Trina Fitch Sean Flanagan Leslie Fleming Silvio A. Foerster Andrew Paul Fortin Rita Freda Noemi F. Fuentebella Brad J. Gabel Melissa Gallegos Bess Ganeff Sharon Garner Anne Geddes Sylvia Gervais Colleen Godenir-Geysen Kelley Gieryn Mary Gillespie Matthew Gorman Carolyn Ann Goshorn Pamela Granger Cynthia Grauel Kimberley A Gray Paula Green Suzanne Michelle Green Elizabeth Greenwell Lisa M Gutierrez Martha Ham Michael Hames Heather M. Hanecak Mary K Hanson Nikola Cheri Hanson Jonathan Harmon Cam Harper

Meghan Hayes Ryan Hedges Michael Edward Helms Katy Herzog Matthew Todd Hieber Mary Hildahl Michael R. Hill Eric Hoerr Terri L. Huber Rebecca N Hui Jolene Huntoon Dana Hupp Andrea L Hutchison Emily Rose Hutchison Katrina Imsland

Kris Chaney Linda Clark Julia Claudio

Sophie Clement Michael D. Clift Heather A Cobb Emily Cohen April M. Conklin Brenda K Cook Andrew Coots Scott Corbett

Laurie Corrigan Constance Costa Rita Coward Lisa Cox Kerry L. Cox Phillip Cox Kimberly A. Cox-Fisher Elizabeth Cramer Rebecca L Creque Stuart Crichton Joe Curtin Jennifer Dahl Donna Daniells Tracie M. Davis Cindy Davis Traci Davis Shelley Davis Ann B Day Sara DeForge Katherine Desjarlais Debbie Dias Rick Dietze Jennifer D Digiovanni Mark S Dion Brittany Donohue Rebecca Fox Dorans Lynn Dreist

Suzanne Isaac Michael Issler Shawn James Mark James Karen Janssen Cameron Jennings

Michelle Jimmy Cheryl L Johns Marsha Cathline Johnson Kristof Johnson Jennifer Johnson Blake A. Johnson Sarah Johnston Cheryl Joyce Alban P Kaculi Saron Kainth Tripti Abhaykumar Kanchan Misty Keels Jacob T. Kercheval

Kyle Kilman Eileen King Tammy L. Kinnes Sharon L. Klein Christine A. Klein Debra Kleinschmidt Kari Klozenburcher

Greg Carcione Marcel Carrière

February 2024

ON THE RISK vol.40 n.3 (2024)

RGA’s digital underwriting system highlights our commitment to continuous innovation. By integrating the latest technologies and refining core processes, we help our clients thrive in the competitive insurance landscape. Here’s how: • Applications, case data and documents requiring full underwriting enter the workbench through a flexible front-end. • Configurable workflows quickly route cases for next actions from underwriter first look through final decision. • Integrated connectivity to numerous evidence providers facilitates seamless ordering and receipt of requirements. • Real-time status updates ensure clients always know where RGA is in the underwriting of a case. • One-click APS ordering and reflex to summarization through integration with DigitalOwl greatly increases efficiency while accelerating speed to decision. RGA’s underwriting workbench powered by partner Agenium serves as the hub of our digital ecosystem.

Learn how RGA, our digital ecosystem, and our people can help you streamline evidence ordering, expedite reviews, and delight your customers. Visit www.rgare.com/underwriting to learn more about our unique underwriting expertise and contact us at cmsteam@rgare.com to discuss your unique path to underwriting transformation.

ON THE RISK vol.40 n.3 (2024)

Gina M Klucas Renee Kok Rena Konaka

Jason J Memmott Michael Merriman Donna Michele

Angela Reedy Christopher Regione Joy Ricks Amy Rider Matthew E. Robinson John D Robinson Peter James Rogers Dean Rolson Colleen M. Roser Raphaël Roy-Brunelle Marissa Alana Rudal Melanie Russell

Danielle Storts Kenzie Story Bonnie Stroder Qiaoling (Jocelyn) Sun William M. Swarner Susan Swenson Rachel S Swigert Wendy Taylor Jennifer Lynn Thompson William M. Tilford Jenny Tischer Marcello (March) Toniolo Tanya Trachenko Martha Rock Trevillian Laura Trout Debra K. Umbarger-Allred Pamela Jane VeDepo Freddy Velasco Andrew Vigar Michaela Voor Vart Jacqueline Grace Waas Lisa M Wagganer Sarah Wagner Deborah S Walker

Dawn M. Koranda Shannon K Kratzke Mirsad Kulovic Christina Kutarna Carol A Lamm Paige Landgrebe Cynthia Landry Michael Learned Norm Leblond Tonia J. Lee Giffin Leiting Jennifer Lynn Letcher Julie Faye Lewis Shiva E. Outten Joanne Lombardi Brigitte Elizabeth Loos Mark Lounds Andrea L Lovelady Lori Lown Jeffrey L. Ludwig Michele Luke Brett W Lyddon Erika Maines Maria Mairena Kevin B. Mann Lana Markov Kovacev

Anna Miclash Melissa Mike Nicholas M. Milinovich Sarah Ann Miller Cindy Mitchell Jasmine Moffett Aaron Shamir Mohammed Kelly Leane Monroe Becky Moore

Roslyn A. Moritz Catie Muccigrosso Sara Muzzatti Melissa Myers Emily Nanneman

Alison Salim Naila Salman

Helena E Sammis John M Schaefer Jeffery Schafer

Jessica Nelson William J. Ness Mfumu Michel Ngamba

Kama S. Schilson Joseph J Schlesser Shoko K. Schottenbauer

Sandra Nichols Laura Nickels

Michel Scott Susan R Scott

Sophie Julie Noel Jennifer L. Nowak Dave O'Donoghue Dan Olden Lori A Olski Kelsey Paszek Shannon M. Peddell Edmund R. Peña Angela Perry Audrey Peynado Ashleigh Lorraine Pierson Victoria Lee Poncelet Sandra Regina Prado Clara Michelle Privett Andre Proulx Jennifer Rancourt Angela A. Read Debra Reed Sabrina Porter Mary Poynter

Roberta P. Scott Elizabeth Seelig Rebecca Severson Avani Shah Michelle Sharp Melinda G. Shaw Victoria Sheehan John Sherman Cynthia Shirley Scott Sibley Kori Sinnwell Carrie Rene' Smith Erin L Snow Cody J. Socher Michelle S Spevak Steve Stanley Kim Steinhausen Richard K. Stevens Jodie M. Stohlman Kelly Stone

Amy Wang Matt Ward Karen Waters Lisa Ann Weaver Viki M Wells Katie Westphal Teri Marie Whiteley Michael L Williams

Scott Marquis Robert Martin Jane Mattson Barbara Maus Cheang May Keng (Veronica)

Zera Williams Linda Wislesky Torrent M Woodard Julia Wysong Fanny Xu Sherry Yang Sally Yee Vicki Rhonda Zandbergen Spencer Zindel

Douglas McCausland Renee M. McClintic Leigh McCrea Joyce McCready Jodi McDonald Laurie McFadden Jason McKeever Jonathan R. Meindel

ON THE RISK vol.40 n.3 (2024)

February 2024

Transforming Medical Data Into Powerful Insights At Scale The Synodex platform offers smart innovation and complex problem solving by deploying advanced machine learning technologies and distributed workflows.

DEPENDABILITY

Our clients depend on medical information to make critical business decisions. Synodex helps organizations identify risk, save time, and make more accurate decisions.

Extensive QA Audit Process •Independent QA Audit team •Defined auditing process •Automated error detection •Staffed by qualified MDs •Corrective feedback to staff •Training and continuous learning •Interactive client feedback Custom & In-Depth Reporting •Customized daily, weekly, or monthly •Reconciliation reports •Data analytics •Readable PDF summaries •Customized data-formats •Regular client meetings and reviews Unparalleled Security •HIPAA, ISO 27001, SOC 1 compliant •Type 2, SSAE 18 compliant

Turning Medical Records Into Relevant Data The team at Synodex is all about working with people. We believe in building lasting relationships with a strong commitment to excellence and dependability. We are part of Innodata, a world leader in data extraction, transformation, and analysis, including data engineering, AI, and solutions for the new digital workplace. Since 2011, Synodex has turned structured and unstructured medical records into relevant data and well-organized summaries. Our team takes great pride in delivering a cost effective, accurate and timely service. We believe in clear communication with customers, paying close attention to details and working to deliver flexible solutions that meet your needs. In 2023, Synodex will be introducing it's new Synthesis Platform, integrating EHR records together with APS documentation in a single workflow .

•Meets progressive 2FA security standards •256 AES encryption (at rest and in motion) •Sungard SOC 2 Type 2 compliance •Medical records securely stored & processed from Sungard data centers in the U.S.

INSURANCE UNDERWRITING •Underwriting manual integration •Medically trained analysts •Page by page data-reviews •Chronologies in a readable, narrative format •Definitive decline rules •Independent data audit team • EHR Workflow Integration •Companion XML, HL7, FHIR & JSON formats •PDF readable report format with hyperlinks to source APS

“

We have confidence in Synodex’s ability to deliver high-quality, consistent data that accurately depicts even the most complex medical cases. We have confidence in Synodex as a key component in the underwriting process. - Chief Underwriter, Life Insurance Carrier

Allan Knudsen • VP Client Relations aknudsen@synodex.com • (201) 371-8096

ON THE RISK vol.40 n.3 (2024)

An Innodata Company

2024 - 2025 Certified Professional Underwriters ALU, AHOU, and the CIU are pleased to present the following 427 underwriters as Certified Professional Underwriters. Congratulations to all!

Jessica G Abernethy Genevieve Adam-Burns Marie-Claude Alarie Ingabyrth Alexander Jessica Alford Lindsey M. Allegretti Matthew Allred Nicholas Amato Daniel Ammirati Misty Andon Alessandra Araneda Jenny Araujo Maria Nina Argallon Debra Arsenault Renee Azzalina Krista R Bainbridge Jenny Balakian Allison Ball Jackelyn P. Ballena Allison Beckett Paige Beettam Jackie Bell Devy L. Bell September S Belt Meghan M. Benesch Alayna Benne Maegan Bennett Darek Beverly Savanajh M. Black James S Blancato Michael R Bonavita Kimberly Borquist Raluca Bouchard Colleen Bourgeois Teri D Bowman Terry Box Adair Briggs Tamarah Britton Meghan Brodeur Dawn Brown Carrie Bauer Kendra Beale

Breann Kathleen Brown Jonathon Buehler Rosemarie Bullin Haley Burdett Laura Butler Wendy Calkins Alatorre Brenda Campbell Jennifer Campbell-Smith Ubaldo Campos Felisha Capron Jessica Caracofe Hubert Cartier J.M. Nicole Cast Andrew Castaneda Yan Chao Elizabeth Chapman Jobin Cheriyan Choo Kah Yee Angel Clark Tina DeBartolo Clark Amy Cocchiarella Kerri Colclasure Kenneth L. Coles Annie Collin Michelle Collins Luis A. Colon Brooke Countryman Mylisa Cowin Kyle Cravey Joanne Chartrand Shikira Chavers Jose Emmanuel Chedid Mercado Angela Curtis Eve, Yan Dai Preeti Dalawari, MD, MSPH Michelle Danay Iyana Davis Emily de Witt Colin M. DeForge Isabelle Delisle Timothy Demeter Gail A Denton Tracy Critchley Ben Crosby, Jr Gilda Cuddemi Toni Curtis

Lisa Derby Kayla Dowd-Davis Debra Lynn Drayton David Dreist Cynthia DuBois Taplin

Justen Grant Karen Grauel Alison Graves Sartore Jennifer Greenly Dawn Griffin Christina Gross Timothy Grunzel Lisa Gully Gina Haakenson Adria Halstead-Johnson Kenneth Allen Harrell Steven Hartis Emilian Hartmann Heather Haslam Eliza Hale Paige Hall Karissa A. Hayden John Edward Hays Andrea Heath Amber Heesaker Karl Heideman Melissa Heighway Christina Henderson Stephen N Hendricks Morgan Hendrickson Dalin Heng Pamela Hennigar Daisy Hernandez Katia Hernandez Fuentes Toni L Hoffman Kelly A. Horvath Jason Houser Maurice Howard Stephanie Hrisko, MD Andrew Hryniewicz Mark Hughes Stephanie Hughes Robert Huntington III Kate Elizabeth Israel Robin Jackson Angie Jacobs Shamir Jamal Shannon M James Jade Hibaya Liz Hickman Erica Hind

Amy Duerer Amy Duffy France Duguay

Chris Dwyer Meshun Eady Rachel Eberle Ashley Ellis Amanda Ernst Amy Margaret Evans Amy Evans Jennifer Fallon Antonio DeCarlo Farrington

Dennis Farronato Heather Ferguson Rebecca Fidanza Jacenette Fields Michele Flagel

Emily Bancroft Dennis Banda Ricardo Alberto Barajas Fuentes Jessie Barriault

Matt Flamm Brett Flender Jerome J Floerke, Jr Kelly Flyte Sherry Foley Alicia France Hernandez Yan Francoeur Brian Frascarelli Ashley Fredrick Kelly G. Tuzon Tonya Fritz Camille Fugère-MacLeod Meredith Galentine Vicki L. Garrett Marilou Gatchalian Erika George Alexus N. Gibson Nicholas Glaser Francine Godin Courtney Lynne Goldwasser

Sherie J. Gomas Dannette Gomez Jennifer Goncalves Joseph Gorski

February 2024

ON THE RISK vol.40 n.3 (2024)

Barbara Janowski Shelley Johns Robert E. Johns II Brad Johnson Jocelyn Johnson Kezia Johnson Sara C. Johnson Andrea Johnstone Greg Jones Michelle Jones Carolyn Jost Michelle Joubert Michael Cal Karason Kent Karnick Kade Kawaya Damarion Kellett Alana M Kelly Dana Kendrick Kristie Kinch Dr Khatchik Kinoyan

Samantha Marotta Justine Marschall Rebecca Martin Rachel Martz Nicole Maryn Brittany Maubach Cortney Mayo

Seth Lartey Peterson Michele Kolbasko Stephanie Pheasant Kyle Phillips Eddie Pires Lisa Pomeoy Shauna M. Porter Stephanie Michelle Pottle Samantha Precourt Kareem Presocd Caroline Prieur Justin Prokopick Mark Pursel Agatha Radziwillowicz

Susan Stajan Kyle Stevan Steadham Susan S. Stegman, MD, DBIM Baileigh R Stewart Dennis D Stewart Loren Scofield Jennifer K. Stiles Clark Stimon Carla Stowe Karen Strelitzer Katie Susler Dr. Sokcheata Tang Kiera H. Taylor Panda L. Taylor Jennifer L. Teufel Shaun Thomas Mary F Thomas Lauren Thorne Wayne Thorpe Joy Tolley Cathy J. Tracy Nancy A. Tunender Chrissy Turpin Derek Valant Maria Vattimo LuAnne M. Veino Paula K. Verschoore Heather Vest Dr. Viech Vanndeth Tina Villarente Jessica Vitale Rajesh Wadhwa MD Michael Anthony Wahl Tracey Wallace Tara Walter Nathaniel Wasserman Joseph Whaling Emily Wilhoite Cheryl Williams Abby Williams Maria Williams Kelsey Nicole Justine Wilt Emily Wood Lori Woods Christopher Woolfolk Jr Olivia Wright Gloria Webber Marisa Weber Page Weddle John Weiss Monique D. Wells

Mandy McBride Dylan McDonald Natalie Marie McGibney Patrick McKinnon Angela McMorrow Robert McNamara Monique McVicar Abhishek Mehetre Philip Meier Isamal Mejias Franceschi Lisa McLeod Bill McMillen

Dilrukshi Rajaguru Nicholas Rakonick

Susan A Rape Kiara Rhines Kelly Ridley

Julie Melendez August Melton Gaea M. Meola Vanessa Metzger Laurie Meunier Wendy M. Meyer Steven Miller Jillian Mills Molly Milner

Becky A. Riehm Alessandra Rios Katie Ripple Tiffany R Roberts

Amy Kirkpatrick Celeste Kjeldsen Danielle Klos LeShann Aretha Knight Michelle Konsky Dr. Santosh Kumar Korivi

Joanna Robitaille, RN Lynn Chartrand Rogers Darell L. Rogers Tracy Rood Kimberly C. Rose Rebecca Ross

Jennifer L Kosch Ruth Ann Koziol Andrew J Kramer Karen J. Kraus

Barbara L. Miskowic Andrietta Mohammed Margarita Montes Ana Montuenga Brittany Morehouse Sonya D Moreno Chen Mu Adrienne Muhammad Shannon Murphy Bradley M Murray Mumbi Musonda Kaung Myat Thu Matthew E Mylroie Donna Nimeskern Sandy O'Callaghan Linda O'Grady Kevin M. O'Hanlon Danielle Orrey Brittany L. Ort Rachel Ortega Rhonda O'Shields Gillian Ottemiller

Carmen A. Ross Lee-Anne Ryan Biswaranjan Sabat Jennifer Sadler Oneeza Fareen Salavani Mirna George Fayek Samaan Jay Sankoff Ivana Santullo Sheila A Saperstein Jack Schlote Mandy Schmuland Lisa Schnarr Kirsten Schramm Anna Schulte Deborah Schwartz Jessica Scott Philippe Sergerie Ankish Shah Madison Mae Shoemaker Tabitha L. Siebrass Jill Siedschlag Ranu Singh

Catherine Labine Adam Lackovic Debbie Lafin Roxanna Laird Andrew Lalonde-Welby Tiffany Lamont Annie Landry

Stefanie Lantink Julie Lapostolle Allyson Lassen Stephanie LaVere Cathy Law Vilma L. Lawrence

Megan Leivant Ross Lennertz Jill Levi

Lori A. Lindsay Emily Lisewski Melissa Ljujic Jennifer Lockwood Karen Louden Shea Loutzenheiser Keren E Louv Erica A. Loveland Gregory Richard Lupinacci Sara A Lydic

Jasmine Pang Kelly Paradis Susie Park Joe Patella

Michael Skipper Andrew Skrobis Shannon Smith Carolyn Smith

Jeanine Wrightson Faye-Rae Yanofsky Quinn Yesker Erika M. Young Mandy Yuen Stephanie Zavadil Dionne Zerff-Lechner Andrew Zimmerman Barbara S Zoghbi

Tangla L. Pavlick Jennifer Pelletier Bill Pelowski Dorothy Penney Bambi Pennycuff Chantal Perry Wanda Peterson

Haley Snell Eric Sobish Stephanie Sopher Rowan Sousa Jen Sproat-Reinhardt Alenna Stacks

Kelly MacDade Lori M Maczka Brigitte Mallozzi Jessica Margetan Tammy Marlotte

ON THE RISK vol.40 n.3 (2024)

February 2024

LOCAL, REGIONAL AND INTERNATIONAL ASSOCIATIONS NEWS: HIGHLIGHTS OF THE 20TH ANNIVERSARY OF THE INTERNATIONAL UNDERWRITING STUDY GROUP

Rafael R. Shabetai International Life Chief Underwriter Manhattan-Trust Intl. Insurer New Orleans, LA rafaelshabetai@manhattan-trust.com

While attending the second AHOU Conference in San Francisco in 2003, a small group of underwrit - ers doing business in international markets, mainly Central and South America, got together over dinner thinking of the possibility of forming a formal group to exchange information and trends. Under the lead of the author, the International Un - derwriting Study Group was founded in 2004 with the blessings of the AHOU, which provided a meet - ing room at the hotel the morning before the official opening of the conference. The late Hank George and the late John Krinik were the ones who inspired me to create the group. They and Paul Howman, President of AHOU at the time, were very supportive. The group was formally inaugurated at the 2004 AHOU on October 3, 2004, in Chicago, IL, and the first meeting took place. The initial members were: • Dr. Carlos Martínez , Chief Underwriter of Na - tional Western Life • Freddy Velasco , Senior Underwriter at American Bankers Life • Bob Cicchi , AUL • Chantal Vollbracht and Tom Bienvenu of ExamOne • Steve Anderson and Jeanette Hernández of American Fidelity Most of them moved on to other positions or compa - nies and others retired.

Executive Summary The IUSG recently held its 20 th Anniversary Meeting. What started as a small group of underwriters specializing in Latin American markets grew over the years. Experi- enced underwriters presented several topics of interest, as they have been doing for 2 decades. Challenges and opportunities were discussed at a high level. 2025 authorities were elected as well. Who would have thought that such a small group was going to grow over the years and become much stronger, with up to 35 Senior and Chief Underwriters attending pre-pandemic meetings. Like for anyone else, COVID-19 was only a “ralentis - seur.” At the Denver Conference in 2022, we came back, and by the time of the 20 th anniversary in Boston, we had already regained a large part of our recurrent members and core group. At the milestones of 5, 10, 15 and 20 years, we cel - ebrated with a special anniversary cake that was graciously provided by some of the sponsors. And for the previous years, we also featured a musical enter- tainment with local Latin American groups during an extended coffee break. The discussions were always very informative and educational, not only for the regular attendees, but also for those who were only able to attend one or two meetings. The meetings were always governed by the Anti-Trust regulations, very similar to the ones of the AHOU. Speaking of sponsors, we were very grateful to have ExamOne, International Underwriting Solutions,

ON THE RISK vol.40 n.3 (2024)

MIB, Scor Re and Hannover Re providing a buffet breakfast and coffee breaks, as well as anniver - sary cakes and musical intermissions for the special milestones. They added a very special touch to our meetings. The 2024 20 th Anniversary Meeting was held in connection with the AHOU Annual Conference in Boston, MA. It was attended by Senior and Chief Un - derwriters, not only from the US, but from Australia, Panama, Spain, Bermuda and Mexico. Jorge Hernández of American Fidelity was the Chair of the 2024 Meeting. The topics for discussion were previously suggested by the members and then dis- cussed during the meeting. Among the most relevant, the issue of still using a COVID questionnaire attached to the applications for insurance, electronic or otherwise. The consensus was that only a question related to having been hospital- ized in the past was important to keep. There was another issue that was seen by only a few companies, where Russian nationals were purchas- ing insurance in Argentina. A couple of years ago, the Argentine police carried out raids as part of an investigation into a “million-dollar illicit network” that provided pregnant Russian women and their partners fake documents, issued in record time, to al- low them to settle in Argentina. Some of those women and their partners tried to obtain life insurance with US carriers as Foreign Nationals. On the Financial side, the accuracy of tax returns and financial statements from Latin American clients was also discussed. Many times, these documents are not truly reflecting the real financial position of the proposed insureds. Many of them have much higher wealth than they declare. That is why Inspection Reports by companies on the ground or operating in the region can provide a better understanding of the reality, when the face amounts warrant the confiden - tial third-party verification. The group also discussed the challenges of obtain- ing medical records in the Latin American markets,

something that has not improved over the years. Lack of digitalization in doctors’ offices is still requiring the insurance agent to visit the physician with a form to be completed or a PDF form to be sent to the at - tending doctor to be completed and submitted to the insurance company. A very similar situation exists with the Medical Exam and Laboratory tests. With the withdrawal of large US labs because of difficulties shipping kits to and from different countries, local country legislation protect - ing local labs, and heavy regulation on the shipping of human fluids, international insurers rely on local laboratories to perform the tests. But most of those labs are clinical labs and don’t have all the reagents or equipment for insurance specific tests, such as NT- proBNP, cotinine and others. Large labs at hospitals are not practical for the industry because clients have to make appointments to go and take extra time out of their daily work schedule, when insurance examin- ers and lab techs can draw the blood and collect the specimen at their home or place of business. Finally, the subject of Artificial Intelligence and Ac - celerated Underwriting was brought up. At the mo - ment, none of the underwriters attending were using those for their current international business. For Accelerated Underwriting, a lot of data is required, which is still not readily available in those markets, especially Latin America. Elections for the 2024/2025 elections took place before the end of the meeting. Luiz Medeiros of American Fidelity was elected Chair of the 2025 IUSG meeting, which will take place in Anaheim, CA, in connection with the AHOU Conference. At the conclusion, because of the 4 th Milestone anni - versary, Certificates of Appreciation were presented to the four Past Chairs: • Sandra Prado

• Jorge Hernández • Dr. Eduardo Mora • Bill Tilford (absent)

We are all looking forward to the next meeting in California.

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