In conclusion, underwriters were encouraged to embrace the future of underwriting. Careful use of all tools can help to build trust with customers and sales partners while streamlining the underwriting process. Underwriters must understand legislation and collaborate to share best practices which benefit the industry. The next session was “Mental Health Variety, the ACEs, and How They Can Affect Mortality in Adult - hood,” presented by Sally Sparby, MA, LPCC, LACD, from Blue Cross Blue Shield. ACEs are adverse child - hood experiences and were the focus of a study done by the CDC in partnership with Kaiser Permanente. The study looked at the relationship between child- hood trauma and long-term health. It identified 10 types of adverse childhood experiences: • Emotional abuse • Physical abuse • Sexual abuse • Witnessing abuse of parent • Substance abuse • Mental health issues in household One point was assigned to each type of trauma and higher scores correlated with adverse health out- comes later in life. Four or more adverse childhood experiences were linked to higher rates of suicide, Alzheimer’s or other dementia, heart disease, cancer, diabetes, respiratory issues, obesity, smoking and substance use issues. There are solutions to address the long-term and lasting effects of trauma, including early interven - tion programs and the promotion of social norms against violence and adversity. Also, acknowledging and releasing the trauma through various thera- peutic methods can help mind and body heal. Early painful messages can stay with a child and, if not processed, may have a negative impact. Once there is an awareness of the past trauma, a person can also work to avoid disproportionate responses in current situations. • Parental separation or divorce • Incarceration in family member • Emotional neglect • Physical neglect The second half of the day began with the introduction of the new TCAHOU officers. There was conversation around hosting a networking event in September. The November meeting will be held at Jax Café on Nov. 7, 2024.
The first speaker of the afternoon was Dr. Regina Rosace, MD and VP Medical Director, SCOR Re. Her talk entitled “Underwriting Hodgepodge. What Is the Risk? Can We Make an Offer?” focused on several different medical topics that are seen in underwriting. She discussed autism spectrum disorder. For anyone on the spectrum, can we ever offer and, if so, under what circumstances? The prevalence of those on the ASD is 1 in 36 children, aged 8 years and under, and seen more prevalently in boys. In the past, we have seen this diagnosis by other names such as autism or Asperger’s. ASD was introduced as a disorder in 2013. Behaviors in these individuals can improve or deteriorate over time. Those with epilepsy as well (20-33%) have a death rate six times that of autism alone. Up to 40% also have a co-morbid psychiatric disorder. A 2016 study showed those who are low functioning have a higher mortality rate, and suicide is much more prevalent in those who are higher func- tioning. Those individuals on the autism spectrum have a two times higher mortality rate than those without this diagnosis. Dr. Rosace next discussed asthma, especially in children. Do we need to postpone or decline these children? The answer she states is usually no, unless we are aware of some red flags: ICU stays, intubation, noted as severe or poorly controlled. Children without significant red flags or concern are usually insurable. Asthma death rates are much higher among older age groups than in children. For those 65 years of age and up, the mortality rates are 10 times that of infants. Careful consideration of red flags is important in all ages. Thyroid nodules were discussed as well. When is it Ok to offer vs. postpone? Worrisome features include: diagnosed in a child, rapid growth, adult under age 30, history of head and neck radiations, family history of thyroid cancer. Most thyroid cancers are papillary and follicular, and these cancers account for 5-6% of all thyroid nodules. Survival rate in the younger ages is pretty high. In some of these scenarios Dr. Rosace suggests rating as if they have it vs. postponing. The next speakers were Mike Hesse, Chief Life Under - writer at Berkshire Hathaway Group, and Joel Larson, Vice President Technical Underwriting at Prudential. Their talk, “Underwriting Non-Traditional Financial Needs,” included the topics of generational wealth planning, business valuation for start-up companies, life insurance as an alternative asset, older age under- writing, and general factors in financial underwriting of non-traditional needs. Some of the key takeaways for general wealth planning were:
ON THE RISK vol.40 n.3 (2024)
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