Congratulations, Vicki Garrett!
Our 2019/2020 RWA Winner

Vicki Garrett is a Senior Underwriting Consultant with more than 25 years underwriting experience. Vicki joined SCOR in 2015 and is currently a member of the Large Case Team. 

During her career, Vicki has gained expertise in foreign and large case risks. She has served on a Research and Development team, trained new underwriters and developed and implemented company foreign guidelines. 

Vicki graduated Cum Laude from Western Kentucky University. Vicki is the recipient of the 2020 Rick Weaver award given by the Northeast Home Office Underwriters Association for her article, “Lifestyle Disease: A Growing Epidemic.”

Lifestyle Disease

Vicki Garrett | Senior Underwriting Consultant-Large Case Team, SCOR Global Life | 09/15/2019

Lifestyle Disease.  Never heard of it?  Probably not, but I bet you’ve witnessed it, underwritten it, and possibly even lived it, and it’s a growing epidemic in Western countries.   The title itself casts a pretty wide net, but unfortunately so do the consequences.  So, what exactly is ‘Lifestyle Disease’?  Per MedineNet Lifestyle Disease is defined as a disease associated with the way a person or group of people lives.  Wikipedia further expounds upon this definition by expressing it is commonly caused by alcohol, drug and smoking abuse as well as lack of physical activity and unhealthy eating.

So how do we even begin to approach such a comprehensive topic in life underwriting that only health insurers to this point have been able to broach?  And more to the point, why should we?  From my research of this topic, the answers to the latter is simple:  because it matters.  But the first question is a bit more complicated, and in fact, can seem overwhelming.  When we address lifestyle choices, we are seemingly throwing darts at the unknown, chancing bias, underwriting shadows, and overall making our job much more complicated.  But just because it is hard, doesn’t mean we shouldn’t do it.  To the contrary, to maintain a viable client portfolio, we must.

I chose this topic because as a 25-year underwriter, I have seen the incidence and intensity of poor lifestyle choices increase dramatically, yet the consequences of them so scantly addressed.  Yes, we have guidelines in place for some lifestyle choices such as alcohol and drug abuse and obesity, or at least we do individually.  We also have them for many of the diseases they are attributed to such as certain cancers, respiratory diseases, Coronary Artery Disease, and Diabetes. However, so often in underwriting, we can see the train ‘a comin’, so to speak, but we can’t make it stop with the tools at our disposal in that snapshot of time we have to review a client’s true mortality risk.  Personally, I have often seen cases on clients I felt better about who had survived a cancer or cardiac event than I have for others in seemingly good health, simply because of the lifestyle choices presented to us in the medical records, inspection report, or on the application.  And at times, I have used my common sense to approach these seemingly healthy individuals with a Standard or rated offer in hopes my auditor will share my concerns and reasoning.  But while acting on your gut is sometimes a good idea, it isn’t always audit-proof or even prudent, unless we can rationalize our gut instinct with actuarial data and proper guidelines to support our decision.

So where is the data to support action?  Let me share with you some random statistics I gathered in my research, and for our purposes of mitigating risks, imagine the potential morbidity concerns we as underwriters are increasingly facing:

    • The World Health Organization attributes approximately 1.7 million deaths a year worldwide from obesity, chronic illness, and ill-health to inadequate fruit and vegetable intake often attributed to poor food choices and the prevalence and the increasing availability of foods with added fats, sugar, and salt.  One third of children today are projected to acquire Diabetes in their lifetime.  Approximately half of obese teenagers already have at least one more risk factor for CAD.  Poor nutrition has also been widely linked to effects on the brain and an increase in the likelihood of adult violence.
    • According to the National Institute on Alcohol Abuse and Alcoholism, 15.1 million adults ages 18 and older and over half a million adolescents ages 12-17 have Alcohol Use Disorder. 28.9% of 12 graders and 40.1% of college students report binge drinking (consuming 5 or more drinks in a row). These statistics increase in college- age students, as does the risks for developing serious alcohol problems, behavioral problems, victimization, delinquency, increased sexual activity, tobacco use, and drinking and driving. Also, latest research shows this is no longer a predominately male issue, as the gap between genders is closing and nearly equal especially in the younger population.

    • The National Institute on Drug Abuse posts similar findings with teens using vaping devices in record numbers and upward trends of Cocaine, Hallucinogens, Heroin, Inhalants, LSD, Marijuana, Methamphetamines, PCP, Tranquilizers, Psychotherapeutics, Pain Relievers, Sedatives and Stimulants.

    • Only 21% of adults today are meeting the physical activity guidelines, while less than 5% perform 30 minutes of physical activity per day according to Medical News Today.  Studies have consistently demonstrated a sedentary lifestyle can contribute to obesity, Diabetes, some types of Cancer, CAD, and early death.  One study with over ten thousand participants associated a sedentary lifestyle and lack of physical activity with a higher risk of developing a mental health disorder, and increased risk of depression.

    • According to studies reported by Wikipedia, a high number of sexual partners is linked to a higher risk of sexually transmitted disease and life-threatening cancers as well as an increased risk of substance abuse and many mental disorders such as anxiety, depression, and personality disorders.

While these statistics only address a small portion of the various lifestyle choices that can contribute to Lifestyle Disease, they do demonstrate the disturbing trends and affects on potential mortality.  But how do we address these concerns if none of the elements are ratable in and of themselves?  Herein lies the challenge, but one worth addressing.  Following is my proposal on assessing these cases:

No other ratable medical conditions, and less than 3 of the following Lifestyle Risks present:
Ages 25 or under: +25 to +100
Ages over 25:  +0
No other ratable medical conditions, but 3 or more of the following present:
Ages 25 or under:  +100 or I.C.
Ages over 25:  +50
No other ratable medical conditions but 5 or more of the following present:
All ages:  +100 up/I.C.
One other ratable medical condition and two or less of the following present:
Ages 25 or under +5o
Ages over 25 +25
One other ratable medical condition and more than two of the following present:
Ages 25 or under +50 to +75
Ages over 25 +50
Two or more ratable medical conditions and 2 or more of the following present
All ages:  +100 up, RMD

Moderate or increasing use of alcohol, not ratable
Use or history of use or abuse of illegal drugs, excessive or dependent prescription or over-the-counter pain medication use.
Documented sexual promiscuity
Documented Sedentary lifestyle
Overweight and/or documented over-eating or binge eating
Tobacco use
Unemployment, poor social environment or working conditions, and/or documented stressful home life
One or more high risk avocations such as extreme sports
Poor driving record

Credits (Max +50):
Preventative measures such as diet, exercise, counseling, support groups, or involvement in self-help programs:  -25
Steady employment, active lifestyle, stable family life and/or good support system: -25
Clear driving record -25
Normal BMI, lipids, and blood pressure -25

WOP, CIR riders:
Overall rating +0 to +50:  Allow rider if underlying ratable condition permits
+75-+100 ages 25 and under:  Decline rider
+75 to +100 ages 26 and up:  I.C.
+100 up, all ages:  Decline Rider

As you can see, there is a lot of overlap, and intentionally, also a lot of room left open for interpretation.  Ultimately, as with most underwriting guidelines, this is to serve only as a tool.  Use of all resources, managers, and your own good judgement and common sense can and should always prevail.  However, a guideline is a useful tool in an industry increasingly faced with mitigating complicated risks, and on-going education and awareness of trends and statistical data is crucial to successfully structured mortality tables and efficient underwriting.