Congratulations, Regina Springli!
Our 2022/2023 RWA Winner

Regina Springli is an underwriter for National Life Group. She has been in the insurance industry for five years and underwriting for two years. During this time she has developed an interest in data driven underwriting and her unique background enables her to employ different approaches and thought processes. She enjoys being part of a profession that relies on integrity and expertise to ensure the value of the Underwriting Profession. 

Regina is the recipient of the 2022 Rick Weaver Award given by the Northeast Home Office Underwriters Association for her article about Polycythemia.

In Regina’s words:

I am grateful for the opportunity to have attended the 2023 AHOU conference, especially with the 2022-2023 NEHOUA Rick Weaver Award funding. I wish I could pinpoint a specific session as a favorite but found this near impossible due to the vast amount of talent represented with record setting attendance at 2023’s AHOU.

Session topics were relevant and offered a range of information to diverse levels of insurance professionals. The clear consistent theme was the growing buzz affecting not only the underwriting industry, but every industry and a daily part of everyone’s life. This evolution of technology, the changes projected and best methods of leverage for an enhanced customer experience.

The insurance industry has made minor changes in the last 30 years, with most of the change occurring within the last five due to Covid-19 and regulation changes. The urgency to maintain business in an altered environment caused by a global pandemic and to provide for customers in an uncertain period, became critical and complicated.  Change was inevitable and as insurance companies met and exceeded expectations– the realization of leveraging technology to close the gap on service time and customer conveniences was too good to pass up.

It was apparent personnel within the industry had shifted, and the connection felt between underwriters, vendors, and other various insurance professionals at AHOU was impactful with numerous opportunities to discuss a range of topics. Data and its multifaceted components were a hot button with new state regulations on personal data points, collection, and usage. Colorado is the first state in the country to enact regulations governing automated decision making (i.e., profiling) in the context of a general state privacy law.

While it is obvious there are several opportunities ahead for innovation in the insurance industry, we know our best decisions are well measured data driven decisions with a good understanding of the basics and a lens on the big picture. As technology changes will continue at rapid speed, the definition of the basics will evolve to include how data is gathered, used, and featured to fit needs. Chances to bring individuals together to learn about those changes with the growth and impact of technology and other variables that affect our industry is one of the many treasures of AHOU.

Regina’s essay

Most underwriters share a common trait: an affection for learning. Underwriters are notorious for having an insatiable request for information. The rapid advancements in technology have tapped into the medical industry with a strong imprint. This perfect storm has made today’s underwriting wealthy with enticements and trials.

Typically, underwriters attend courses taught and lead by medical professionals within the industry. The data is pre-collected, prepared and presented in a condensed package for ease of learning and relevance. I wanted to extend outside of these normal parameters and decided to go to the source for my information. I wanted to hear what the afflicted of a rare blood cancer were willing to share. The process I used to research this impairment was reading and speaking with people living with Polycythemia. This disorder has two categories, absolute and relative, as well as two types, primary and secondary. Polycythemia Vera is known as “primary” and is part of a group of diseases called myeloproliferative neoplasms (MPNs), which is rarely seen in the industry, while “secondary” polycythemia is more commonly seen in underwriting.

Initially, I joined one of the several available support groups online to chat directly with Polycythemia Vera (P. Vera) patients. While these individuals were open and genuinely excited to answer my questions, the answers were difficult to accept. One individual named “Sara” told me it took six years to get a diagnosis. Remember, survival rates of treated patients at the time of diagnosis is evolving but on average is between 8 and 15 years. Sara saw several specialists, including gastroenterologist, rheumatologist, neurologist, and a hematologist. Due to her age and wide range of symptoms such as fatigue, sleeping all day, “feeling off”, itching, and sweating at night, she believed menopause was the cause of her overall feeling of awfulness. Sara was finally diagnosed by a hematologist with a bone marrow biopsy to look for fibrosis. P. Vera can develop slowly, go unnoticed for years and be diagnosed by chance. Especially with the younger population since data can be hard to find. This is what happened to “Zuri” is a younger woman with symptoms like tiredness, itching, and sweating. Zuri’s symptoms were dismissed as other impairments such as anxiety, she believes this to be mainly due to her demographics. Zuri was finally diagnosed with P. Vera when her broken arm never healed properly, and surgery was needed.

Underwriting is a finesse between not over simplifying facts but also not forecasting the future. When it comes to rare diseases, it’s important to look at the facts available at the time because in underwriting there is only one chance to get it right. Polycythemia is referred to as Erythrocytosis at times but there is a difference, Polycythemia is an increase in both red blood cell mass and hemoglobin concentration. An important fact to determine is what is the cause for the abnormal complete blood count. Blood tests in people with P. Vera may show abnormalities in red blood cell count and mass, hematocrit, hemoglobin, white blood cells, platelets, and erythropoietin. Several factors can cause abnormalities in blood test such as testosterone replacement therapy, tobacco use and living in high altitude. P. Vera diagnosis are commonly done by blood tests, genetic testing for a Janus-associated kinase 2 (JAK2) mutation or a bone marrow biopsy to look for fibrosis. I learned even cats and dogs can have P. Vera. Unfortunately, cardiovascular events are also a major factor in diagnosing P. Vera. Due to the increased thickness of the blood with red blood cell mass, increased hematocrit and hemoglobin, thrombosis becomes a major complication and an increase in risk of mortality, it is also why many patients choose to treat with phlebotomy.

While today many blood diseases are insurable, some are not. The ever-evolving advancements of technology and medicine could mean changes in the future to what is not currently insurable. HIV is an example of how medicine advancements have changed the disease risk assessment. With the changes today and on the horizon, it has become increasingly important for underwriters to have a consistent, systematized approach to avoid missing abnormalities, identify trends, and continually grow our knowledge base.

Sources Sited:
• NORD National Organization for Rare Disorders:
• Lisa Duckett, MD (ret.) RGA Vice President and Medical Director presented on this topic to the RMSHOU (Rocky Mountain Society of Home Office Underwriters) in Feb 2018
• Taber’s Cyclopedic Medical Dictionary, edition 18, F.A. Davis