Welcome to At Your Service Your Place for NL Service Updates

May 28, 2021

Medical Underwriting Corner: Cancer

Better preparing you for field underwriting.

Cancers are malignant tumors that generally have the following characteristics:

  • Disorganized tumor cells containing DNA mutations
  • Rapidly growing and dividing tumor cells
  • Tendency to infiltrate adjacent normal tissue
  • Tendency to metastasize

Cancers are staged according to their size, lymph node involvement, and presence or absence of metastases using a tumor staging system called TNM staging. T refers to the primary tumor size, N refers to lymph node involvement, and M indicates whether metastases have occurred. Metastasis is the spread of cancer from the initial or primary site to another site in the body.

The TNM categories are often grouped into stages described as:
  • Stage 0 – early tumor which has not invaded into surrounding tissue
  • Stage 1 – tumor which is confined to the organ in which it originated
  • Stage 2 – tumor invasion into adjacent areas or into local lymph nodes
  • Stage 3 – regional metastases
  • Stage 4 – distant metastases

Depending on the type of tumor and stage of tumor, treatment generally consists of one or a combination of the following:

  • Surgery
  • Radiation
  • Chemotherapy
Various types of cancers respond differently to the treatments, so insurability depends on the details of the case.

In underwriting cases of cancer, the following factors are taken into consideration:

  • Type of cancer
  • Stage of cancer, which is determined by pathology reports
  • Specific treatment and dates of treatment
  • The outcome of the treatment, and whether the cancer is in remission
  • Results of follow-up evaluation, such as tests which investigate possible recurrence
  • Compliance of follow-up as recommended by their physician
  • Results of follow-up testing which may include but not be limited to: PET scans, ultrasounds, oncology visits, x-rays, and laboratory testing.
  • Lifestyle changes including ceasing tobacco use, decreasing alcohol consumption, exercise, and eating well.

In underwriting cases of cancer, usually some amount of time must pass after completing cancer treatment to ensure the cancer is in remission and shows no signs of recurrence.

Many of the factors outlined above can be assessed by questions on the application, on the Tumor Questionnaire, and by documentation the client may have available if asked (path report, staging information). Please list full details on the application along with physician follow-up information, date last seen, specialist contact information, and any pending appointments or tests.

For any specific questions or inquiries on an applicant with a history of cancer, please submit a Quick Quote to our Underwriting team; underwritingquotes@nationalllife.com. The best offer is made whenever possible according to underwriting guidelines.

-Lisa Papazian, M.D., DBIM