Life Insurance Solutions
Positively Possibly PreferredA Look at Four Medical Impairments By Dr. Jacki Goldstein
Rheumatoid arthritis (RA) affects 1.3 million people in the
United States3. It is a chronic disease that primarily causes chronic inflammation of the joints, but can also affect other
Malcolm, 36, is a computer programmer, who is
organs. While there may be periods of remission, rheumatoid
married with a young family. He’s applying for $500,000
arthritis is often a progressive disease that may result in joint
of life insurance. Malcolm has been treated for depression
destruction, chronic pain and functional disability. Anemia,
since he was in college. He has never been hospitalized,
lung disease and heart disease, including an increase risk of
attempted suicide or had a history of substance abuse. He sees
heart attack, can be associated with RA. Although there is no
a psychotherapist monthly and has been on Prozac, an anti-
cure for RA, there has been improvement in the prognosis
depressant, for many years. Malcolm has been successful at
thanks to early diagnosis and aggressive treatment with several
Depression is a serious, sometimes life threatening, mood
disorder that is associated with both increased morbidity and
children. She and her husband are both applying for $ 500,000 of life insurance. Two years ago Vivian donated a kidney to her
In 2006, the CDC estimated that 15.7 percent of people in the
father, who had kidney failure due to diabetes. Her creatinine
United States have depression at some point in their lives and
prior to donating her kidney was 1.0 and since the removal
that 17-18 million Americans have this disorder.1 Not only
of the kidney has been stable at 1.2. Her blood pressure is low
can depression result in suicide, a leading cause of death in
normal, her urinalysis is normal and she is a non-smoker with
the U.S.2, but persons with depression are more likely to have
cardiovascular disease, diabetes and obesity, as well as being more likely to become smokers, heavy drinkers and physically
A kidney transplant is a surgical procedure to place a healthy
inactive. However, the type and severity of depression varies
kidney from a donor into a person who has end-stage kidney
greatly. Many individuals with depression can have an excellent
failure. Common causes of end-stage kidney failure include
diabetes, chronic, uncontrolled high blood pressure and chronic glomerlonephritis. Donated kidneys can be from
Marci, 44, is a landscape architect applying for a $1 million
deceased or living donors. In 2009, approximately 6,300 living
life insurance policy. At age 32, Marci complained of painful
swollen joints that limited her ability to do her job. She was
Living donors are screened to be sure they have no medical
diagnosed with rheumatoid arthritis. For the first six years
problems that would be adversely affected by a loss of one of
Marci was on various disease-modifying anti-rheumatoid drugs
their kidneys. Once they are recovered from the major surgery
as well as occasional short courses of prednisone to control her
to remove one of their kidneys, survival rates in living donors
arthritis and allow her to work. For the past six years, she has
are not affected by the kidney donation.
been maintained just on Plaquenil and has continued to be well controlled. Marci has very few joints that are involved, minimal joint damage, no organ involvement, a low level of rheumatoid factor and is fully functional at work and home.
1. cdc.gov/features/dsBRFSSDepressionAnxiety/
3. niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp
2. cdc.gov/ncipc/pub-res/Suicide%20Fact%20Sheet.pdf
4. ustransplant.org/show_Citation.aspx?id=413
For Producer and Broker/Dealer Use Only. Not For Public Distribution.
Positively Possibly PreferredA Look at Four Medical Impairments
Carl, 72, is a retired college administrator. He and his
So how will Malcolm (mild depression and anxiety), Marci
wife are applying for a $2 million joint life policy. At age 66,
(mild rheumatoid arthritis), Vivian (kidney donor) and Carl
Carl was noted to have an elevated PSA at 13.4 ng/ml and an
(localized prostate cancer) fare in life underwriting?
irregular prostate exam. A prostate biopsy revealed prostate
They all would be eligible for a preferred rating, provided they
cancer. Carl elected to have a radical prostatectomy. His cancer
meet all other underwriting criteria.
was Gleason 7 and was staged as T2bN0M0 (confined to the
These are just four examples of how your clients, even those
prostate cancer with no evidence of spread). PSA levels since
with potentially significant medical conditions, if they meet
the surgery have been undetectable and exams have also shown
certain criteria, may be “positively possibly preferred”.
It is estimated that 217,730 men will be diagnosed with and 32,050 men will die of cancer of the prostate in 2010.5 After skin cancer, prostate cancer is the most common cancer in men in the U.S. and the second-leading cause of cancer-
The cases presented here are hypothetical. Specific ratings will
related death.6 Fortunately, due to earlier detection and
vary based on a client’s complete medical history.
improved therapies, the overall survival of prostate cancer has been improving since the early 1990’s, particularly for early (localized) stages.
5. seer.cancer.gov/statfacts/html/prost.html#incidence-mortality6. cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-key-statistics
Life insurance products are issued by MetLife Investors USA Insurance Company, Irvine, CA, Metropolitan Life Insurance Company, New York, NY, and in New York only, by First MetLife Investors Insurance Company, New York, NY. All guarantees are based on the claims-paying ability and financial strength of the issuing insurance company. Variable products are distributed by MetLife Investors Distribution Company, Irvine, CA. All are MetLife companies. October 2010
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Reserve prices in all-pay auctions with complete information Dipartimento di economia politica e metodi quantitativi We introduce reserve prices in the literature concerning all-pay auctions with complete information, and reconsider the case for the so-called Exclusion Principle (namely, the fact that the seller may find it in her best interest to exclude the bidders with the largest willin