
underwriting
Gender Differences in Diabetes
How Diabetes Differs for Men and Women | Diabetes Forecast Magazine
Women with diabetes have it worse, on average, than men with diabetes. This shocking inequality was revealed in a 2007 study that found that, between 1971 and 2000, death rates fell for men with diabetes, while rates for women with the disease didn’t budge. Plus, while men with diabetes live 7.5 years less on average than those who don’t have the disease, among women the difference is even greater: 8.2 years.

Independent Underwriting Audits–Why so Few?
This article has been cross-posted at the Society of Actuaries Marketing and Distribution Section website.
It’s the middle of August and I can state with 100 percent confidence that the 50-day record of triple degree temperatures in Oklahoma will be shattered. In the midst of this horrendous heat, I’ve been juggling three projects and doing some preliminary work for a fourth project that kicks off in October. If my timing is good and at least one of my current projects gets done by the end of September, I should have more time in October to do some of the pleasurable things I like to do besides work (like eat and sleep). So I’m juggling three projects, setting up a fourth, and Juliet Sandrowicz asks me to write an article for the Marketing and Distribution Section’s newsletter.
Of course I said yes.
And of course, life got busier. Two of the four current and future projects are audits. The work for the other two projects consists of technical underwriting and litigation support. I started to think about my topic and I thought underwriting audits would be a great topic. Writers write about what they know.
The topic of this article is independent underwriting audits. The question is why so few?
In a typical life insurance company the underwriting department does their own routine desk audits. Different companies have different procedures, but typically 25 to 50 cases per underwriter are audited by higher level, experienced underwriters on a routine basis, perhaps on a quarterly or semi-annual basis. Reinsurance companies conduct their own audits every two years or so of perhaps a hundred files. Despite the obvious lack of statistical validity, what’s wrong with this picture?
Audits done by internal staff and/or by reinsurance companies essentially will inform management of issues such as the following:
- Adherence to internal underwriting guidelines and procedures;
- Consistency;
- Trend identification;
- Identify concentrations of mortality risk by impairment, sales channel, underwriter, or plan of insurance;
- Quality of underwriting decisions;
- Quality of file documentation;
- Adherence with or deviation from approved underwriting manuals;
- Adherence with or deviation from generally accepted industry standards; and
- Identify areas for group or individual training.
I’ll ask the question again–what’s wrong with this picture?
Audits performed by a company’s own underwriters or reinsurers are not independent. The readership for this article is a smart sophisticated audience. The value of an independently conducted objective underwriting audit should be readily apparent. Our industry can ill afford another Equity Funding scandal. But the question is why are there so few independent underwriting audits?
My upcoming audit engagement is with a NYSE listed company whose Internal Audit department conducts independent life underwriting audits in partnership with a life underwriting subject matter expert. The life underwriting expert changes in a regular two- or three-year rotation. Internal Audit reports only to the Audit Committee of the Board of Directors, not to internal management. The final audit findings are reported also to the Audit Committee of the Board of Directors.
After many years and many audits in the life insurance business it was quite refreshing to come across a company who applies stringent standards of risk management to the risk selection process.
I have ideas and suspicions on why so few independent life underwriting audits are performed. In a few months I’ll have one life company’s rationale for conducting independent life underwriting audits. Stay tuned.

Red Meat Consumption May Increase DM2 Risk
Conclusion: Our results suggest that red meat consumption, particularly processed red meat, is associated with an increased risk of T2D.

Life Settlements Update – 09.28.11
In PHL Variable vs. Price Dawe 2006 Insurance Trust Insurance Company, the court has affirmed the common law ability of a legally insured person or insurable trust to sell a policy on that person’s life for market value — provided that procurement of the policy is not part of a straw purchase pursuant to a prior agreement to resell to an investor, and that the procurement is not part of an illegal wager in which a third party directly or indirectly pays the premiums.
The court holds that an arrangement involving an agreement with a straw man is illegal. An illegal arrangement occurs when an investor has a pre-negotiated arrangement for an immediate transfer of ownership of the policy, and there is no insurable interest on the part of the original owner, according to the court.
The court has ruled that the “intent” of the insured to sell a policy is irrelevant. The transaction itself is legal if, at inception, the individual procuring the policy has insurable interests and does not have a pre-negotiated agreement to immediately transfer ownership.
Setback for Life Settlements – WSJ.com

Lower Cognitive Scores – Low B12?
Markers of B12 insufficiency all predicted lower global cognitive scores over nearly five years of follow-up, Christine C. Tangney, PhD, of Rush University Medical Center in Chicago, and colleagues found.

Older Women Have 2X Mortality Risk First Year Post Hip Fx
Older women who experience a hip fracture have a twofold increase in mortality risk in the first year after the fracture, researchers found.
During the 12 months following the fracture, 16.9% of the women died, compared with 8.4% of controls, for an odds ratio of 2.3 (95% CI 1.9 to 2.8), according to Erin S. LeBlanc, MD, of Kaiser Permanente Northwest in Portland, Ore., and colleagues. They researchers adjusted for potential confounders such as age, bone mineral density (BMD), and coexisting conditions such as diabetes, hypertension, and stroke.
And the increased mortality risk during the first year remained after further adjustment for specific hip fracture risk factors such as total hip BMD (OR 2.4, 95% CI 1.9 to 3.1), the researchers reported online in Archives of Internal Medicine.

Teriparatide (Forteo) for OA?
In a mouse model of osteoarthritis, giving the drug for a month resulted in knee-joint cartilage that was 32% thicker than in control animals, the researchers said in Science Translational Medicine. Medical News: Lab Notes: Building a Better Knee – in Lab Notes, Lab Notes from MedPage Today
There is hope. Unfortunately, I am not a mouse.

Statins Linked to Lower Mortality in Afib
Among patients with atrial fibrillation, those who are taking a statin may be less likely to die during follow-up than those who are not taking a statin, a retrospective study showed.
Interesting report. Do note the study limitations.

MKSAP – Memory Loss in an 81 Year Old Male
Mild cognitive impairment denotes abnormal cognitive decline
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
I actually got this one right.

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