Life Insurance Underwriting Strategies for Elevated Liver Functions

Life insurance applicants are sometimes surprised they are required to pay an extra premium due to findings of elevated liver functions in their insurance company labs.  They feel terrific and have never even thought about their liver before!  None of them are pleased about having to pay higher premiums.  Fortunately, not all life insurers underwrite elevated liver functions using the same criteria, so let’s explore life insurance underwriting strategies for elevated liver functions and confirm the applicant has access to our industry’s best solution(s).

Causes of Liver Enzyme Elevations

Elevated liver enzymes indicate some type of liver irritation. Acute causes include recent viral infections or exposure to toxins. Chronic elevations may be the result of obesity, the long-term use of certain medications, regular alcohol use, or various liver diseases.

Types of Liver Enzymes

Life insurers test for elevations of Gamma-Glutamyl Transferase (GGT/GGPT), Alanine Aminotransferase (ALT/SGPT), Aspartate Aminotransferase (AST/SGOT), Alkaline Phosphatase (ALP), and several other liver function related variables.

GGT is the most frequently elevated enzyme. It’s an “inducible” enzyme, meaning levels fluctuate based on detoxifying demands placed on the liver. This includes the liver’s conversion of alcohol and medications into harmless substances.

Elevations of ALT and AST are caused by damage to liver cells, allowing those enzymes to leak into the bloodstream. The degree of enzyme elevation roughly parallels the degree of liver cell damage. 

Significant elevations of ALP are relatively rare. They are caused by various conditions affecting the liver and other organs.

Impact on Life Insurance Underwriting

Modest elevations of a single enzyme, absent clinical history or other adverse underwriting evidence, are ignored by most life insurers for otherwise healthy applicants.

Elevations of two or more enzymes at double or greater than normal range, absent known cause, will lead to price increases, postponements, and even declines at some insurers.

Intelligent Life Insurance Underwriting Strategy

In many cases, elevated liver enzyme findings on an insurance company exam is the first such finding. There is no diagnosis, no obvious cause. Answers to a few clarifying questions can sometimes hint at a benign cause, allowing the underwriter to reconsider and offer coverage at favorable pricing.

The first question to ask the underwriter is whether there is any evidence of poor blood specimen handling. Insurance company lab specimen are often shipped across the country to specialty labs. Is it possible the specimen was damaged by sitting on a delivery truck in summer heat or winter cold? Is there any evidence of hemolysis (ruptured red blood cells)?

An applicant might also be able to shed some light on a possible cause. What prescription or over-the-counter medications were taken in the weeks prior to the exam? Were those listed on the exam?  Did the applicant have a viral infection in the weeks prior to the exam?

Once a cause has been established, life insurers offer pricing based on their underwriting classification for that underlying cause.  There can be significant differences from one insurer to the next.

Carrier Selection is Key

Conservative insurers interested in attracting preferred risks discourage policy placement with ratings, pricing their offer above market – or not making an offer at all.  Impaired risk insurers may be willing to offer acceptable product pricing.

In order to identify our industry’s top solution(s) for an applicant, it’s important to negotiate facts with medical directors at several insurers that are comfortable underwriting elevated liver functions.

Elevated Liver Enzyme Fact Finder

Answers to the following questions, together with biopsy or ultrasound reports (if completed), will allow for a market survey to identify the industry’s top option(s):

• Age:
• Gender:
• Current or recent tobacco use pattern:
• Initial date of elevated liver functions:
• Which enzymes are elevated and what are recent levels?
• AST/SGOT:
• ALT/SGPT:
• GGPT:
• ALP:
• Bilirubin:
• List any other abnormal lab findings, especially for HDL or iron:
• Have abnormal lab findings been increasing, fluctuating, decreasing?
• Which medications – both OTC and prescription – are taken regularly? How much? To treat which condition(s)?
• Describe alcohol consumption, including frequency and amount:
• Has the alcohol consumption pattern changed recently?  If yes, how?
• Has there been a diagnosis of hepatitis A, B, or C?
• Have liver studies already been completed (ultrasounds, CT scans, MRIs, biopsies)? If so, when and what were the results?
• If a liver biopsy was completed, what was the fibrosis score (0-4):
• If a FibroSure blood test was completed, what was the score (0-4):
• Are there any other known medical conditions?

Reducing the Risk of Elevated Liver Function Findings

Most elevated liver functions underwriting complications result from incidental lab findings. What if applicants could avoid such testing in the first place?  For many healthy applicants, there is a much easier way to acquire significant amounts of quality life insurance.  Why risk exposing an applicant to avoidable price increases, or worse, when there is a better way?

Opportunities for Financial Advisors

Have you run into difficulties obtaining life insurance for one of your clients?  If so, let’s put our heads together and develop an intelligent life insurance underwriting strategy.  Connect with your CPS Advantage Representative or request a callback via email.  We look forward to surveying the market so you can provide your client with our industry’s top life insurance policy options.