Courses and Descriptions
2009 | 2008 | 2007 | Special Morbidity Risk Package
2009 Courses
Pulse Pressure in Underwriting
Incidentalomas: The Underwriting of Incidental Diagnostic Test Findings
Risk Implications of Rx and Other Forms of Patient Noncompliance
Underwriting Assessment of Renal Function Tests
Cancer of the Uterus and Its Precursors
Atrioventricular (AV) and Bundle Branch Blocks
Myelodysplastic Syndrome (MDS)
Case Clinic on Pathology Report Analysis
Underwriting Implications of Socioeconomic Status and Risk-Taking Behaviors
2008 Update: Contemporary Underwriting Issues in Lab Testing
Cognitive Impairment and the Risk of Dementia
New CV Risk Markers (NT-pro BNP, Apos A1 and B100, Trig: HDL-C ratio, Homocysteine, etc.)
Major Sexually-Transmitted Diseases (STDs)
Benign and Precancerous Breast Disease
Coronary Artery Calcium Scores in Underwriting
Basal and Squamous Cell Skin Carcinomas
Anemia II: Thalassemia, Hemolytic Disease, Anemia Over Age 65, & Anemia in CV Disease
Stress: Issues in Risk and Insurability
Colorectal Polyps and Carcinoma In-situ
Smokeless Tobacco and Betel Use
Social Anxiety Disorder and the Phobic States
Benign and Malignant Ovarian Disease
Special Morbidity Risk CE Package Courses
Case Clinic on Laboratory Tests
Posttraumatic Stress Disorder (PTSD)
Underwriting Assessment of Syncope (Fainting)
Sexually-Transmitted Diseases (Excluding HIV + HBV)
Benign & Premalignant Breast Disease
Stress: Issues in Risk & Insurability
Smokeless Tobacco and Betel Nut
Underwriting Incidental Diagnostic Test Findings
Risk Implications of Rx and Other Forms of Patient Noncompliance
Case Clinic on Pathology Report Analysis
Socioeconomic Factors, Health Habits and Risk-Taking Behaviors in 21st Century Risk Appraisal
2009 Course Descriptions
Too often, busy underwriters focus only on the ECG results, glossing over or missing highly significant non-ECG findings inherent in a treadmill test report. These include METS achieved, chronotropic incompetence, post-exercise heart rate recovery, blood pressure response to exercise, symptoms during the tests and the correlation of these with medical histories. This course will cover all of these and those who complete it will acquire greatly-enhanced expertise on a very important (given the prevalence of clinical treadmill testing) subject.
This course covers underwriting of elevated uric acid. It also reviews all of the latest information on gout, including symptoms, complications and WORST CASE criteria.
This is a complex subject where the pace of new clinical insights rivals any field of medicine. We will focus on hypertrophic cardiomyopathy as well as heart muscle damage associated with alcoholism and diabetes, as well as post-partum cardiomyopathy and myocarditis.
The use of psychotropic drugs is growing rapidly in most domains of psychiatric medicine. New approvals, widening off-label use and potent adverse effects abound. This course will provide the background underwriters need to underwrite individuals taking these drugs in all risk contexts.
The mortality and morbidity risks associated with alcohol use vary widely by level and pattern of consumption. There is a robust new literature showing us the distinctions between never-use, former-use and extent of current use as it relates to risk. We will also look at the question of whether or not crediting temperate alcohol intake is feasible and appropriate in some underwriting settings.
There are many forms of colitis and this course will cover them all, with a special emphasis on ulcerative colitis. We will focus on identifying cases which can be approved without medical records as well as RED FLAGS for high risk in UC and other significant large bowel conditions.
This disorder is diagnosed with increasing frequency as people age and is often first discovered based on routine blood profile findings. MGUS will be covered in sufficient depth, focusing on its risk implications as well as RED FLAGS for those most likely to progress to myeloma and related malignancies.
E.R. visits do not always get the attention they need. We will look at the most prevalent significant impairments predisposing to E.R. visits and how to distinguish those cases, based on teleinterviews and application histories, which need further underwriting assessment. To our knowledge, this is the first underwriting course to ever cover this important but oft-neglected subject.
This course will encompass all significant clinical developments of the last 5 years into a comprehensive review of what underwriters must know about asthma in all of its presentations.
We have found that the three prediabetic disorder – impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM) are less well understood and appreciated by most underwriters. We will examine all three, emphasizing not only their relative risk of progression to T2DM but also their implications as "stand-alone” impairments.
PCOS is one of the most prevalent female disorders and its risk implications are now known to the highly significant to mortality as well as morbidity. This course will provide underwriters with a sound understanding of PCOS and how to relate it to its prevalent comorbidities.
Over the last three decades, knowledge has expanded dramatically on familial and sporadic (non-inherited) nevi at risk for transformation to melanoma. We will cover them all; with a special emphasis on dysplastic (atypical) moles and key characteristics distinguish common benign moles from those capable of malignant change. Melanoma in situ will also be addressed.
Carcinoma of the colon is one of the most common malignancies at significant risk for a fatal outcome. This course will cover all aspects of preinvasive and invasive colon cancer, including predisposing conditions, and identify BEST CASE criteria.
Issues and disagreements abound regarding the mortality and morbidity risks associated with use of cannabis on any basis. We will review all of the salient considerations regarding marijuana, including comorbidities and potential morbidity and mortality consequences.
Insurers have been clamoring to discover the most effective ways of detecting pre-existing malignancies. We believe that the most reliable and cost-effective approach is to optimizing underwriters’ understanding of all of the clues that are potentially associated with both undiagnosed and non-disclosed cancers. This unique course will range across physical findings, recent histories, lab test results and other clues associated with this issue.
Nonalcoholic fatty liver disease (NAFLD) is now recognized as one of the most prevalent impairments in humans. We will look at every aspect of simple fatty liver, its more significant presentation as NASH and all factors bearing on its asymptomatic presence and excess mortality and morbidity. Alcoholic fatty liver will also be covered, mainly in terms of distinguishing it from NAFLD.
Pulse Pressure in Underwriting
Knowledge of this blood pressure marker and its underwriting implications is essential in assessing risk at ages 60 and over. Unfortunately, pulse pressure has yet to be addressed in most underwriting manuals. This course will cover what underwriters need to know and suggest how PP could be effectively interfaced with systolic and diastolic readings as well as other evidence of undiagnosed circulatory system pathology.
Going forward from our 2008 course in TREADMILL TESTING, we will dissect all of the tests used to further assess at-risk individuals for coronary disease and related impairments. Stress echocardiography will be covered in depth, along with radioisotope scans and the latest new techniques. This is essential learning for all mortality and morbidity risk underwriters.
Incidentalomas: The Underwriting of Incidental Diagnostic Test Findings
This unique course examines a wide range of common incidental (unexpected) findings on x-rays, CT scans, sonograms and other clinical diagnostic tests, as well as pathology and cytology analyses. The emphasis will be on how to assess potential risks – if indeed, they exist – related to such findings, a matter often left unaddressed in clinical care (and underwriting manuals!).
This course updates and expands our earlier course on diabetes, focusing on type 2 DM and its precursors (gestational diabetes as well as impaired fasting and postprandial glucose). The emphasis will be on new developments, RED FLAGS, BEST CASE criteria and other issues affecting risk appraisal.
A continuation of the Type II Diabetes course. The emphasis will be on new developments, RED FLAGS, BEST CASE criteria and other issues affecting risk appraisal.
Risk Implications of Rx and Other Forms of Patient Noncompliance
Patient noncompliance with physician recommendations is a common and insidious problem. We will look closely at the extent of this problem and its manifestations in various domains including medications, routine screening of high and average risk patients and disease prevention interventions. All of this will be related back directly to case underwriting. This is an essential body of knowledge in teleunderwriting as well as Rx profiling.
The CBC is one of two most commonly ordered blood tests in medicine. There are many potential RED FLAGS embedded in what may often seem like innocent abnormalities on individual tests, as well as many other findings that cause concern but have little or no mortality and/or morbidity implications. In addition to reviewing all components of the CBC, we will also include illustrative cases.
Underwriting Assessment of Renal Function Tests (includes cases)
This will cover the full range of clinical laboratory screening and diagnostic testing for suspected or known renal impairment, including creatinine, BUN, creatinine clearance, eGFR, macro- and microalbuminuria and the promising new test cystatin C. Case examples will embellish a solid understanding of how these tests relate individually and collectively to pinpointing and evaluating renal (and related) impairments.
Cancer of the Uterus and Its Precursors
Like all of the cancer courses we have done, this one will cover all underwriting-salient aspects of premalignant conditions, endometrial in situ and invasive carcinoma, as well as underwriting of uterine bleeding. WORST CASE and RED FLAG criteria will be cited in depth, based on the most current literature.
Atrioventricular (AV) and Bundle Branch Blocks
As the name suggests, we will cover first, second and third degree AV blocks, left anterior and posterior hemiblocks, and right and left bundle branch blocks. The latest studies on their insurability significance will be reviewed, with special emphasis on potential underlying causes, synergistic implications with symptoms and other conditions, and RED FLAG factors.
Headache is one of the most common symptoms leading to medical visits and therapeutic intervention. This course will explore the range of headache and related symptoms, diagnostic tests and interventions with the emphasis on identifying RED FLAG issues. Migraine syndromes will also be covered to assure an in-depth appreciation of their risk implications.
Myelodysplastic (Preleukemic) Disorders and Monoclonal Gammopathy
These disorders are often discovered incidentally during routine screening or evaluation of (ostensibly) unrelated symptoms and findings. Their manifestations may be overlooked or underappreciated. Given their insidious mortality and morbidity implications, this is absolutely essential knowledge for underwriting at ages 55 and higher.
Case Clinic on Pathology Report Analysis
Our first case clinic course (lab testing) was so well received that we will do another case clinic based on pathology report analysis. While the majority will deal with precancerous conditions and malignancies, we will also cover liver biopsy findings in chronic hepatitis and early cirrhosis, etc. For each case presented in section one, there will be a comprehensive underwriting analysis in section two.
GAD is one of the most prevalent psychiatric disorders. It has significant implications for morbidity as well as, in some contexts such as comorbidities, for mortality risk. GAD may also be misdiagnosed or missed altogether in primary care. As we did with the other anxiety disorders, we will cover all aspects of relevance to risk appraisal.
Socioeconomic Factors, Health Habits and Risk-Taking Behaviors in 21st Century Risk Appraisal
There is extensive evidence that these factors can have important risk implications independent of, as well as in context with, conventional impairments. We believe this to be the first time a course has examined elements of these three issues bearing on insurability. In the age of teleunderwriting, the potential to finally address at least some of these issues is at hand.
Neurology I: Parkinson Disease and Peripheral Neuropathies
As the title implies, this course will focus on the underwriting analysis of Parkinson disease, as well as tremors and other Parkinsonian symptoms associated with other conditions. Peripheral neuropathies are very prevalent medical complaints. Most are transient; others have insidious insurability implications. RED FLAGS and other essential insights will be provided.
Contemporary Underwriting Issues in Lab Testing (includes cases)
Lab testing is an ever-changing domain. There are essential “pro and con” issues which need to be independently addressed. We will review the latest analytical and clinical developments in hopes of clearing the air…to facilitate their most productive use and thus maximize their payoff in underwriting. Cases will be included.
This course, like the one on T2DM, is updated and expanded from an earlier AD course. It will provide a firm, contemporary foundation in the analysis of pathologic and physiologic cognitive symptoms and signs, and explore the range and implications of cognitive function testing, with an emphasis on screening-feasible components for specialized geriatric paramedicals, etc.
Hip fracture has ominous insurability implications. We will dissect the risk factors as the post-fracture implications for short- and long-term mortality, prolonged disability and health care management. The underwriter will come away with an in-depth knowledge of traumatic and non-traumatic hip fracture and their implications.
Case Clinic on Laboratory Tests
This is our first-ever case clinic course, requested by many enrolled companies. It will have 20+ cases involving laboratory test results and other risk co-factors. Full case details will be provided with questions raised for each case. Our best answers to these questions will then be provided as a surrogate for our usual self-examination.
Posttraumatic Stress Disorder (PTSD)
PTSD is increasing in prevalence and needs to be covered in depth for mortality and morbidity risk issues. This course will have all of the latest information on epidemiology, diagnosis, treatment and prognosis for full-blown PTSD as well as the now-recognized subthreshold form of the disorder.
Major 21st Century Markers for Atherosclerotic Disease Risk
There have been tremendous advances in the development of effective markers for atherosclerotic circulatory disease risk. Among the ones we will cover are BNP, NT-proBNP, hs-CRP, homocysteine,apolipoproteins A-1 and B-100, hemoglobin A1-c, the triglycerides-to-HDL-C ratio and what is called “non-HDL-C cholesterol.”
Perhaps no prevalent disease is less appreciated by underwriters than gluten-sensitive enteropathy, better known as celiac disease. We will cover all risk-relevant aspects of this disorder, including the latest on diagnostic testing, comorbidities and prognosis, and, of course, BEST CASE criteria.
Underwriting Assessment Of Syncope (Fainting)
Syncope is one of the five most common symptoms for which patients seek medical care. There are many causes; some with little risk significance and others with profound implications for insurability. This course will cover all aspects of syncope with a special focus on identifying the WORST CASES based on typical medical histories where a definite clinical diagnosis is not established.
Sexually-Transmitted Diseases (Excluding HIV + HBV)
The prevalence of STDs is increasing and there may been many advances in the diagnosis and treatment of some of these disorders. This course will review all of the prevalent STDs except for HIV and hepatitis B (we did a comprehensive HBV course in 2005). All that underwriters need to know to assess these conditions will be included.
Benign & Premalignant Breast Disease
This course will examine all of the major forms of benign and precancerous breast lesions, from cysts to atypical hyperplasias. These growths are more and more frequently being identified and diagnosed due to screening mammography. Some portend significant mortality and morbidity risks. The underwriter will come away with a strong understanding of these pathologies and their relationship to insurability.
Coronary Artery Calcium Scores and the Risk of Circulatory Events
The use of helical CT-scanning to compute calcium scores has expanded greatly in recent years. Many persons now pay for their own scanning (which is quite affordable) when it is not covered by their health insurers. This course will review all that underwriters MUST know about this test, including what may...and may not...be inferred from the results.
Eye disease is another subject that all-too-often falls under the radar of underwriters. These four conditions all have implications that transcend their direct impact on vision. All four will be covered in depth, with the latest on diagnosis, work-up, comorbidities, prognosis and therapies.
Basal and squamous cell skin carcinomas are among the most commonly-diagnosed malignancies. Many confer little risk; in others, that risk is anything but modest. We will cover every salient aspects so underwriters can easily distinguish more-common BEST CASES from their sinister WORST RISK counterparts. We will also address comorbidities and other risks that have come to be associated with skin cancer.
This course will complete our coverage of anemia. The focus will be on thalassemia (one of the most prevalent disorders in the world), the various hemolytic diseases and in-depth focus on two issues: the implications of anemia in older-age applicants (which are all-but-unrecognized in most manuals) and the links now appreciated between low-grade anemia and enhanced CV risk.
Stress: Issues in Risk & Insurability
We all know intuitively that stress and disease are profoundly linked. For the first time in underwriting education, these links will be explored in depth for both morbidity and mortality. The world literature will be sifted and the most relevant aspects reviewed in depth. This course may well have implications for readers that transcend matters of underwriting!
Colon Polyps and Carcinoma In-situ
With the advent of screening colonoscopy, the incidence of colorectal polyp discovery and excision has grown steeply. This course will provide a broad-based understanding of the various types of polyps, based on morphology, pathology and association with cancer risk, as well as the polyp-forming syndromes and practices related to lower GI screening.
Smokeless Tobacco and Betel Nut
The proper insurability status for smokeless tobacco continues to be debated. Betel nut use is highly prevalent in persons from Pakistan to the end of the Indonesia archipelago, as well as in immigrants from those countries. This course will give the student a comprehensive understanding of all insurability-salient aspects of both topics.
(Brand new course, updated for developments from 2003 to 2007)There are thought to be well over four million chronic HCV-infected Americans and millions more worldwide. HCV is now the #1 cause of cirrhosis and liver cancer in most parts of the Western world and second only to hepatitis B in Asia. There have been so many advances in knowledge about aspects of HCV related to insurability that we MUST now update and expand our 2003 course for matters bearing on how we identify high risk individuals and assess diagnosed cases of this serious disorder. BEST and WORST CASE criteria will, of course, be discussed in depth.
Hereditary and non-inherited forms of hemochromatosis have significant implications for insurability, as stand-alone disorders and comorbidities. This course will provide a strong understanding of everything from genetic tests for the hereditary form to key factors for identifying probable undiagnosed cases based on blood profile test results and medical and family histories.
Social Anxiety Disorder and Other Phobic States
Social anxiety disorder – once called social phobia – is a very prevalent anxiety disorder. It exists in two main forms, both of which have significant morbidity risk and one of which also has important mortality implications. We will examine in depth the comorbidities that so often influence the outcome of this condition. We will also look at the other phobic states that have insurability issues.
Ovarian cancer is one of the leading causes of female cancer mortality. It is also a disease where great strides have been made in diagnosis and treatment. There are several borderline tumors that are being diagnosed more often now, as well as various cysts and benign tumors that need to be understood in a risk context. This course will cover all of this and provide BEST CASE criteria for ovarian cancer.
Special Morbidity Risk Package Courses
Case Clinic on Laboratory Tests
This is our first case clinic course, requested by many enrolled companies. It has over 20 cases involving laboratory test results and other risk cofactors. Full case details are provided with questions raised about each case for the underwriter to consider. Our best answers to these questions are then cited in depth.
Posttraumatic Stress Disorder (PTSD)
PTSD is increasing in prevalence and must be understood as a morbidity risk. This course has all of the latest information on epidemiology, diagnosis, treatment and prognosis for full-blown PTSD as well as the now-recognized subthreshold form of the disorder.
Underwriting Assessment of Syncope (Fainting)
Syncope is one of the five most common symptoms for which patients seek medical care. There are many causes; some with little risk significance and others with profound implications for insurability. This course covers all aspects of syncope with a special focus on identifying the WORST CASES based on typical medical histories where a definite clinical diagnosis is not established.
Sexually-Transmitted Diseases (Excluding HIV + HBV)
The prevalence of STDs is increasing and there may been many advances in the diagnosis and treatment of some of these disorders. This course reviews all prevalent STDs except for HIV and hepatitis B. All that underwriters need to know to assess these conditions will be included.
Benign & Premalignant Breast Disease
This course examines all major forms of benign and precancerous breast lesions, from cysts to atypical hyperplasias. These growths are more and more frequently being identified and diagnosed due to screening mammography. Some portend significant morbidity risk. The underwriter will come away with a strong understanding of these pathologies and their relationship to insurability.
Eye disease is subject that all-too-often falls under the radar of morbidity underwriters. Cataracts, glaucoma and macular degeneration of the retine have implications that transcend their direct impact on vision. They are covered in depth, with the latest on diagnosis, work-up, comorbidities, prognosis and therapies.
Stress: Issues in Risk & Insurability
We all know intuitively that stress and disease are profoundly linked. For the first time in underwriting education, these links are dissected in depth. The world literature has been searched thoroughly and the most relevant aspects are reviewed in depth. This course may well have implications for readers that transcend matters of underwriting.
Smokeless Tobacco and Betel Nut
The proper insurability status for smokeless tobacco continues to be debated. Betel nut use is highly prevalent in immigrants from parts of Asia and yet underwriters know little about this carcinogen. This course will give the student a comprehensive understanding of all insurability-salient aspects of both topics.
Social anxiety disorder – once called social phobia – is a very prevalent anxiety disorder. It exists in two main forms, both of which have significant morbidity risk. All aspects of social anxiety are dissected. We also examine in depth the comorbidities that so often influence the outcome of this condition.
Underwriting Incidental Diagnostic Test Findings
This unique course examines a wide range of common incidental (unexpected) findings on x-rays, CT scans, sonograms and other clinical diagnostic tests. The emphasis is on how to assess potential risks – if indeed, they exist – related to such findings (a matter often left unaddressed in clinical care…and underwriting manuals!).
This course focuses on the risk factors for and diagnosis of type Ii diabetes mellitus. It goes into considerable depth regarding the factors which influence excessive morbidity.
This topic is so large…and so important…that we divided it into two parts. This course is a continuation of Type II Diabetes: Part I. The emphasis is on new developments, RED FLAGS, BEST CASE criteria and other issues affecting risk appraisal of diabetics.
Risk Implications of Rx and Other Forms of Patient Noncompliance
Patient noncompliance with physician recommendations is a common and insidious problem. We look closely at the extent of this problem and its manifestations in various domains including medications, routine screening of high and average risk patients and disease prevention interventions. All of this is related back directly to case underwriting. This is an essential body of knowledge in teleunderwriting as well as Rx profiling.
The CBC is one of two most commonly ordered blood tests in medicine and consequently underwriters see cases with abnormal CBC findings almost every day. There are many potential RED FLAGS embedded in what may often seem like innocent abnormalities on individual tests, as well as many other findings that cause concern but have little or no morbidity implications. In addition to reviewing all components of the CBC, we include illustrative cases to help the underwriter understand this subject in context.
Migraine headache is one of the most common conditions leading to medical visits, disability and therapeutic intervention. This course explores all aspects of migraine, its specific syndromes, symptoms, diagnostic tests, complications and interventions with the emphasis on identifying RED FLAG issues.
GAD is one of the most prevalent psychiatric disorders. It has significant implications for morbidity. GAD may be misdiagnosed or missed altogether in primary care. We cover all aspects of relevance to morbidity risk appraisal.
Case Clinic on Pathology Report Analysis
Our first case clinic course (lab testing) was so well received that we did another case clinic, this time based on pathology report analysis. The focus is on precancerous conditions and malignancies. For each case presented in section one, there will be a comprehensive underwriting analysis in section two.
Socioeconomic Factors, Health Habits and Risk-Taking Behaviors in 21st Century Risk Appraisal
Migraine headache is one of the most common conditions leading to medical visits, disability and therapeutic intervention. This course explores all aspects of migraine, its specific syndromes, symptoms, diagnostic tests, complications and interventions with the emphasis on identifying RED FLAG issues.