10/8/2023

Medical & Impairments

Risk Underwriting

Presented by : Dr. A. K. M.G. Mohiuddin Ahmed

SEVP & Head of Underwriting
MetLife Bangladesh

Contents of the Medical Risk Underwriting Presentation

- Medical Risk Underwriting: Considerable Points

- Medical Risk Underwriting Grids
- Medical Procedure, Pathological tests (Urinalysis, ECG/ECHO/ETT, CXR, Blood Profile etc.)
and their Important Uses in Life Insurance Medical Risk Underwriting
A. Medical Procedure (Generally Questionnaire Types)
B. Pathological Tests:
1. Urinalysis (Generally Urine R/E)
2. ECG/ECHO/ETT
3. CXR
4. Blood Profile etc.
- Understating of the Human Body
- 10 Major Systems of the Human Body
- Organization and General Plan of the body
- Details of Common Medical Impairments
* Blood Circulation and Asthma * Diabetes Mellitus
* Liver Diseases & Liver Cirrhosis * Gull Bladder Disease
* Gusto Intestinal Tract and its disease * Hematological Diseases
* AIDS * Blood Pressure & Hypertension
* Hyperlipidemia * Pulse Related Diseases
* Urinary Tract Disease * Heart/Coronary Artery Disease
* Mental & behavioral disorders

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Medical Risk Underwriting: Considerable Points

Points to be consider during medical risk underwriting:
 Health Details Declaration:
The applicant’s past medical disorders and degree of recovery have a major bearing on
future mortality and morbidity. Attending physician’s statements and questionnaires
specific to a diseases or disorder are valuable sources of information used by the
underwriter in the determining the degree to which past disorders may influence
future mortality.
 Present Physical Condition & Family History:
The present physical condition of the proposed insured has a major impact on the risk.
Details such as build, blood pressure and condition of the heart, lungs, abdominal
organ etc. must be determined for the thorough evaluation of the risk to be insured.
The family history is important for hereditary elements of some diseases or disorders
and must considered when evaluating future mortality.
 Any Illness or Disease, Accidents or Routine Check-ups:
Name of Illness and diseases, date of symptoms first occurred, date of first
consultation with the doctor, nature of tests, treatment or operations, current
situations, date and nature of accident, details of injuries, details of deformity, medical
or other problems resulting therefrom.
 Pathological Tests Report etc.

Medical Risk Underwriting Grids

In arriving in the medical underwriting grid and for the setup of the medical
underwriting guidelines the following factors are applicable,
1. Claim Experience
2. Underwriting experience/expertise
3. Product Pricing
4. Ratio of Medical Business
5. Market Study
6. Business Study
7. Internal and External Benchmarking
8. Loss ratio per line of business & product

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Medical Procedure, Medical tests (Urinalysis, ECG/ECHO/ETT, CXR, Blood

Profile etc.) requirements and their Important Uses in Life Insurance
Underwriting
Most of the Company follow below mentioned medical procedures and test regarding
medical underwriting:

A. Medical Procedure (Generally Questionnaire Types)

B. Medical Tests:
1. Urinalysis (Generally Urine R/E)
2. ECG/ECHO/ETT
3. CXR
4. Blood Profile etc.

A. Medical Procedure:
The procedure of doing a medical is generally filling up a questionnaire by an enlisted
Medical examiner of the Company.
Medical Examiners collect the answer to several questions from the
insurance applicant, e.g.:
1. Last Consult Physician (If any)
2. Treatments or indications of disease (If any) related questions
3. Present Physical Conditions, weight change, mental health, smoking and alcohol
consumption & AIDS-related questions.
4. Family History Related questions etc.
Medical Examiners keep the measurements of an insurance applicant, e.g.:
1. Height, Weight, Chest and Abdominal measurements
2. Pulse Rate, Heart Enlargement, Blood Pressure etc.
3. Any abnormality visually seen by medical examiner etc.

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B. Pathological Tests:
1. Urinalysis:
A urinalysis is a common test that can assess many different aspects of our health with a
urine sample. They often provide the first clue to the presence of renal or urinary tract
pathology.
In general, Laboratory technician can examine a urinalysis urine sample for the following
broad aspects:
 Physical Examination (Color and appearance)
 Chemical Examination
 Microscopic Examination
Physical Examination (Color and appearance):
Normal urine color is usually some shade of yellow and can range from colorless or pale
yellow to deep amber. An unusual urine color can also be a sign of disease. For example:
Red urine can be caused by hemoglobinuria and brown urine by bilirubinuria.
Cloudy or Turbidity of urine is caused by pus, red blood cells or crystals, sperm or skin cells,
and which is not always indicate unhealthy urine or may indicate several different medical
conditions, including:
• Dehydration
• Urinary tract infection (UTI)
• Sexually transmitted diseases and infections (STDs and STIs)
• Kidney Stones
• Diabetes

Chemical Examination:
To examine chemical aspects of a urine sample, lab technicians often use special test strips
called dipsticks to test for certain chemical substances in the urine sample.
Common types of tests that use a dipstick that providers may include in urinalysis include:
* Protein urine test: Indicate several health conditions, such as heart failure, kidney
issues and dehydration.
* Urine pH level test: A high urine pH may indicate conditions including kidney issues
and a urinary tract infection (UTI). A low urine pH may indicate conditions
including diabetes-related ketoacidosis and diarrhea.
* Glucose urine test: The presence of glucose could be a sign of diabetes or gestational
diabetes.
* Bilirubin urine test: Bilirubin presence indicates liver or bile duct issues.
* Urine-specific gravity test: A specific gravity test shows the concentration of all
chemical particles in your urine. Abnormal results may indicate several different health
conditions.

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Microscopic Examination:
Microscopic tests that providers may include in urinalysis include:

* RBC urine test: A high number of RBCs indicates blood in your urine. In some cases,
higher-than-normal levels of red blood cells in your urine may indicate bladder, kidney
or urinary tract issues.

* WBC urine test: An increased number of WBCs and/or a positive test for leukocyte
esterase may indicate an infection or inflammation in your urinary tract.

* Epithelial cells: It’s normal to have some epithelial cells in your urine, but high
numbers of epithelial cells may indicate infection, inflammation and/or cancer in your
urinary tract.

* Bacteria, yeast and parasites: Sometimes, bacteria can enter your urethra and
urinary tract, causing a urinary tract infection (UTI).

* Urinary casts: Casts are tiny tube-like particles that can sometimes be in your urine.
They’re formed from protein released by your kidney cells. Certain casts may indicate
kidney issues, while others are completely normal.

2. ECG/ECHO/ETT:
ECG (Resting Electrocardiogram):
ECG is included in certain medical examinations of insurance applications; ECG has low
specificity and sensitivity. So, ECG is not usually used to diagnose specific diseases, but the cost
of ECG is low. So, ECG is usually used in life insurance underwriting. Several ECG diagnoses
underwriters frequently meet LVH, RVH, ST abnormalities, LBBS, RBBB, A-B blocks, and several
kinds of arrhythmia.
ECHO (Echocardiography/Cardiac Ultrasound):
Echocardiography (cardiac ultrasound) is a diagnostic test that utilizes high frequency sound
waves to visualize the structure and function of the heart and great vessels. This test has
become indispensable in the diagnostic evaluation of patients with known or suspected
cardiovascular disease because it is accurate, relatively inexpensive, non-invasive, and ionizing
radiation is not present.
ETT (Exercise Electrocardiogram/Treadmill ECG):
The use of exercise ECGs has decreased enormously in recent years by virtue of setting
progressively higher screening thresholds. Nevertheless, the practice persists among most life
insurers.
The exercise ECG helps doctors find out if you have coronary heart disease, as it shows whether
your heart muscle is getting enough blood from the coronary arteries during physical activity.
3. CXR (Chest X-ray):
Some of the common conditions detected on a chest X-ray include, pneumonia, enlarged heart,
congestive heart failure, lung mass, rib fractures, fluid around the lung (pleural effusion), and air
around the lung (pneumothorax).

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4. Blood Profile:
A count performed as a diagnostic laboratory test, indicating the red blood cell
count and the white blood cell count in one microliter of whole blood and other
quantitative information about blood composition, such as cell volume,
hematocrit, and hemoglobin content. This information is used in the diagnosis of
anemia, infections, and other medical disorders.
Blood Profile Reason
• CBC (RBC, Hb%, PCV, MCV, MCH, MCHC, To detect blood related abnormality (Ex:
Platelet Count, WBC- Total & Differential Anemia, Bacterial Infection, RBC
count Morphology
• FBS or RBS, HbA1C For Diabetes
• Fasting Lipid Profile (Total Cholesterol, To detect Dyslipidemia
HDL, LDL & Triglycerides)
• HBsAg- Screening test To identify whether the applicant is
• HIV suffering from Chronic hepatitis B virus
infection or HIV
• Serum Creatinine Possible kidney disease
• GGT, SGPT & SGOT Possible liver disease & alcohol abuse
• PSA for Males whose age is greater than Benign or malignant change of Prostate
or equal to 50 years

Common Terms for Body

Parts & Areas

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Details of Common Medical Impairments

• The physical or mental conditions hinder an applicant of being
selected as standard or preferred underwriting risk can be considered
as medical impairments.
• These are different types of Communicable diseases (Hepatitis, AIDS,
Cancers etc.), noncommunicable diseases (HTN, Diabetes, Cancers
etc.) or Psychological disorders (Dementia, Schizo-affective disorders).

Asthma & Blood Circulation:

Asthma:
Asthma is a respiratory condition marked by attacks of spasm in the bronchi of the
lungs, causing difficulty in breathing. It is usually connected to allergic reaction or
other forms of hypersensitivity. Asthma can not be cured, but its symptoms can be
controlled. Because asthma often changes over time.

Blood Circulation:
The heart is a muscular pump which propels blood throughout the body. Blood
delivers nutrients and oxygen to the cells and carries away the waste products of
cellular metabolism. This continuous rotation of blood is referred to as circulation. The
heart acts as a double pump in circulation. The right-side pumps oxygen-depleted
blood to the lungs through the pulmonary circuit and the left side pumps oxygenated
blood to the other body tissues through the systemic circuit. Circulation is two types:
1. Pulmonary Circulation & 2. Systemic Circulation.

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Underwriting Requirements:
- Pulmonary Function Test

Diabetes Mellitus:

• Diabetes mellitus is a group of metabolic disorders characterized by chronic

hyperglycemia from insulin deficiency or resistance or both.

• It is a common disease and affects approximately 30 million people world-wide.

• Diabetes is usually irreversible and, although a reasonable life-style can be

enjoyed, the late complications result in reduced life-expectancy.

• Macrovascular disease leads to an increased prevalence of coronary artery

disease, peripheral vascular disease and stroke.

• Microvascular damage results in diabetic retinopathy and nephropathy.

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Major types of Diabetes:
Type 1 diabetes mellitus
• Type 1 diabetes mellitus, also
known as juvenile-onset
diabetes mellitus, usually
develops in childhood or
adolescence (prior to age 30).
• It accounts for 10 to 15% of all
cases. In type 1, the cells in the
pancreas responsible for
producing insulin have either
been destroyed or produce no
insulin.
• treatment involves injection of
laboratory-manufactured
insulin for effective control of
glucose metabolism.
• Risk factors for type 1 include
autoimmune disease and a
family history of diabetes.
Diabetes: Cont.…
• A fasting blood sugar level from 100 to 125 mg/dl (5.6 to 6.9 mmol/L) is
considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two
separate tests, you have diabetes.
• For this test, you fast overnight, and the fasting blood sugar level is
measured.
Underwriting information
• Diagnosis
• age at diagnosis (How many years)
• control (FBS, HbA1C)
• treatment compliance (On insulin or
not)
• any complications (Urine sugar,
protein)
• presence of other risk factors
(CAD…)
10/8/2023
Type 2 diabetes mellitus Gestational diabetes
• Type 2 diabetes, or adult-onset • Gestational diabetes
diabetes, is commonly (GDM) starts or is first
associated with obesity and recognized in pregnancy,
onset after age 30. in a previously non-
• A family history of diabetes is diabetic woman.
common in type 2. Sufferers
probably inherit a
• It usually becomes
predisposition to glucose
apparent during the 24th
intolerance which is
to 28th week of pregnancy.
exacerbated by obesity. Unlike
type 1, type 2 is relatively
• 30 to 50% of individuals
common in all populations
with a history of
enjoying an affluent life-style.
gestational diabetes
The incidence increases
develop type 2 diabetes
markedly with age, degree of
within ten years.
obesity and lack of physical
activity.
• Risk factors are obesity,
hypertension, dyslipidemia,
prior history of GDM, family
history, and certain
medications.
Underwriting Requirements:
- HBA1c
- Diabetic questionnaire by the
Proposed Insured
- Urinalysis
- FBS/RBS
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Example: An applicant having diabetes for 5 yrs. with FBS 6.9mmol/l with HbA1c-
7%applied for policy, the case was sub standardly rated EM+50 as per Swiss-re

Liver Diseases
What is fatty liver?
Fatty liver disease is a result of the deposition of fat within the parenchyma of the liver. The
liver is enlarged and soft, and biopsy shows cells distended by fat.
Fatty liver disease can be classified according to an etiology and the stage and
grade of the disease. A liver biopsy can quantify the proportion of liver tissue that is
fat, the degree of any necrosis and inflammatory activity (grade) and the presence
or absence of fibrosis or cirrhosis (stage). Non-alcoholic fatty liver disease (NAFLD)
has 5 levels of worsening severity:
 Fatty liver without inflammation (hepatic steatosis)
 Fatty liver with mild scattered lobular inflammation
 Non-alcoholic steatohepatitis (NASH)
 NASH with fibrosis
 Cirrhosis

Underwriting information to help you accurately assess fatty liver

 Underlying cause if known
 Alcohol consumption
 Medication and drug use
 Results of all investigations, particularly liver enzymes and liver biopsy
 Results of treatment including weight loss

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Liver Diseases Continue-……

Liver Cirrhosis:
Cirrhosis is the replacement of normal liver tissue by bands of fibrosis, which
separate nodules of regenerated liver cells (hepatic fibrosis by itself does not
involve regeneration of hepatocytes).
It is usually detected following the occurrence of symptoms relating to the
primary cause or to complications of cirrhosis, i.e., ascites, bleeding from
esophageal varices or encephalopathy.

Underwriting information to help you assess cirrhosis

 Underlying cause
 Complications, if any
 Likelihood of transplantation
 Liver function tests, including albumin and INR

Gull Bladder Diseases:

Gull Bladder tumors:
Bladder tumors may be either single or multiple papillary growths with histology
ranging from a benign papilloma through carcinoma in situ to invasive cancer.
Cholecystitis
Inflammation of the gallbladder, it usually follows obstruction of the opening of the
gallbladder or of the cystic duct by stone(s), but cholecystitis without gallstones may
occur and parasitic/helminthic infection can cause obstruction.
Cholangitis
Cholangitis is inflammation of the bile ducts, which may occur as a complication of
cholecystitis but is nearly always associated with stones in the common bile duct
(choledocholithiasis) or hepatic ducts.
Underwriting information to help you accurately assess gallbladder and biliary tract disorders
The nature of the gallbladder and biliary tract disorder. If gallstones are present,
location (i.e., gallbladder, biliary ducts) Number and frequency of episodes
Complications, if any. Surgery and
any complications Results of all investigations Details and dates of diagnosis, treatment
and all pathology reports. Details of any intravesical chemotherapy, intravesical BCG
instillation and rarely, if done, any systemic chemotherapy or radiotherapy

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Gusto Intestinal Tract and its disease:

Gastrointestinal disorders include such
conditions as constipation, irritable
bowel syndrome, hemorrhoids, anal
fissures, perianal abscesses, anal
fistulas, perianal infections, diverticular
diseases, colitis, colon polyps and
cancer. Many of these can be
prevented or minimized by maintaining
a healthy lifestyle, practicing good
bowel habits and submitting to cancer
screening.
Gastrointestinal disorders include such
conditions as constipation, irritable
bowel syndrome, hemorrhoids, anal
fissures, perianal abscesses, anal
fistulas, perianal infections, diverticular
diseases, colitis, colon polyps and
cancer.

Hematological Diseases
Leukemia:
Leukemia is characterized by a neoplastic proliferation of white blood cells and subdivided into
acute and chronic types. Acute leukemias are rapidly fatal if untreated or if there is no response
to treatment. However, major advances have been made and a considerable proportion of
individuals have prolonged survival and appear to be cured.
Underwriting information to help you accurately assess leukemia
* Investigations including pathology reports and type of leukemia
History of all treatment and duration since completion of treatment (i.e., stem cell or bone
marrow transplant, prophylactic cranial irradiation, surgery, radiotherapy, or chemotherapy)
* Age at diagnosis
* Any residual disability
Anemia:
The most common symptom of anemia is fatigue (feeling tired or weak). If you have anemia, you
may find it hard to find the energy to do normal activities. Other signs and symptoms of anemia
include Shortness of breath. Dizziness. Headache. Coldness in the hands and feet. Pale skin.
Underwriting information to help you accurately assess iron deficiency anemia
Iron-deficiency anemia due to inadequate dietary intake is rare in insurance applicants. The body
conserves iron well, and dietary sources are usually readily available. An applicant with a
diagnosis of iron-deficiency anemia should be underwritten cautiously with:
- Results of all investigations to include cause and source of bleeding
- Details of treatment
- Recent CBC and confirmation that hemoglobin level has stabilized or returned to normal.

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AIDS (Acquired Immune Deficiency Symptom)

Human immunodeficiency virus (HIV) infection is a retroviral disease which
causes the acquired immunodeficiency syndrome (AIDS). AIDS is the term
used to refer to an HIV positive individual with one of the indicator conditions
such as an opportunistic infection or some types of lymphoma, as defined by
the Center of Disease Control (CDC).

Risk classification for HIV-positive applicants

HIV positive applicants with favorable prognostic markers can be evaluated
for life insurance on a case-by-case basis, where full details can be provided.

Risk classification of HIV-negative applicants

In addition, the underwriter needs to identify those individuals who are at
risk of contracting the virus either through unsafe sexual practices or
intravenous drug abuse.

Blood Pressure & Hypertension:

Blood :
Blood is a remarkable fluid vital to life. The red color of blood is due to oxygenated
hemoglobin, a globular protein, which is carried by the red blood cells. Blood consists of
plasma (the liquid portion of the blood) and solid formed elements which consist of red
and white blood cells and Platelets.
The average adult has about 5 liters of blood. The blood has several major functions
including transportation, protection and regulation.
Blood is pumped around the body continuously by the heart and this circulating blood
maintains the internal environment by haemostasias. Haemostasias is a mechanism
preventing the loss of blood from the circulation when a blood vessel is ruptured.
Artery

Pressure over the

arterial wall

Hypertension (HTN or HT), also known as High Blood Pressure (HBP), is a long-term
medical condition in which the blood pressure in the arteries is persistently Elevated.
• The lateral pressure that is exerted by the blood upon the walls of the blood
vessels and especially arteries.

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• BP consists of 2 components. The systolic blood pressure is the maximum pressure

achieved during left ventricular systole whereas the diastolic is the minimum
pressure which occurs at the end of diastole.
• Blood pressure is usually measured in millimeters of mercury (mm Hg), the height
to which the pressure of blood in the arterial system can push a column of mercury.
The European Societies classification is based on the earlier WHO-ISH (International
Society of Hypertension) guidelines:
Classification Systolic BP Diastolic BP

Optimal < 120 and < 80

Normal 120 - 129 80 - 84
High normal 130 - 139 85 - 89
Grade I hypertension (mild) 140 - 159 90 - 99
Grade II hypertension (moderate) 160 - 179 100 - 109
Grade III hypertension (severe) ≥ 180 ≥ 110
Isolated systolic hypertension (ISH) > 140 < 90
• Lower blood pressures may be regarded as normal in specific diseases for example
130/80 for diabetes mellitus and renal disease.
• Blood pressure may also be decreased:
Hypotension - low blood pressure; usually < 90/60
Underwriting Requirements:
Hypertension questionnaire by proposed insured stating the current and past blood
pressure reading compliance with treatment, and risk factors or complications, if any.

Hyperlipidemia:
Hyperlipidemia is an abnormally elevated levels of any or all lipids or lipoprotein
in the blood. Hyperlipidemia is defined as serum cholesterol is greater than 240
mg/dl with desirable level is lesser than 200 mg/dl. High LDL or total cholesterol
is associated with an increased risk of coronary artery disease, cerebrovascular
disease, peripheral vascular disease and all-cause mortality.
Underwriting Requirements: Lipid Profile Test
Build:
Build can be measured by BMI. BMI (Body Mass Index) is a value divided from
the mass (Weight) and height of an individual.
BMI Classification Underwriting Requirements:
≤ 18.5 Underweight - Apply rating basis insured on the
18.5-24.9 Normal Weight application form; otherwise for
25.0- 29.9 Overweight medical examination whenever
30.0-34.9 Class I obesity BMI rating exceeds 75%
35.0-39.9 Class II obesity - BMI < 18 – Individual Consider
≥ 40.0 Class III obesity

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Sinus bradycardia:
Often found in athletic people with good cardiac reserve and is common during sleep.
* It may result from medications such as beta blockers for hypertension or angina, or secondary
to hypothyroidism. It can also be seen with certain infectious fevers, toxic conditions and
occasionally with organic heart disease.
* Marked sinus bradycardia in the elderly may be indicative of underlying sick sinus syndrome.
Sinus bradycardia occurs in less than 4% of apparently healthy elderly people.

Sinus tachycardia:
Sinus Tachycardia is a sinus rhythm of rapid rate (100 to 160 beats per minute; bpm). This is not
a primary arrhythmia, but a response to a physiological, psychological or pathological stimulus
and is usually fluctuates. The 100-bpm cut-off is at the 99th per centile and cardiovascular risks
are apparent at lower heart rates.

Underwriting information to help you accurately assess sinus bradycardia & tachycardia
 Age at onset
 Underlying cause
 Pulse rate
 If pulse rate greater than 120/minute, obtain ECG to confirm and exclude other
dysrhythmia

Urinary Tract Disease

The urinary tract consists of the kidneys, ureters, bladder and urethra. kidneys filter
blood, creating urine, which travels through the ureters to the bladder, where it is
stored. When the appropriate time comes, the muscles of bladder contract and urine
exits from body through urethra. Urinary disorders include any diseases, disorders or
conditions that affect kidneys, ureters, bladder or urethra, or that affect their function.

Examples of urinary disorders include cancers of the urinary tract, incontinence

(inability to control urine flow), interstitial cystitis, kidney stones, kidney failure,
and urinary tract infections. Common symptoms of urinary disorders include
abdominal, pelvic, or lower back pain or discomfort; blood in the urine; changes
in the urine; difficulty producing urine; fever and chills; frequent urination;
leaking of urine; and urgent need to urinate. Some urinary disorders, such as
infections, may develop quickly, while others, such as cancer, develop more
slowly.
Underwriting Requirements:
- Urinalysis
- CT scan or ultrasound of the kidney, prostate/rectal sonogram and renal
angiogram

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Heart/Coronary Artery Disease (CAD):

Coronary artery disease occurs when the coronary arteries are unable to supply
sufficient blood to perfuse the myocardium (heart muscle) adequately. It is
caused by one or more of the following factors:
 progressive atherosclerotic narrowing of the coronary arteries
 sudden thrombosis secondary to rupture of a vulnerable atherosclerotic
plaque
 vascular spasm

• This deficiency of blood supply, and therefore reduced supply of oxygen and nutrients,
to the heart muscle is called ischemia. When coronary artery disease is severe enough
to cause prolonged ischemia to a section of the heart, necrosis or death of that tissue
occurs. This is termed myocardial infarction.

Heart/Coronary Artery Disease (CAD): cont.…..

Risk factors:
Age. Simply getting older increases your risk of damaged and narrowed arteries.

Sex. Men are generally at greater risk of coronary artery disease. However, the risk for
women increases after menopause.
Family history. A family history of heart disease is associated with a higher risk of coronary
artery disease, especially if a close relative developed heart disease at an early age. (Before
age 65)
Smoking. People who smoke have a significantly increased risk of heart disease.
High blood pressure. Uncontrolled high blood pressure can result in hardening and
thickening of your arteries, narrowing the channel through which blood can flow.
High blood cholesterol levels. High levels of cholesterol in your blood can increase the risk
of formation of plaques and atherosclerosis. High cholesterol can be caused by a high level
of low-density lipoprotein (LDL), known as the "bad" cholesterol. A low level of high-
density lipoprotein (HDL), known as the "good" cholesterol, can be a sign of
atherosclerosis.
Diabetes. Diabetes is associated with an increased risk of coronary artery disease. Type 2
diabetes and coronary artery disease share similar risk factors, such as obesity and high
blood pressure.

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Heart/Coronary Artery Disease (CAD): cont.…..

Overweight or obesity. Excess weight typically worsens other risk factors.
Physical inactivity & Sedentary lifestyle. Lack of exercise also is associated
with coronary artery disease and some of its risk factors, as well.
High stress. Unrelieved stress in your life may damage your arteries as well
as worsen other risk factors for coronary artery disease.
Investigations
• Resting electrocardiogram (ECG)
Exercise electrocardiogram (treadmill ECG)
Echocardiography (cardiac ultrasound)
Coronary angiography (cardiac catheterization)
Underwriting information
• date of last attack
• frequency of attacks Underwriting Requirements:
• results of all investigations including LV - Angiography Report with Discharge
function, ejection fraction and angiography Summary for PTCA/CABG
report - CAD questionnaire by the
• any cardiovascular risk factors and risk factor attending Cardiologist
modification - All available latest investigation
• treatment and response to treatment
reports including stress ECG & 2D
• any complications
• any occupational implications Echo

Mental & behavioral disorders : Anxiety, Mood and Stress

& adjustment disorders

Anxiety disorders
A group of disorders characterized by chronic,
unrealistic anxiety, worry and/or fear often punctuated
by acute attacks of anxiety or panic.

Mood disorders
Mood may either be depressed or elevated compared to normal, both occur in
bipolar and related disorders. In the general population symptoms of depression
are common.

Stress and adjustment disorders

Stress and adjustment disorders describe an intermediary psychological state
between psychiatric pathology, major mental disorder and normal coping under
stress

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Mental & behavioral disorders : Anxiety, Mood and Stress

& adjustment disorders ……Continue

Other disorders we take into considerations are:

• Personality disorders

• Somatoform disorders

• Cognitive impairment

• Communication disorders

• Dementia

• Dissociative disorders

• Schizoaffective disorders

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