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Medical Underwriting at Work for You
LIFE AND DISABILITY INSURANCE
Underwriting Applicants with LVH and HOCM
What the differences could mean for insurability
By Linda Cullings, R.N.
Senior Medical Underwriter
Michael, 41, an accountant, is applying for term life
insurance and disability insurance (DI). He has a history of
hypertension, which has been well controlled with medication.
At a recent physical, his blood pressure and his cardiovascular
exam were normal.
Michael’s electrocardiogram (EKG) showed high voltages
and deep t-wave inversions in the inferior and lateral
leads, suggesting left ventricular hypertrophy (LVH). An
echocardiogram was done and showed that the thickness of the
intra-ventricular septum was 1.4 centimeters and the posterior
wall was 1.2 centimeters. All other echo measurements were
normal. A recent stress test demonstrated excellent exercise
capacity and was negative for ischemia.
Jason, 51, a business owner, is applying for life insurance
and DI. Three years ago, he was diagnosed with hypertrophic
obstructive cardiomyopathy (HOCM). His most recent
echo shows left atrium of 4.1 centimeters, a left ventricular
dimension of 4.5 centimeters, intra-ventricular septum
thickness of 1.7 centimeters and a posterior wall dimension
of 1 centimeter.
Jason’s EKG shows deep t-wave inversions. His
echocardiograms have been stable for the three
years since the HOCM was discovered.
Enlarged Left Ventricle
Left ventricular hypertrophy and hypertrophic obstructive
cardiomyopathy are two cardiac conditions in which the
muscular wall of the heart’s left ventricle is enlarged.
However, they are not the same.
LVH is an adaptive response to high blood pressure and is
characterized by symmetrical, or concentric, hypertrophy
of the left ventricle.
In HOCM there is asymmetrical hypertrophy of the left
ventricle in which the septum (the wall separating the left
and right ventricles) is enlarged. This hypertrophy may cause
an obstruction of blood flow, particularly when the heart is
stressed, such as during exercise.
HOCM is usually inherited and occurs in the absence of an
obvious cause. It may also be called idiopathic hypertrophic
sub-aortic stenosis (IHSS) or asymmetrical septal hypertrophy
(ASH). An elevated ratio between the thickness of the intraventricular septum and the posterior wall of the heart is
considered one of the diagnostic criteria for this type of
cardiomyopathy.
Continued >
If your client has been diagnosed with LVH
or HOCM…
Here are questions to ask your clients who have been
diagnosed with LVH or HOCM:
•What did the physicians tell you that you have? When was
it diagnosed?
•What type of cardiac testing have you had?
•Have you ever been hospitalized with problems related to
this? If yes, when?
•Have you ever been advised to change your activities based
on your diagnosis?
•What medications are prescribed?
For Producer or Broker/Dealer Use Only. Not for Public Distribution.
Underwriting Applicants with LVH and HOCM
What the differences could mean for insurability
Continued >
LVH and Hypertension
Left ventricular hypertrophy, when caused by hypertension, is
a health concern because it indicates that hypertension in the
affected individual has started to have important physiological
effects. These individuals may also have other manifestations
of high blood pressure, such as kidney damage and an
elevated risk of stroke and heart attack.
If hypertension and LVH are left untreated or are poorly
controlled, the heart eventually will no longer be able to pump
blood effectively, leading to congestive heart failure.
Left ventricular hypertrophy, while a significant health
concern, may improve when blood pressure is controlled
with medications.
Not all people with hypertrophic obstructive cardiomyopathy
have symptoms, so they may not realize they have the
condition. Some people may exhibit one or more of
these symptoms:
• Chest pain
• Dizziness
• Shortness of breath
• Hypertension
• Fainting during exercise.
Unfortunately, for some, the first manifestation of this disease
is a fatal arrhythmia. Of those with HOCM, about 1 to 3
percent each year may have a fatal arrhythmia.1
Generally speaking, hypertrophic obstructive cardiomyopathy
is a more immediate concern than mild or moderate forms
of LVH because it is associated with sudden death. The
only effective treatment is surgical reduction of the left
ventricular muscle.
Life Underwriting
Michael would qualify for a standard rating with his left
ventricular hypertrophy.
Jason would qualify for a moderate substandard rating for his
hypertrophic obstructive cardiomyopathy.
Disability Underwriting
Michael would qualify for DI with 75 percent extra premium
and a two- year benefit period limit.
Jason would not qualify for disability insurance with
hypertrophic obstructive cardiomyopathy.
The cases presented here are hypothetical. Specific ratings will
vary based on a client’s complete medical history.
1. Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA. Mar 13 2002;287(10):1308-20.
Life insurance products are issued by MetLife Investors USA Insurance Company, Irvine, CA 92614, Metropolitan Life Insurance Company, New York, NY 10166, and in New York only by
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products are distributed by MetLife Investors Distribution Company, Irvine, CA 92614. All are MetLife companies. May 2012
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